Letter to Senator Cassidy of Louisiana re: American Health Care Act

Senator Bill Cassidy

520 Hart Senate Office Building

Washington DC 20510

​Dear Senator Cassidy,

Human Rights Watch is an independent, non-governmental organization that monitors and advocates for human rights, including the right to health. In the last several years, Human Rights Watch has interviewed hundreds of people in every corner of Louisiana about access to health care and services, and released two major reports focused on access to HIV treatment and care.^[1] We have worked closely with people living with HIV and their advocates as well as health care providers, state public health officials, correctional officials, state legislators and many others to promote greater access to care, particularly for the most vulnerable populations. As the Senate considers health care reform, particularly changes to the Medicaid program, we write to highlight the impact that such action would have upon residents of Louisiana.

A man with cerebral palsy, epilepsy, and HIV. A mother of two who was legally blind, and now has limited vision. A school bus driver who got Medicaid through the expansion and now can pay for her HIV medications. The director of a drug treatment center who has seen a “sea-change” in who can afford treatment since Medicaid expansion. These are the stories of Louisianans who would suffer if the Senate adopts the Medicaid provisions of the American Health Care Act (AHCA).

Current GOP proposals threaten to decimate the Medicaid program: the AHCA would strip 880 billion dollars from Medicaid over the next ten years, and the administration’s budget proposal removes another 660 billion dollars on top of that. The AHCA would also phase out the Medicaid expansion by 2020, an action that experts estimate would do severe harm to the Louisiana economy, including the loss of 26 billion dollars in federal funding, an estimated 37,000 jobs, and 639 million dollars in state and local tax revenue.^[2]

Overall, some experts estimate that under funding cuts proposed by the AHCA, states would have to increase their Medicaid budgets by an average of 37 percent by 2026 in order to maintain Medicaid benefits at current levels.^[3] In a state that a recent study recently ranked 50th in economic strength, such drastic cuts in federal funding could be devastating to Louisiana’s economy.^[4]

The health impact of phasing out the Medicaid expansion by 2020 would be enormous; in less than one year, expansion has provided health insurance to more than 425,000 Louisiana residents, provided preventive care to 96,000 people, screened more than 14,000 women for breast cancer, and enabled 8,000 people to access treatment for substance use amid a severe opioid crisis.^[5]

Nationwide, more than 40 percent of people living with HIV depend on Medicaid, including people like Roberta, a 47-year-old school bus driver who lives in Campti, Louisiana. (Like other Medicaid recipients referenced in this letter, she preferred to use a pseudonym to protect her privacy.) Maintaining her health has not been easy for Roberta. A single mom, she struggled to pay for her HIV medications until the state expanded Medicaid last July. “I couldn’t always afford my medications. Sometimes I had to buy pills from people I knew had extra, a few pills at a time.” Now with Medicaid coverage, she has gotten glasses, been to the dentist, discovered a thyroid condition through blood tests, and most importantly, not missed a dose of her HIV medicine.

 “Maybe President Trump doesn’t realize that these programs help people,” said Steven, a 49-year-old man from Natchitoches. Steven has cerebral palsy, epilepsy, and HIV. He takes 15 medications, all of which are paid for by Medicaid, as are his home health aides who help him with every aspect of his daily activities. For Steven, Medicaid is more than health insurance—it is nothing less than a lifeline.

It is difficult for Ellen, another Natchitoches resident, to imagine how she and her family would survive with less assistance from Medicaid. Ellen, 44, is a mother of two boys. She worked for many years for the school system as a teaching assistant, but in 2006 she became legally blind. After several cornea transplant operations, she has limited vision. Ellen also is HIV-positive and Medicaid pays for her anti-retroviral medications. When asked what impact reduction of Medicaid benefits might have on her, Ellen replied simply, “It would be overwhelming.”

Medicaid benefits are also critically important to efforts to combat the opioid crisis. Nationwide, more than 1.2 million formerly uninsured people have accessed substance use treatment through Medicaid expansion, including 7,000 in Louisiana.^[6] Leigh Ann de Monredon is the director of Odyssey House Louisiana, a health clinic that also provides residential drug treatment in New Orleans. Ms. de Monredon described the difference at Odyssey House since the state expanded Medicaid as a “sea- change” in access to care: more people can afford residential treatment as well as medications that are the standard of care for opioid dependence. “We can now give them medications like Suboxone and Vivitrol, and our relapse rates are much lower,” she said. The clinic also provides preventive care services, so that “our doctors can identify potential drug problems before they become addictions.” These services are vitally important in a city where drug overdose deaths doubled in 2016.^[7]

These are just some of the stories gathered by Human Rights Watch that demonstrate the importance of protecting Medicaid—both its financial viability and its expansion—in states like Louisiana.  As a sponsor of the Patient Freedom Act, a bill that would permit states to preserve their Medicaid expansions, we know that you share this concern. For the sake of Roberta, Steven, Ellen and thousands like them, we urge you to take all steps necessary to protect Medicaid and continue the progress that is currently underway in promoting public health and human rights in Louisiana.

Sincerely,

Megan McLemore

Senior Researcher

Health and Human Rights Division