BEYOND THE NUMBERS
Eliminating the Affordable Care Act’s (ACA) Medicaid expansion — or imposing even bigger Medicaid cuts by converting the program to a block grant or per capita cap, as leading Republicans favor — would jeopardize state innovations that are pioneering new ways to deliver care and improve beneficiaries’ health. For instance, Hennepin Health, a nationally renowned health program in Minnesota, could be forced to close if coverage for its members, who gained Medicaid eligibility under the Medicaid expansion, is eliminated. “[T]he financial model for Hennepin Health could be completely undermined,” the organization warns. “It’s a huge threat.”
Minnesota began expanding Medicaid soon after the ACA’s enactment. Hennepin County, which comprises Minneapolis and its surrounding suburbs, pioneered a new way to care for hard-to-reach Medicaid beneficiaries in 2011, focusing on Hennepin’s newly eligible adults with chronic conditions who frequently used the emergency department. The county health department, the public hospital, a health center, and a Medicaid health plan partnered to create an accountable care organization, Hennepin Health, to care for the county’s highest-need patients. Ninety percent of Hennepin Health’s members have a mental health diagnosis and 43 percent lacked stable housing.
The partner organizations created teams of health and social service providers to coordinate clinical and social services for their members, including services for substance use disorders and stable housing. And Hennepin Health works: emergency department visits dropped nearly 10 percent and primary care visits rose, as did the share of members receiving recommended care. Hennepin Health members receiving stable housing were 35 percent less likely to visit the emergency room and 16 percent less likely to be admitted to the hospital.
States like Minnesota have the flexibility to design innovative ways to deliver care because of the reliable funding that Medicaid provides. Hennepin Health required significant upfront funding to expand its workforce, invest in IT systems, and pay providers. This kind of experimentation and investment requires reliable funding and comprehensive coverage — which would disappear under ACA repeal or other large cuts in federal Medicaid funding.
Proponents of repealing the ACA and cutting Medicaid claim these actions would give states more flexibility but, in reality, they’d undermine state innovation. As Minnesota Senator Al Franken, who has spent time with Hennepin Health providers and patients, says, “Republicans are proposing drastic cuts to Medicaid all for the sake of giving ‘states more flexibility.’ Instead, their proposals would hamstring state budgets and could shutter innovative programs in Minnesota, including Hennepin Health. This misguided approach will rip coverage away from millions of Americans, hamper innovation, and undermine state budgets.”
Moreover, without the ACA’s expanded Medicaid coverage to support its ongoing work, Hennepin Health won’t be able to afford to provide the intensive care that’s improving the health of their patients, who will likely have to return to the emergency room for their care.