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Davida Silverman, Staff Attorney, NHeLP

“Shared sacrifices.” “Tough decisions.” “Everything is on the table.” This is the rhetoric being used to describe the Super Committee’s daunting task of reducing the national deficit by $1.2 trillion over the next ten years. And it makes sense that politicians and lawmakers want to frame deficit reduction as a great equalizer – “everyone has to give a little” makes it easier to justify major changes, namely budget cuts to federal programs.

Let’s face it: there is no equality in what they are doing. Regardless of the rhetoric, one thing is clear: the poor and vulnerable will be the losers in any political deal.

Under the Budget Control Act of 2011, the Super Committee is charged with creating a proposal by November 23 that reduces the national deficit by at least $1.2 trillion over the next ten years. The Super Committee’s plan may cut federal spending, increase revenues, or any combination thereof. – Entitlement programs, like Medicaid, are not exempt from the Super Committee process, and it appears that entitlement programs may face significant cuts. (There is also a chance the Super Committee may fail to reach an agreement, or that the agreement will not be signed into law. In that case, a process for across-the-board cuts called “sequestration” will occur. Although Medicaid is exempt from sequestration, sequestration threatens other health programs, including programs that provide women’s health and reproductive health services).

At this point, no one knows what the Super Committee will propose. However, cuts to Medicaid appear in recent proposals from both Democrats and Republicans. The most recent Democratic proposal included a $50 billion cut to Medicaid; the latest Republican plan includes $770 billion in spending cuts, which includes cuts to Medicaid.

And what is the largest population most likely to be affected by those cuts? Women.

Women tend to be poorer than men and are more likely to be employed in low-wage or part-time jobs that do not offer insurance. As a result, women account for 3 in 4 adult Medicaid enrollees, and a little over half of the general Medicaid population. At all ages, women make up the majority of Medicaid enrollees. For example:

• In 2008, over 13 million women of reproductive age (15-45 years old) were able to get reproductive health services through Medicaid. These services include: family planning services and supplies, pregnancy-related services (prenatal care as well as services for other health conditions that might complicate pregnancy), labor, delivery, and post-partum care. Funding restrictions for abortion leave only extremely narrow exceptions for pregnancies that result from rape or incest and where continuing the pregnancy will endanger the life of the woman. In sum, Medicaid helps women plan for wanted and healthy pregnancies.

• Half of all women with disabilities (a little over 4 million women) are covered by Medicaid. Medicaid coverage provides access to a broad array of services, including physician services, home health services, and, oftentimes, durable medical equipment and prescription drugs.

• Over 4.5 million older, low-income women rely on Medicaid, and elderly women (age 65 or older) account for 20% of all female enrollees. Medicaid coverage assists elderly women, some of whom have disabilities or chronic conditions, with long-term health services, such as nursing home care and home health services.

• Medicaid provides coverage for nearly 30 million children, providing them a comprehensive set of services including screenings and treatments (EPSDT), check-ups, physician and hospital visits, age appropriate counseling and education and vision and dental care. Although there isn’t a well-documented data source for the number of girls enrolled in Medicaid, it can be reasonably assumed that at least half of the children enrolled in Medicaid are female.

Women enrolled in Medicaid are already feeling the effects of state budget cutbacks as states across the country are trying to balance their budgets by drastically cutting costs. As a whole, these cuts harm women, and their families, who depend on Medicaid for health care because the cuts negatively impact their access to providers and services. For example, some states, like California, have cut medical provider reimbursement rates. When reimbursement rates are too low, providers pull out of the program, and make it even harder for Medicaid enrollees to gain timely access to services they need. Meanwhile, changes in some states, like Arizona, are forcing thousands of low-income and under-resourced individuals to go without Medicaid coverage.

In addition, the recent economic climate has spurred more states to run their Medicaid programs through managed care organizations (MCOs) as a way to save money. MCOs are attractive for states because the state pays a flat (capitated) amount to the MCO, regardless of how much or how little care is provided to patients. However, MCOs do not always translate to better coverage, especially when rates and networks are inadequate to provide good patient care. For women’s health, MCOs can be especially problematic; some MCOs may not offer comprehensive women’s health service, or they may refuse to provide services they find “morally objectionable,” like contraception.

Health care reform expands Medicaid eligibility starting in 2014, and it is estimated that by 2019, 16 million new individuals will receive coverage through Medicaid or CHIP (a public-funded health care program for low-income children). The Medicaid expansion will be transformational for low-income women – but only if Medicaid remains fully funded to accommodate the influx of newly eligible Medicaid enrollees. Decreasing Medicaid funding will undermine one of the main tenets of health reform: ensuring that people, regardless of the size of their wallet, can obtain health care coverage.

In short, ensuring access to quality health care requires well-funded Medicaid programs. Although Medicaid coverage improves health outcomes and increases health utilization, coverage alone does not guarantee access to quality health care. – Without adequate funding, states will continue cutting their programs, and millions of women and girls enrolled in Medicaid will face greater barriers to care.

This post was written by Davida Silverman, Staff Attorney at the National Health Law Program (NHeLP). NHeLP is a legal non-profit that protects and advances the health rights of low-income and underserved individuals through policy work and litigation. For more information about Medicaid, Medicaid coverage of reproductive health, and the political and budgetary threats to Medicaid, please visit NHeLP’s website at www.healthlaw.org.