MANSFIELD, La. — When Desoto Regional Well being System took out $36 million in loans final yr to renovate a rural hospital that opened in 1952, officers have been banking on its major funding supply remaining steady: Medicaid, the joint federal-state well being program for low-income individuals and the disabled.
However these {dollars} at the moment are in jeopardy, as President Donald Trump and the GOP-controlled Congress transfer to shrink the practically $900 billion well being program that covers greater than 1 in 5 People.
Desoto CEO Todd Eppler mentioned Medicaid cuts may make it more durable for his hospital to repay the loans and for sufferers to entry care.
“I simply hope that the people who find themselves making these selections have thought deeply about it and have some context of the real-world implications,” he mentioned, “as a result of it’s going to have an effect on us as a hospital and going to have an effect on our sufferers.”
One of many decision-makers is Eppler’s consultant in Congress: Home Speaker Mike Johnson, who lives about 35 miles north of right here. He mentioned he is aware of the Republican chief and his employees perceive hospitals’ plight: The mom of Johnson’s chief of employees is CEO of a rural hospital within the district.
“I’ve by no means met a congressman but that wished a rural hospital of their district to shut, and positively Mike isn’t any exception to that rule,” Eppler mentioned.
Final yr practically 290,000 individuals in Johnson’s district have been enrolled in Medicaid, about 38% of the whole inhabitants, in response to knowledge compiled by KFF, the well being data nonprofit that features KFF Well being Information.
About 118,000 of them are in this system because of the Inexpensive Care Act, which allowed states together with Louisiana to broaden Medicaid to cowl low-income adults, lots of whom have been working in low-paying jobs that don’t present medical insurance.
Louisiana ranks second in Medicaid enrollment, at practically 32% — a mirrored image of the state’s excessive poverty price. As Republicans weigh cuts, their actions may have dramatic penalties for his or her constituents right here. Of the eight GOP-held Home districts with probably the most Medicaid enrollees because of the enlargement, 4 are in Louisiana. Johnson’s largely rural district ranks sixth in enlargement enrollees.
Amongst them is Chloe Stovall, 23, who works within the produce aisle on the SuperValu grocery retailer in Vivian, Louisiana. She mentioned her take-home wage working full time is $200 every week. She doesn’t personal a automobile and walks a mile to work.
The shop offers well being protection, however she mentioned she received’t qualify till she’s labored there for a full yr — and even then, it can price greater than Medicaid, which is free.
“I’m simply barely surviving,” she mentioned.
In February, Johnson pushed a funds decision via the Home that requires reducing not less than $880 billion over a decade from a pool of funding that features Medicaid, to assist fund an extension of Trump’s tax cuts and his border priorities. Republicans in Congress at the moment are contemplating the place to make cuts, and Medicaid is more likely to take a giant hit.
Defending the plan, Johnson mentioned that Medicaid is “not for 29-year-old males sitting on their couches taking part in video video games.”
Stovall mentioned virtually everybody she is aware of on Medicaid works not less than one job. “I don’t even personal a TV,” she mentioned.
Contacted for remark, Johnson’s workplace pointed to his remarks at a convention in Washington final month. “We’re going to be very cautious to not reduce a profit for anybody who’s eligible to obtain it and depends upon it,” Johnson mentioned.
KFF Well being Information spoke with two dozen Medicaid enrollees in Johnson’s district. Most mentioned they have been unaware their congressman is main the Republican cost to upend this system. These knowledgeable of the Republican plan mentioned it scares them.
Some GOP members of Congress wish to eradicate the ACA’s Medicaid enlargement funding, which led to twenty million working-age adults gaining protection and helped slash the nation’s uninsured price to its lowest stage in historical past. Forty states and the District of Columbia have agreed to the change, which promised further federal funding in trade for increasing eligibility.
On this closely Republican district, the place Johnson received with 86% of the vote in November, 22% of residents reside in poverty.
Like Trump, Johnson says he desires cuts to Medicaid however hasn’t elaborated aside from saying this system mustn’t cowl “able-bodied” adults with out imposing a piece requirement.
“All people is dedicated” to preserving Medicaid advantages “for individuals who desperately want it and deserve it and qualify for it,” Johnson mentioned at a information convention in February. “What we’re speaking about is rooting out the fraud, waste, and abuse.”
Medicaid recipients in Johnson’s district, instructed about GOP plans to chop this system, mentioned their lives are laborious sufficient in a state the place the minimal wage is $7.25 an hour. With out Medicaid, they mentioned, they couldn’t afford well being protection.
In Vivian, close to the borders with Arkansas and Texas, near half of the two,900 residents reside in poverty. The principle-street outlets are largely shuttered, apart from a thrift retailer and a mom-and-pop restaurant that focuses on fried pork chops.
“Most everyone you understand is on Medicaid right here,” mentioned Doris Luccous, 24.
Luccous mentioned she makes $250 every week after taxes as a housekeeper at a nursing dwelling whereas elevating her 2-year-old daughter in her childhood dwelling. Whereas procuring along with her father — who doesn’t work, due to a incapacity — she mentioned she counts on Medicaid for her bipolar medicines and to pay for remedy appointments.
“I don’t know the place I might be with out it,” she mentioned.
Neither Luccous nor Stovall mentioned they voted within the final election, and neither knew that Johnson is their consultant in Congress.
Vivian has few massive employers, and most employers pay the minimal wage, which hasn’t modified since 2009. “We’re simply caught,” Stovall mentioned.
Nonetheless, she mentioned, “it’s a group the place everyone is aware of everyone, and individuals are at all times keen to assist as a result of so many are in troublesome monetary circumstances.”
Willie White is CEO of David Raines Group Well being Facilities, which operates six outpatient clinics in northwestern Louisiana that serve primarily Medicaid enrollees. He mentioned that Louisiana already ranks among the many worst states for individuals’s well being and that Medicaid cuts would solely worsen the state of affairs.
“You can’t count on well being outcomes to enhance if individuals can’t afford to entry care,” White mentioned.
Whereas the clinics present major and dental care on a sliding price scale for uninsured sufferers, signing them up for Medicaid provides them higher entry to specialists and brings the well being facilities income to cowl the price of delivering care.
Lots of the facilities’ sufferers gained protection via Medicaid enlargement. Afterward, charges of screenings for colon and cervical most cancers went from 10% to 50%, White mentioned.
But when Congress cuts Medicaid, the well being facilities can be compelled to chop providers, he mentioned.
“Mike Johnson has been right here and is aware of us, and he and his workplace have been responsive about our points,” White mentioned. “The message in prior years was, ‘We’d like further funding,’ however now it’s asking for no cuts.”
Group well being facilities, which in 2023 offered care nationally to greater than 32 million largely low-income individuals, have seen funding will increase from Republicans and Democrats for many years.
“Everyone seems to be supportive, however the query stays what that help will appear like underneath the present administration,” White mentioned. “If there are to be reductions, they must be achieved with a scalpel.”
Anticipating cuts, the well being facilities have already restricted journey and put a maintain on filling vacant positions, White mentioned.
Sitting in a David Raines clinic in Bossier Metropolis, Benjamin Andrade, 57, mentioned having Medicaid has been a lifesaver since he wanted coronary heart surgical procedure in 2020. Andrade is a chef and mentioned he helps his spouse and two youngsters on $14 an hour.
He had not heard about any potential cuts to this system. With out Medicaid, he mentioned, “it will be very laborious for me to pay for all of the medicines I take.”
Dominique Youngblood, 31, who was on the clinic for a dental checkup, mentioned she’s had Medicaid most of her life. “Medicaid helps me so I don’t should pay out-of-pocket going to the medical doctors,” she mentioned.
Youngblood, who has two youngsters, makes $12 an hour at a day care middle. Requested about GOP efforts to cut back this system, she mentioned, “It’s not truthful, as a result of it helps lots of people who can not afford drugs and emergency room journeys, and people are prices you’ll be able to’t management.”
Again in Mansfield, Eppler’s hospital is greater than only a well being facility — it’s the place many individuals on the town come for lunch. The cafeteria was packed on a latest Friday as employees served boiled shrimp, fried okra, and baked fish.
Eppler mentioned he’s conscious Republicans in Congress are focusing on a system of taxes that some states, together with Louisiana, levy on hospitals and different well being suppliers to attract down extra federal Medicaid funding. That cash helps finance what are often called supplemental funds to suppliers. Some conservatives belittle the additional funding as “cash laundering.”
However that cash accounts for about 15% of the DeSoto well being system’s funds, mentioned Eppler, a retired Air Power lieutenant colonel who has been CEO for a dozen years. “We’re utilizing that cash to spend money on the following 50 years of Desoto Parish, to construct a hospital that they’ll have that will likely be sustainable,” he mentioned.
The supplemental funds, for instance, assist pay to offer psychological well being providers at three outpatient clinics. “If that $4 million went away, we must restrict providers — it’s simply that straightforward,” he mentioned.
