The House Speaker’s Eyeing Big Cuts to Medicaid. In His Louisiana District, It’s a Lifeline.

MANSFIELD, La. — When Desoto Regional Well being System took out $36 million in loans final 12 months to renovate a rural hospital that opened in 1952, officers had been banking on its important funding supply remaining steady: Medicaid, the joint federal-state well being program for low-income individuals and the disabled.

However these {dollars} are actually in jeopardy, as President Donald Trump and the GOP-controlled Congress transfer to shrink the almost $900 billion well being program that covers greater than 1 in 5 People.

Desoto CEO Todd Eppler stated Medicaid cuts might make it more durable for his hospital to repay the loans and for sufferers to entry care.

“I simply hope that the people who find themselves making these choices have thought deeply about it and have some context of the real-world implications,” he stated, “as a result of it’s going to have an effect on us as a hospital and going to have an effect on our sufferers.”

One of many decision-makers is Eppler’s consultant in Congress: Home Speaker Mike Johnson, who lives about 35 miles north of right here. He stated he is aware of the Republican chief and his employees perceive hospitals’ plight: The mom of Johnson’s chief of employees is CEO of a rural hospital within the district.

“I’ve by no means met a congressman but that needed a rural hospital of their district to shut, and definitely Mike isn’t any exception to that rule,” Eppler stated.

Final 12 months almost 290,000 individuals in Johnson’s district had been enrolled in Medicaid, about 38% of the overall inhabitants, based on knowledge compiled by KFF, the well being info nonprofit that features KFF Well being Information.

About 118,000 of them are in this system because of the Inexpensive Care Act, which allowed states together with Louisiana to increase Medicaid to cowl low-income adults, a lot of whom had been working in low-paying jobs that don’t present medical health insurance.

Louisiana ranks second in Medicaid enrollment, at almost 32% — a mirrored image of the state’s excessive poverty fee. As Republicans weigh cuts, their actions might have dramatic penalties for his or her constituents right here. Of the eight GOP-held Home districts with probably the most Medicaid enrollees because of the enlargement, 4 are in Louisiana. Johnson’s largely rural district ranks sixth in enlargement enrollees.

Amongst them is Chloe Stovall, 23, who works within the produce aisle on the SuperValu grocery retailer in Vivian, Louisiana. She stated her take-home wage working full time is $200 every week. She doesn’t personal a automobile and walks a mile to work.

The shop supplies well being protection, however she stated she received’t qualify till she’s labored there for a full 12 months — and even then, it is going to value greater than Medicaid, which is free.

“I’m simply barely surviving,” she stated.

In February, Johnson pushed a finances decision via the Home that requires slicing at the least $880 billion over a decade from a pool of funding that features Medicaid, to assist fund an extension of Trump’s tax cuts and his border priorities. Republicans in Congress are actually contemplating the place to make cuts, and Medicaid is prone to take a giant hit.

Defending the plan, Johnson stated that Medicaid is “not for 29-year-old males sitting on their couches taking part in video video games.”

Stovall stated nearly everybody she is aware of on Medicaid works at the least one job. “I don’t even personal a TV,” she stated.

Contacted for remark, Johnson’s workplace pointed to his remarks at a convention in Washington final month. “We’re going to be very cautious to not minimize a profit for anybody who’s eligible to obtain it and depends upon it,” Johnson stated.

KFF Well being Information spoke with two dozen Medicaid enrollees in Johnson’s district. Most stated they had been unaware their congressman is main the Republican cost to upend this system. These knowledgeable of the Republican plan stated it scares them.

Some GOP members of Congress need to eradicate the ACA’s Medicaid enlargement funding, which led to twenty million working-age adults gaining protection and helped slash the nation’s uninsured fee to its lowest degree in historical past. Forty states and the District of Columbia have agreed to the change, which promised additional federal funding in alternate for increasing eligibility.

On this closely Republican district, the place Johnson received with 86% of the vote in November, 22% of residents stay in poverty.

Like Trump, Johnson says he desires cuts to Medicaid however hasn’t elaborated apart from saying this system mustn’t cowl “able-bodied” adults with out imposing a piece requirement.

“Everyone is dedicated” to preserving Medicaid advantages “for individuals who desperately want it and deserve it and qualify for it,” Johnson stated at a information convention in February. “What we’re speaking about is rooting out the fraud, waste, and abuse.”

Medicaid recipients in Johnson’s district, advised about GOP plans to chop this system, stated their lives are laborious sufficient in a state the place the minimal wage is $7.25 an hour. With out Medicaid, they stated, they couldn’t afford well being protection.

In Vivian, close to the borders with Arkansas and Texas, near half of the two,900 residents stay in poverty. The primary-street retailers are largely shuttered, aside from a thrift retailer and a mom-and-pop restaurant that focuses on fried pork chops.

“Most all people you realize is on Medicaid right here,” stated Doris Luccous, 24.

Luccous stated she makes $250 every week after taxes as a housekeeper at a nursing residence whereas elevating her 2-year-old daughter in her childhood residence. Whereas purchasing along with her father — who doesn’t work, due to a incapacity — she stated she counts on Medicaid for her bipolar medicines and to pay for remedy appointments.

“I don’t know the place I’d be with out it,” she stated.

Neither Luccous nor Stovall stated they voted within the final election, and neither knew that Johnson is their consultant in Congress.

Vivian has few giant employers, and most employers pay the minimal wage, which hasn’t modified since 2009. “We’re simply caught,” Stovall stated.

Nonetheless, she stated, “it’s a neighborhood the place all people is aware of all people, and individuals are at all times prepared to help as a result of so many are in tough monetary circumstances.”

Willie White is CEO of David Raines Group Well being Facilities, which operates six outpatient clinics in northwestern Louisiana that serve primarily Medicaid enrollees. He stated that Louisiana already ranks among the many worst states for individuals’s well being and that Medicaid cuts would solely worsen the state of affairs.

“You can’t anticipate well being outcomes to enhance if individuals can’t afford to entry care,” White stated.

Whereas the clinics present major and dental care on a sliding price scale for uninsured sufferers, signing them up for Medicaid provides them higher entry to specialists and brings the well being facilities income to cowl the price of delivering care.

Most of the facilities’ sufferers gained protection via Medicaid enlargement. Afterward, charges of screenings for colon and cervical most cancers went from 10% to 50%, White stated. 

But when Congress cuts Medicaid, the well being facilities can be pressured to chop providers, he stated.

“Mike Johnson has been right here and is aware of us, and he and his workplace have been responsive about our points,” White stated. “The message in prior years was, ‘We want further funding,’ however now it’s asking for no cuts.”

Group well being facilities, which in 2023 supplied care nationally to greater than 32 million largely low-income individuals, have seen funding will increase from Republicans and Democrats for many years.

“Everyone seems to be supportive, however the query stays what that help will appear to be below the present administration,” White stated. “If there are to be reductions, they should be accomplished with a scalpel.”

Anticipating cuts, the well being facilities have already restricted journey and put a maintain on filling vacant positions, White stated.

Sitting in a David Raines clinic in Bossier Metropolis, Benjamin Andrade, 57, stated having Medicaid has been a lifesaver since he wanted coronary heart surgical procedure in 2020. Andrade is a chef and stated he helps his spouse and two kids on $14 an hour.

He had not heard about any potential cuts to this system. With out Medicaid, he stated, “it could be very laborious for me to pay for all of the medicines I take.”

Dominique Youngblood, 31, who was on the clinic for a dental checkup, stated she’s had Medicaid most of her life. “Medicaid helps me so I don’t must pay out-of-pocket going to the docs,” she stated.

Youngblood, who has two kids, makes $12 an hour at a day care middle. Requested about GOP efforts to reduce this system, she stated, “It’s not truthful, as a result of it helps lots of people who can’t afford medicines and emergency room journeys, and people are prices you possibly can’t management.”

Again in Mansfield, Eppler’s hospital is greater than only a well being facility — it’s the place many individuals on the town come for lunch. The cafeteria was packed on a latest Friday as employees served boiled shrimp, fried okra, and baked fish.

Eppler stated he’s conscious Republicans in Congress are concentrating on a system of taxes that some states, together with Louisiana, levy on hospitals and different well being suppliers to attract down extra federal Medicaid funding. That cash helps finance what are generally known as supplemental funds to suppliers. Some conservatives belittle the additional funding as “cash laundering.”

However that cash accounts for about 15% of the DeSoto well being system’s finances, stated Eppler, a retired Air Pressure lieutenant colonel who has been CEO for a dozen years. “We’re utilizing that cash to spend money on the subsequent 50 years of Desoto Parish, to construct a hospital that they will have that can be sustainable,” he stated.

The supplemental funds, for instance, assist pay to supply psychological well being providers at three outpatient clinics. “If that $4 million went away, we must restrict providers — it’s simply that easy,” he stated.