As Republicans in Congress craft legislation that could replace the Affordable Care Act, Medicaid is a program many lawmakers are eager to shrink. But low-income Utah families depend on the Medicaid program as a safety net for their kids.
For Emily and David Ybarra of Lehi, their health insurance situation got complicated after their first son Cruise was born in 2007.
"When my oldest was born my husband and I were still going to school full time at BYU and so we had insurance through BYU," Ybarra says.
Emily left school to parent full-time and David started going part-time. He was also working as a full-time mechanic. They lost their health insurance through BYU and in the process their son was able to qualify for Medicaid, the state-federal partnership that provides health insurance to low-income people.
But Emily began to notice something peculiar with the Cruise was responding to sounds. She thought her son might be deaf because he didn’t respond to his name.
"At the same time he would respond to small sounds. So I was really confused about what was going on," she says.
Doctors diagnosed Cruise with autism. Medicaid helped pay for him to attend occupational and speech therapy, and for his medication and psychiatry visits for anxiety and attention deficit disorder. Cruise also spends about half his time at school in special education classes, which Medicaid funding supports.
Today the Ybarras have two other sons and Cruise’s condition is improving. But Emily is afraid of what could happen if his Medicaid coverage is reduced or taken away altogether.
"Obviously he’s always gonna have autism, but because of all those interventions he’s made so much progress," Ybarra says.
According to Voices for Utah Children, there are about 200,000 kids on Medicaid in the state. This week the Congressional Budget Office estimated that the Better Care Reconciliation Act, the Republican plan in the U.S. Senate to replace Obamacare, would reduce Medicaid spending by $772 billion, or 26 percent, over the next decade. Advocates say even though Utah didn’t expand Medicaid, cuts that size will undoubtedly affect kids.
"When you look at that, that cuts back on either the level of care we can offer each child or, more likely, how many children we can cover," says Dr. Bill Cosgrove.
Cosgrove is a pediatrician in Murray. He’s the former president of the Utah chapter of the American Academy of Pediatrics and a current advisor to the state’s Medicaid program.
Cosgrove says delaying healthcare services for kids creates a domino effect of costly outcomes in the future.
"If the child is suddenly ill and somebody decides ‘well, we can’t afford the high cost of an ambulance so we’ll drive them to the hospital' or they’ll wait and stay at home and see if it’s gonna be serious. So, some delays. That really has a high, increased chance of mortality," he says.
But even before the current healthcare debate, reining in the cost of Medicaid is something that has frustrated members of the Utah legislature like Republican Representative Robert Spendlove.
"We want to help people that need Medicaid but we’ve got to have a way to control costs. And in the federal government that’s a foreign concept to them," Spendlove says.
Representative Spendlove says as Medicaid gets more expensive it pushes out other priorities in the state budget, like education, transportation, and corrections.
Both Republican health bills, first in the House and now the Senate, would give states more flexibility to create their own locally tailored health plans. In return, states would get a limited sum of money from the federal government, in the form of either a per-capita cap or a block grant.
"The benefit of both of those in my opinion is it gives states more control. It gives the states more autonomy," Representative Spendlove says.
Dr. Cosgrove disagrees.
"The flexibility they’re asking for really just means we get local control of who we hurt," Cosgrove says.
The Ybarras are working hard to support their family, but Emily is a stay-at-home mom and David doesn’t have access to health insurance through his job. With three kids, one of whom is on the autism spectrum, their bills are more than they can handle without Medicaid, and they can’t afford to buy insurance.
"It seemed like every other year or so we would look into it. ‘Ok, can we afford it now? Can we afford it now?’ And every time we would get a quote we were like, ‘that’s more than half what we make a month.’ We just can’t afford it," Ybarra says.
The future of Medicaid funding hinges on proposed Republican bills in Congress that would replace the ACA. The House passed their version, but legislation in the Senate is on hold until after a weeklong July 4th recess. After that senators could offer changes to the bill or bring it to the floor for a vote.