ICYMI: TIME Magazine Focuses on NH to Underscore Devastating Impact Trumpcare’s Medicaid Cuts Would have on Efforts to Combat the Opioid Crisis, State Budgets, And Care for Most Vulnerable Citizens

WASHINGTON – TIME Magazine highlighted the devastating impact that the massive cuts to Medicaid included in Trumpcare and the President’s budget proposal would have on efforts to combat the opioid crisis, state budgets, and care for children, individuals who experience disabilities, and seniors in nursing homes.

The piece highlights the story of New Hampshire substance misuse treatment advocate Ashley Hurteau, who was Senator Hassan’s guest of honor for President Trump’s Joint Session of Congress Address and also attended the emergency Trumpcare field hearing that Senators Hassan and Shaheen held in Concord last Friday.

TIME also spoke with Senator Hassan about her own family’s experience and how important Medicaid is for individuals who experience disabilities: "There's a whole bunch of stuff that even the best private insurance doesn't cover," Hassan tells TIME. "Medicaid recognizes that there are some vagaries in life that hit some people harder than others. We never know when one of our children is going to be born with a particular condition that requires this kind of intensive care, not only to keep them alive but to keep them out of the hospital, out of intensive nursing homes, and be members of the community."

Click here for full TIME story or see excerpts below:

TIME: Beyond Repeal and Replace

By Philip Elliott

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.

[…] Clear majorities oppose the GOP plan in polls; one survey of the Senate proposal found that just 1 in 5 Americans supported the idea.

[…] For a while, it sounded like President Trump would break with his party and emerge a Medicaid defender. "I'm not going to cut Medicare and Medicaid," Trump promised in 2015, a vow he repeated in the months that followed. Since then he has sent mixed messages. After the House passed a measure dramatically scaling back Medicaid in May, he summoned allies and the press to a victory rally in the Rose Garden to praise lawmakers for taking action in the name of scrapping Obamacare. Later, he said the bill was "mean" and urged the Senate to come back with something "with heart."

[…] The White House insists that the changes in spending shouldn't be called a cut, since they are merely decreases from what everyone thought they'd spend in the coming years. "If you spent $100 last year on something, and we spend $100 on it this year--on that same thing--in Washington, people call that a cut," White House Budget Director Mick Mulvaney said in May. As White House counselor Kellyanne Conway put it on June 25, "This slows the rate for the future."

That leaves those steeped in the budget bemused, since no one expects health care to stop becoming more expensive. "If the federal government says, 'Well, we're only paying a certain amount going forward,' then one of two things happen: either services are going to be cut or 25% of people who are currently covered are going to be cut," says Andy Slavitt, a former administrator for the Centers for Medicare and Medicaid Services. "There's no way around it--there's not that much slack in state budgets."

Here's the rub: the states that have benefited the most from federal subsidies for state-run health care programs like Medicaid are often Republican. The non-college-educated, lower-income residents who helped fuel Trump's rise to the White House often rely disproportionately on government-subsidized health care. Republican governors in several states, including Ohio, Arizona and Nevada, are panicked about the current plans, which reduce the number of insured and delay hard choices about which poor residents will be denied coverage starting next year. "They think that's great? That's good public policy?" an incredulous Ohio Governor John Kasich asked during a June 27 news conference in Washington. He had traveled to the capital to rally against his own party's bid to overhaul one-sixth of the American economy. "Are you kidding me?"

Study after study shows the risks of skimping on relatively cheap procedures and the high return on investment for them, but that's on the table too. Medical associations, whose members stand to lose patients, predict that higher long-term costs will result. "If women are not going to get mammograms and not going to get Pap smears, we'll see an increase in breast cancer, in cervical cancer and in vulvar cancer," says Dr. Hal Lawrence, executive vice president and CEO of the American Congress of Obstetricians and Gynecologists. "There will be a cascade turning back the health of the nation."

In fact, almost every major health care group, including the American Medical Association and hospital associations, oppose the Republicans' proposals. "Most states are in a budget crisis, and if there is a federal reduction in Medicaid, then most states will not be able to make up the difference with state dollars," says Kirsten Sloan, vice president for policy at the American Cancer Society Cancer Action Network. "So we will mostly see states cut back. Cancer care is very expensive, and our fear is that one of the ways states will cut back is by cutting the most expensive care."

[…] Back in the Senate, McConnell has talked about creating carve-outs to address some individual Senators' concerns, including a pot of money to specifically target the opioid epidemic. Conservative activists, in turn, have attacked the Republican governors for betraying their ideological roots. And suspicion of widespread abuse, or opportunism, in the current Medicaid system is not limited to Washington. Susan Lees of Danbury, Conn., is a 50-year-old nanny and dog walker who is covered by Medicaid, which she pays some money toward. "A lot of them do need to go out and get a job. I'm not going to lie," she says. "There are people out there who are soaking the system. I see it."

Lees would be hard-pressed to convince the likes of Democratic Senator Maggie Hassan from New Hampshire, who met with TIME on a recent morning between meetings in her third-floor Senate office. As the phones rang incessantly with constituents calling in to voice their concerns about the bill, Hassan leaned back in her chair. For her, the Medicaid issue is personal. Her 28-year-old son Ben has severe cerebral palsy, cannot walk and gets most of his nutrition through a feeding tube. Like roughly 9 million other disabled people, he and his family benefit from Medicaid support.

"There's a whole bunch of stuff that even the best private insurance doesn't cover," Hassan tells TIME. "Medicaid recognizes that there are some vagaries in life that hit some people harder than others. We never know when one of our children is going to be born with a particular condition that requires this kind of intensive care, not only to keep them alive but to keep them out of the hospital, out of intensive nursing homes, and be members of the community."

[…] Health care spending thus could force lawmakers to ditch highway-exit ramps, welcome centers or college dormitories. Or, the state could direct patients to less-expensive (and often less-effective) treatments. The urgent would overtake the preventive, and mental health advocates worry that visible ailments would take priority over less obvious ones. "Mental illness, behavioral issues and addictions are chronic conditions," says Arthur Evans, CEO of the American Psychological Association and one of the many critics of this plan. "They require sustained support over a period of time--sometimes years. When you truncate that and only give people help during crises, that sets them up for failure. It's just expensive, and you don't get the outcomes you want."

Consider Hurteau. Her husband died from an overdose on June 11, 2015. She was in and out of jail for 10 years before his death, entering for the last time on Dec. 27 of that year. She had lost custody of her son and was addicted to heroin, and had no plan to remedy either situation. New Hampshire officials helped her enroll in a Medicaid program that provided counseling and treatment. Today she works to help others fight their addictions. "There's a lot of potential behind the [prison] wall," she says. "There's a lot of opportunities for people with insurance, but without insurance, there's no treatment." For millions of Americans, that's a prospect that should worry them.

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