Medicaid covers 1 in 5 American adults, nearly half of all children in America and 41 percent of births in America. But despite acting as a lifeline for many Americans, the program is under threat of significant cuts from the federal government. In a Health Calls special, CHA's Senior Director of Government Relations Paulo Pontemayor and Barbara DiPietro, PhD, Senior Director of Policy at the National Health Care for the Homeless Council, join the show to discuss the importance of Medicaid. They discuss how potential changes to the Medicaid program would impact American families, employment and community health. They also share how listeners can advocate for the program and the families that depend on it for vital health care coverage. Resources
Medicaid covers 1 in 5 American adults, nearly half of all children in America and 41 percent of births in America. But despite acting as a lifeline for many Americans, the program is under threat of significant cuts from the federal government.
In a Health Calls special, CHA's Senior Director of Government Relations Paulo Pontemayor and Barbara DiPietro, PhD, Senior Director of Policy at the National Health Care for the Homeless Council, join the show to discuss the importance of Medicaid. They discuss how potential changes to the Medicaid program would impact American families, employment and community health. They also share how listeners can advocate for the program and the families that depend on it for vital health care coverage.
Resources
Visit CHA's "Medicaid Makes It Possible" page to learn how you can take action for Medicaid
Watch and share CHA's new informational Medicaid video
Advocate for Medicaid coverage to your elected representatives by calling the House switchboard at (202) 224-3121
Brian Reardon (00:08):
Welcome to Health Calls, the podcast of the Catholic Health Association of the United States. I'm your host, Brian Reardon. And for this episode we're going to take a little bit of a detour from the theme that we've had for this season, which has been on technology and humanity. We've got a really important topic that we want to cover in this episode, and that is Medicaid. And so for this discussion, I'm going to bring in Paulo Pontemayor. He's the Senior Director of Government Relations for the Catholic Health Association. Paulo and I are going to chat and then we're going to bring in a couple of minutes. Barbara DiPietro. She is Senior Director of Policy for the National Healthcare for the Homeless Council, and the National Healthcare for the Homeless Council is a member of the Partnership for Medicaid, which CHA chairs. We're going to talk about that partnership and let me welcome back to the show. Paulo, it's good to see you again. Welcome back to Health Calls.
Paulo Pontemayor (00:59):
Yeah, thanks for having me. It's always such a pleasure talking to our members and the larger world about the work we're doing here in Washington DC especially on a topic that I really appreciate and is very close to my heart, the Medicaid program.
Brian Reardon (01:13):
And you've taken a great leadership role for CHA on that from a policy perspective and advocacy perspective. And this is a major issue that has major implications, and that's what we're going to talk about. So again, we felt this episode, it was important to focus on this pressing issue of the threats to the Medicaid program. I guess Paulo, to start off with, can you share with our listeners a little bit about why protecting Medicaid is such a priority for CHA and our members?
Paulo Pontemayor (01:37):
Yes, thanks, Brian. So CHA is really committed to the Medicaid program really since its founding more close to 50 years ago. In 1965, Medicaid truly represents kind of the best of Catholic social teaching, our commitment to the poor and vulnerable, as well as this whole idea of providing dignity for people through getting health insurance. Medicaid fills in the gap for a large set of the population that would not be able to get healthcare any other place. Medicaid is central to really also our organization's vision statement of ensuring flourishing for all through our policy advocacy. And lastly, Medicaid, as we continue to write about and talk about our story to policymakers on the Hill, is it's more than just a health program. It's a lifeline to a lot of individuals, families, and communities that truly depend on it. So a lot's happening with Medicaid. And the reason for it being such a big part of our program is again, our commitment to Catholic social teaching and being a Catholic healthcare organization, I think go hand in hand.
Brian Reardon (02:51):
Yeah, it also fits nicely with the first pillar of our strategic plan, which is care for all. So that notion of everybody having access to care is so critical to the work we do. Paulo, you were recently named as chair for the Partnership for Medicaid. Talk a little bit about how this group came about and who are some of the organizations that are participating?
Paulo Pontemayor (03:10):
The partnership for Medicaid has been around for close to 20 years, so it was founded in 2005, and it's truly an honor for the Catholic Health Association to be elected chair for the partnership during such a pivotal time. And the partnership for Medicaid is a natural extension for us to work with other national organizations here in DC to continue fighting for the Medicaid program. Right now, there are about 24 organizations as part of this partnership, and we work together in tandem, not only with Capitol Hill, but also the executive branch to really raise the profile of why Medicaid is important for a lot of the communities and populations we serve, as well as the membership of the organizations we represent. So the Catholic Health Association, which represents Catholic hospitals, healthcare systems, long-term care facilities and other healthcare organizations is really kind of only enhanced by our partnership with larger groups. We have groups that represent pediatricians, pediatric nurse practitioners, community health centers, and organizations that pretty much day in and day out are working with populations that are served by Medicaid and also represent safety net health plans and providers. And it truly is, like I said, an honor to be elected into the leadership of this coalition.
Brian Reardon (04:32):
And one of the organizations that is a partner is the National Healthcare for the Homeless Council. And as I mentioned at the top of the show, we have another guest with us. It's Barbara DiPietro. She is the Senior Director of Policy for the Council. Barbara, welcome to Health Calls.
Barbara DiPietro (04:48):
Thank you so much for having me.
Brian Reardon (04:50):
So Barbara, the fight to protect healthcare access, as Paulo mentioned, really is a collaborative effort. Can you tell us a little bit about how the council is partnering with CHA and the others to protect Medicaid from the potential or pending Medicaid cuts?
Barbara DiPietro (05:04):
Sure. I think one of the things that our members do most, so as our name implies, we are healthcare providers for people who are homeless. Our members generally are federally qualified health centers. We've got 300 of these programs nationwide. Collectively, they serve about a million patients a year. Of those million patients, about half are insured through Medicaid. And Medicaid, as Paolo had said, is a lifeline for meeting our members' healthcare needs. And so homelessness itself is often misunderstood and certainly the connection between health and homelessness is often not thought of. But in the space with the partnership for Medicaid, we're able to participate with associations like the Catholic Health Association to educate members of Congress and their staff about the connection between health and homelessness, the importance of Medicaid in that space, and really how we can be addressing several problems in this country, both the access to healthcare and access to housing using Medicaid as a vehicle. And so that's something that's very important to us and we're delighted to work in collaboration with Catholic Health Association and the partnership, again, just on that advocacy and education about the role that Medicaid plays for 80 million Americans, but definitely for us that 1 million Americans that lack housing
Brian Reardon (06:28):
And those that lack housing. Let's just talk a little bit about those. Those are not necessarily the people that we might see as we're walking in a downtown area. A lot of times those are folks that may be living in their car that are between apartments, borrowing someone's couch. So the face of the unhoused really, I think is much more nuanced than what we might expect. We
Barbara DiPietro (06:50):
Completely agree. There is a lot of nuance there. And I think for the general public, it's the behavioral health issues that we most often think about mental health and addiction and some of the things that drive some of the most visual markers of homelessness in our communities. But to your very point, what we're seeing the most of our patients work, but they live in shelters, they're living in their car, they're low wage earners, they can't afford rent. And so this is again, where Medicaid becomes such an important driver because in this discussion as we move forward on Medicaid work requirements and some of the changes that we're making to Medicaid, that really puts low income people at a significant disadvantage because often it's the Medicaid coverage that allows them to work. So for example, many of our patients, just like any American diabetes, high blood pressure, asthma, hypertension.
(07:48):
So some of these things are the kinds of things that need to be managed through medication and chronic disease management in order for someone to hold a job. When we take that away, as we're proposing for a lot of folks in some of the proposals right now in dc, what that ends up doing is it ends up not only compromising people's health, but then their ability to work. And so I think, again, as part of our discussion about the needs of people in the healthcare space, keeping people covered and keeping people engaged in care, that's what drives the strength of our communities and the strength of our country in the workforce. Yeah, I absolutely appreciate your nuance here. I think it's really important in the policy discussion,
Brian Reardon (08:31):
And I think work requirements are one particular issue that we're concerned about at CHA. And so I'd like to ask both of you again, we're at mid-March when this episode is coming out. Still may be some uncertainty on the particulars of what the budget reconciliation bill will actually do to Medicaid. But let's start with the work requirements. And Paulo, I turned back to you. What is our concern with the work requirements that have been floated is one way to save costs on Medicaid.
Paulo Pontemayor (09:01):
So the work requirements argument that Barbara has pointed out is kind of a misnomer when we talk about policy options to address Medicaid in that the conversations right now are that there is a lot of fraud and abuse in Medicaid and that people who should be on Medicaid should be people who truly deserve Medicaid work. Reporting requirements are just that in that many of the people on Medicaid are working and people who aren't working have a reason that they aren't able to work. They're handling or battling or working through some chronic disease conditions that they might have addiction or they might be taking care of a family member, or they also might be in areas of the country that don't necessarily have a economy that allows them to have a lot of work options. And so the work reporting requirement is just that it adds additional red tape to already a population that is really doing the best that they can and healthcare being kind of that lifeline for them.
(10:07):
We know that there are examples out there, not at a national scale, but at the state level where some states have actually imposed some of these work reporting requirements. And after the analysis and several years have been done with these programs, people actually had lost coverage as part of this experiment. There's also another work requirement state right now with Georgia, and we have seen that the uptake with that expansion population has not been as successful. And part of it was nothing has changed other than these new work reporting requirements. So additional barriers to accessing coverage only provides Medicaid state officers more requirements to meet. But I think Medicaid is what we like to call a countercyclical program, that it's always there when economic downturns happen, public health emergencies happen and some other things that are totally out of control for the vast majority of the population. So it truly is a lifeline, as we say,
Barbara DiPietro (11:08):
Not only have work requirements in the Medicaid space been studied and demonstrated to be both expensive and ineffective in increasing work. I think the irony here is that it actually does quite the opposite of what the policymakers intend. So if the goal here is to increase employment, taking health coverage away from folks has been demonstrated not to be successful there. But I think what we also need to look ahead to here is that Medicaid funding doesn't go into thin air. That money pays for doctors and nurses and therapists and case managers and the people who were delivering that care. And one of the things that we saw after 14 when the Affordable Care Act Medicaid expansion went into effect, we saw a rapid increase in the number of our patients that were insured with that came the additional funding through Medicaid as we were able to in our clinics, be able to bill insurance for the first time.
(12:10):
Many of our clinics actually have just longstanding grant funding, which anyone who's been grant funded knows is usually you get grants for just a couple of years at a time. It's always uncertain. It's very hard to expand and staff and plan for the future. So getting Medicaid coverage, which is a sustainable predictable funding stream from a business perspective is what you need in order to plan and strategically grow. And so what we saw over the last 10 years, strategic growth in our staff, in our workforce, in the amount of, and the number of services and in the locations where we're able to deliver care. My fear here is that if we start implementing changes to Medicaid, like the work requirements, which will in effect push lots of people off of Medicaid, not only will we see the problems that result from people becoming uninsured, but what we'll see in the healthcare space is a contraction of workforce, a contraction of services, and a contraction of the places where we can deliver care.
(13:13):
And I really worry that in that space, we are increasing unemployment because you're going to start seeing more layoffs come out of the healthcare space as that Medicaid funding starts to decline. So I think that's the kind of impact that we will see. And I'm very concerned for local communities where healthcare may be one of the driving industries. And as Paolo said, there's a lot of places in this country where there are not alternative employment opportunities that will allow people to continue being stably housed, provide for their family, and all the things that we really want families to be able to do.
Paulo Pontemayor (13:50):
And Barbara's right, many of our members are some of those anchor institutions in their communities. Many of our members are also the largest provider of Medicaid in their states, but we all know that it really is jobs multiplier when you have healthcare facilities in a community providing care, not only is it just a place where people go for healthcare conditions, it also is a place that contracts out with businesses to run cafeterias or to do laundry services. So it really is kind of an asset to a community, and Medicaid is a huge component of that revenue stream. But again, the ecosystem is so delicate right now that any large scale change could really disrupt a lot of what happens in some communities. As Barbara mentioned, the most hardest hit will be rural communities, which many people in Congress are really taking a laser focused view to see how they can continue to support rural communities that not only are losing population, but also losing industries and healthcare facilities. So Medicaid is probably the one program that policymakers can focus in on if they'd really like to focus on that rural sustainability and rural growth.
Brian Reardon (15:15):
And I'm glad we're talking about the economic impact because I think that has been lost in a lot of the discussion from my perspective, if we want to have a healthy economy, if we want people to have, again, human dignity, flourishing work is such a key part of that. And for our workforce to be productive, they need to be healthy. I mean, so this whole chicken and egg thing, should you work to get Medicaid or to me it's like everybody should have access to care because I want the person working with me that I'm buying goods and services from to be healthy. The bottom line is everybody should be healthy. And I think that kind of brings me to my next question for both of you is that we talked about one particular group of people being unhoused, but really the faces of Medicaid, there are neighbors there, our senior citizens. I don't think people also realize the, again, Barbara mentioned, I think the 80 million Americans who rely on Medicaid as a lifeline. So I was hoping both of you could maybe just talk a little bit about who are the folks that rely on Medicaid, what do they look like?
Paulo Pontemayor (16:23):
We were just pleased that Barbara and her organization circulated a letter a couple of weeks ago talking about how Medicaid is important to the populations that her organization not only important to the population her organization serves, but really this larger impact. I mean, nearly 80 million people in our country are on Medicaid. One in two children now get derived their coverage from Medicaid or chip. And a large number of people in nursing homes also are covered by Medicaid. Medicaid pays for 41% of all births. And right now, Medicaid also is, excuse me, the largest provider of behavioral health and substance use disorder treatment. So there are huge swaths of people that only benefit from Medicaid. And so you're right, there is a face to Medicaid and it is members of Congress, constituents, our neighbors, our family, our friends. So it's not a program that just exists kind of in a vacuum. It's part of the real life that a lot of us go through and the people that we serve.
Barbara DiPietro (17:36):
And I'll add to what Apollo heads described here too, and particularly in this space where Medicaid is the number one payer in this country for behavioral health services. And I think one of the things that I look to is in the new administration, the focus on getting people into treatment and a number of, not just at the president's office, but members of Congress and others in leadership have talked about the importance of connecting people to mental health care, connecting people to substance use treatment. We can't do that without Medicaid. And in fact, cutting Medicaid undermines the very policy goals that have been articulated in other spaces. And so I think one of the things we are looking at is all of the people out there, and not necessarily even those who are unhoused or stably housed, but we've got lots of folks out there that are struggling with addiction and struggling with mental health.
(18:33):
We need to give them more supports, not less. And I think one of the things that we see are 11 million households in this country that are spending more than half their income on rent. And so those are the folks that are just at the precipice of really worrying about whether they're going to make this month's rent, whether something goes wrong, a flat tire, the daycare doesn't work out, and those are the folks that are going to be slipping out of stable housing and into shelters and doubled up on couches. And I think, again, this idea of Medicaid being an American program for Americans, it's a health insurance program. And yet I fail to think of any other health insurance program in this country that we put the amount of stigma and discrimination on like Medicaid.
Brian Reardon (19:23):
Good point.
Barbara DiPietro (19:24):
And when we do that, we make it easier to stigmatize the program. We make it easier to stigmatize the people who rely on the program.
Brian Reardon (19:31):
Oh, great point. So what else, Barbara, can we do? What can those listening do maybe individually and collectively to advocate on behalf of Medicaid?
Barbara DiPietro (19:39):
I actually came in with a list. So I've got four things, things that I would ask your listeners to do or to keep in mind. One is, as you are talking with your representatives, include homelessness in your discussions and help people better understand that Medicaid and homelessness are two things that are really important to keep strongly connected. Second thing is fighting back against this deserving versus undeserving poor narrative. We're very quick to dismiss what's being called an able-bodied population as somehow not needing healthcare. I don't understand that narrative. So again, this idea that we all deserve healthcare because we are human beings and we deserve that humanity and dignity. Third thing is that absolutely, let's embrace the opportunity to talk about what in healthcare can be improved and can be made more efficient, but slash and burn techniques and kicking people off Medicaid is just not the way to achieve the kinds of healthcare system that we would look to with pride.
(20:44):
And finally, I just really would come back to a universal message to be including again in our conversations, not just with our policymakers, but also with our friends and family, our neighbors, just to talk about how we all benefit when we all get what we need to be healthy and stable. This is what our communities need, this is what our nation's vision is, and we have the resources to be able to deliver on that vision. It's just a matter of how we employ them in our policy decisions. So I would just implore folks here in this space to keep this conversation in mind as we think about how we move forward in the coming months.
Brian Reardon (21:19):
A great list, Paulo, I'll give you the final word.
Paulo Pontemayor (21:21):
Sure. And I will also talk to our listeners and remind them of many of the resources we've developed at the Catholic Health Association. Our campaign, our ongoing campaign on Medicaid, Medicaid Makes It Possible, has a list of ways that you can engage and look up kind of what's happening in your state, not only with your policymakers, but seeing what local media has said about the impacts of any proposals for your state. As we all know, Medicaid is both a federal and state program and really highlighting kind of the state importance only informs kind of federal policymakers. This is a program that continues to be very nimble and allows for many people on Medicaid to weather, both public health emergencies as well as economic emergencies. So we need to all work together, as Barbara mentioned, talk to our family, our friends and our communities about who truly benefits from Medicaid. And it not just is people on the program, but whole communities as well. I think that when people are able to have that improved health outcome, the health of the community is also increased as part of our commitment to each other and working with each other to advance kind of a healthy society.
Brian Reardon (22:37):
Well, I appreciate both of your perspective and taking time to talk about this really important issue. And I think you both did a great job of bringing forward points that maybe haven't been discussed enough. And so I think from this conversation, hopefully this will give our listeners more, I guess fodder, if you will, as they have conversations with their elected officials, with their colleagues, and with other stakeholders to really elevate the importance of Medicaid, again in upholding human dignity. And again, it's about the common good and making sure that everyone can flourish. So thanks to again, Paulo Pontemayor. He is Senior director of Government relations for the Catholic Health Association and Barbara DiPietro, she's Senior Director of Policy, National Healthcare for the Homeless Council. Thank you both for being with us. Thank you.
Barbara DiPietro (23:21):
Thank you so much for having me.
Brian Reardon (23:23):
And this has been another episode of Health Calls, the podcast of the Catholic Health Association. I'm your host, Brian Reardon. Health Calls Executive Producer is Josh Matejka with additional production support from Yvonne Stroder. This episode was engineered by Brian Hartmann at Clayton Studios in St. Louis, Missouri. You can find health calls on all of your favorite podcast apps and services, as well as on our website, chausa.org/podcast. And Paulo mentioned our Medicaid page. That would be chausa.org/medicaid. Check that out. There's a lot of great resources on this topic, and if you've enjoyed the show, please give us a five star rating and share any feedback you may have. We'd love to hear from you. As always, thanks for listening.