Beyond Repeal and Replace

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from TIME Magazine,

Ashley Hurteau knows she’s not your typical public-health advocate.

In and out of jail, a recovering heroin addict equipped with few credentials beyond her personal story, the 32-year-old New Hampshire resident says it took waking up to find her husband dead from an overdose to put her on the path toward recovery. That and health care. Which is why, at a public forum on June 23, Hurteau stepped up to the microphone and pleaded with her state’s two U.S. Senators to fight with everything they had to block Republican plans to gut health care programs like the one she credits with saving her life.

“I got back custody of my son two weeks ago, and I’ve been sober 17 months,” Hurteau said as more than 200 people watched that afternoon in a law-school classroom in Concord, N.H. “Medicaid expansion is really about opportunity, the opportunity to get sober, to move on and to live a clean life.” She was there as a success story–and a warning about what could go wrong if someone like her didn’t have access to care during a time of need.

But scaling back Medicaid–the 52-year-old federal health care program for the needy–is exactly what Senate Republicans are vowing to do when they return from the July 4 holiday. It is a huge risk for the GOP and helps explain why Mitch McConnell postponed a vote on his party’s latest plan in the final week of June. The public defections betrayed deeper problems for the bill, which will be weaponized against its supporters in coming elections.

When it comes to changing Medicaid, the Republican plan has two main parts. First, it would roll back programs that allow states to enroll residents who earn wages slightly above the poverty line in state-run Medicaid programs. That alone has boosted the rolls of people with health coverage by more than 14 million, allowing, for instance, families of three who earn $27,000 to qualify for free or low-cost coverage.

The second part would cap federal funding that states use to underwrite their Medicaid programs, which roughly 76 million Americans rely on for health care. While each state’s program goes by a different name–like MaineCare, Healthy Louisiana and New Jersey FamilyCare–their collective reach is epic. Nearly half of all babies born in America are covered by Medicaid, as are close to 40% of all children and two-thirds of all nursing-home residents. Roughly 9 million more Americans who are blind or disabled, including those born with Down syndrome or cerebral palsy, also rely on Medicaid for coverage. Most children’s vaccines are covered, and adults in many places get their flu shots at the corner drugstore for free as well.

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