Last month, President Donald Trump signed into law the One Big Beautiful Bill Act, which includes changes to work requirements and increased frequency of Medicaid redetermination, which are checks to ensure an individual still qualifies for the program.
The health center foresees an increase in uncompensated or uninsured patient care, which is unsustainable, said Rocking Horse CEO Dr. Yamini Teegala.
Rocking Horse almost never turns away patients, so if many lose access to Medicaid, she said it would write off more care expenses.
“The other thing that is a little concerning is how do they make the cuts to Medicaid that they want to make or make the savings without severe programmatic cuts?” Teegala said. “What else is coming in the pipeline?”
For a community that had been “about to make some progress by understanding that we need to invest in social determinants (and) community health workers need to be reimbursed,” chronic disease will become harder to manage if patients lose access to care, Teegala said.
Teegala is concerned that inability to always meet work or alternative requirements and the new redetermination process could increase gaps in care.
This means poorer health outcomes, she said.
“Having access to care and access to medications and access to case management and all those other things at the end of the day will work towards keeping that chronic disease under control,” Teegala said. “And if not, it is going to show the effect of worsening burden of the chronic disease itself. I’m not going to sit here and say it’s mortality, but it’ll definitely be more morbidity.”
Mortality refers to death rates, while morbidity measures the state of being unhealthy, according to the National Institutes of Health.
While the changes are estimated to save the federal government nearly $1 trillion over the next 10 years, Teegala said this does not account for increased health care spending in response to patients losing access to care, saying it could end up costing more in the long run.
In Clark County, 47,757 residents (36% of the population) have health coverage through Medicaid, according to the most recent data from the Clark County Department of Job and Family Services. Of those people, 24,595 are aged 19 to 44.
Some noncitizens considered humanitarian entrants, like refugees, asylees and humanitarian parolees, have qualified for Medicaid.
But the newly passed reconciliation legislation strips that away for many beginning October next year. Only some immigrants, including some Haitians, will remain noncitizens eligible for Medicaid with legislation language restricting the definition of qualified immigrants.
“Federally-qualified health centers have been longstanding safety networks for anybody that needs care, regardless of their legal status in this land,” Teegala said. “But we are hearing that we might be called as a federal public benefit and people may not utilize our services if they are unqualified aliens.”
Rocking Horse is closely aligned with the Ohio Association of Community Health Centers and the National Association for Community Health Centers, which have both advocated for protecting Medicaid and funding for community health centers. The NACHC estimated at least 1,800 community health centers across the country could close due to the budget reconciliation legislation.
“CHCs (community health centers) serve as the health care safety net for at least 10% of the U.S. population, including at least 20% of rural communities,” the NACHC said in a press release. “Rather than reducing coverage and access for patients insured through Medicaid, Congress should prioritize investing in primary care and expanding access to affordable healthcare for the 100 million Americans currently struggling to obtain it.”
The Rocking Horse Community Health Center, like others that provide a lot of uncompensated care, faces questions of sustainability in the long run.
“There are some critical services that always run at a loss in federally-qualified health centers, as well as hospitals,” said Teegala, saying some of those services include women’s clinics, prenatal health and dental services.
“How am I going to run a net loss service line and still take the hit from the paying service lines if Medicaid enrollees are going to shrink?” Teegala said.
About the Author
