Tolkkinen: As the Republican Party looks to trim Medicaid, rural Minnesotans tally the cost

MOORHEAD, MINN. - In a northwestern Minnesota conference room, a small group of about 40 Minnesotans was contemplating how Republican cuts to Medicaid would affect them, their friends, and society as a whole.

At our table, three of the Minnesotans were immigrants. One was a county worker who helps low-income people obtain health insurance. And there was me, a journalist who has experienced poverty and witnessed firsthand how the fortunes of the poor rise and fall depending on which political party is in power.

We were brought together at an event organized by the Minnesota Department of Human Services, one in a series of discussions about the program the department is hosting throughout the state.

About a quarter of Minnesotans depend on Medicaid, which is known as Medical Assistance or MA in our state. Republicans in Congress, which include Tom Emmer, Brad Finstad, Michelle Fischbach and Pete Stauber, are hammering out a new budget. Among their tasks is to cut $880 billion over the next 10 years from the sector that includes Medicare and Medicaid.

Trump administration officials have promised that Medicare, which provides health insurance for those age 65 and up while including some younger people with disabilities, would not be affected, leaving Medicaid, which provides health insurance for low-income adults and children, squarely in the crosshairs.

The federal government now spends some $600 billion a year on Medicaid, a fraction of $6 trillion in annual federal spending. States also contribute to the program.

Without a clear idea of what Republicans will eventually do with Medicaid, it’s difficult to figure out exactly how Minnesotans would be affected.

But as our group talked about the many ways greater Minnesota depends on the program, we came up with a few possibilities:

Many new mothers wouldn’t get the postpartum care they need.

Medical debt would grow.

Property taxes would likely rise as the responsibility for caring for the poor shifted from the federal government to counties.

As we talked, someone scribbled notes on a large sheet of paper. The list grew and grew, and the note taker started scribbling in the margins.

Family members who get paid to take care of a disabled loved one might lose that payment and have to find a job.

Rural hospitals and clinics could lose a significant source of funding. Emergency rooms could be stressed by people seeking care for minor problems they couldn’t get treated elsewhere.

Low-income people might seek less medical care, causing treatable illnesses to grow into chronic problems.

“I didn’t realize how big it was until we discussed it,” said Ilhaam Hassan of East Grand Forks, one of those at the table.

Medicaid pays for 3 out of 10 births in the state, according to the Department of Human Services. It provides health insurance for 41% of children, pays for drug and alcohol treatment, pays for most nursing home care, and even pays for transportation to medical appointments in some circumstances.

Cutting health insurance that covers so many children is especially ironic, given the chatter among Washington bigwigs about persuading Americans to have more children.

Republicans say they want to preserve Medicaid programs, and that solutions include requiring able-bodied people on Medicaid to work. But the savings there seem scant. According to the state, most recipients who can work already do. Almost all are working, in school, are a caregiver, are looking for work, or can’t work because of health problems.

Could Republicans find $880 billion in fraud, waste and abuse in Medicaid? No doubt some fraud exists, but wholesale cuts will do nothing to prevent it. It seems likely that most of the spending cuts will come at the expense of the poor, and Republicans will use tools like extra paperwork, requirements and deadlines to force people off the rolls.

My own family has lived in and out of poverty for a good many years. At times we have had no health insurance (including during the COVID pandemic) and at times we struggled to pay expensive private insurance. Some years, we qualified for state health insurance.

When Democrats were in charge, we had smaller or no copays and less paperwork to apply for state health insurance. When Republicans took power, the opposite was true. It is the Democrats who expanded Medicaid through the Affordable Care Act and Republicans who have tried to repeal it. To be poor, is, alas, to be a political football.

But the GOP wants tax cuts, which would benefit the wealthiest the most, and it has to pay for them somehow. Surrounded by billionaires, and himself insulated from the struggles of the poor and the working class, President Donald Trump says the wealthy would simply flee the country if they were asked to pay more.

The poor have neither the wealth nor the opportunity to jet off to a distant land. So even though many of them voted for Trump, the cost of tax cuts for the rich will rest on them.