Lazaro Gamio / Axios
The Republican health care bill would slash Medicaid funding by $834 billion over the next decade, and hospitals have not taken kindly to that proposal. One hospital subgroup would be especially hurt by those cuts — children's hospitals.
Roughly half of the money a children's hospital collects, on average, comes from Medicaid. More than 30 million kids are on Medicaid, and another 6 million are on the Children's Health Insurance Program. Mark Wietecha, CEO of the Children's Hospital Association, has been pounding those messages to legislators on behalf of the country's 220 children's hospitals.
Wietecha spoke with me about the Republican bill (teaser: he believes it has nothing to do with health care anymore) and why the Medicaid cuts deserve more attention. Read on for an edited and condensed version of our conversation.
How would you describe the American Health Care Act's changes to Medicaid?
"It is a catastrophic bill for children's hospitals and really any hospital that's a high-Medicaid hospital. You take a category with 30 million kids — 40% of all the kids in the country — with an inadequately funded program, and then you reduce it. It just does not compute."
But Republicans have touted the budget savings from cutting Medicaid.
"They may save money on the budget, but it's the largest health care program for children in the nation. Right now, kids are sitting in the firing line with adults."
How are members of Congress responding when you tell them about Medicaid's effect on children?
"There's nobody up there who's opposed to kids. They just are generally unaware or haven't come to grips with the fact that the biggest cohort of affected people could well be children. When you say that to people, they just stare at you like, 'What? What are you talking about?'"
Is there a reason for that disconnect?
"One, Medicaid has never been well-understood in Washington because it has such a state-based element to it. Second, nobody's really, beyond us, been raising this issue about kids. Third, and maybe most important now, I don't think this current bill has anything to do with health care. It's now down to political survival and party existentialism."
Based on your conversations on Capitol Hill, what are the odds Congress does something with health care?
"It's a coin toss. If you talk to Republicans, there's a strong view this has to get pushed through before the Fourth of July."
Children's hospitals are still doing rather well financially, thanks in part to the ACA's Medicaid expansion in most states. What else is behind that?
"As a general rule over the last three to five years, both the children's and general adult systems have done pretty well ... A lot of that has been driven by commercial rates, which have continued to stand up as pretty good rates."