Explainer by Patrick O'Mahen, Health Services Researcher
Background and Guide to a Single Talking Point + Phone Script for a Coordinated Defense of the ACA XXIII: A Delayed Medicaid cutoff is still a cutoff
Relevant Policy Background:
The House: One of the most damaging parts of the House-passed American Health Care Act is the destruction of Medicaid (1) Starting in 2020, the AHCA drastically reduces the federal government's matching funding for states seeking to cover able-bodies childless adults under the program from 90 percent to 57 percent, which effectively would end the Medicaid expansion in most states. Beyond that, the AHCA also caps federal funding for all other participants in the program, limiting growth by an artificially low measure of inflation. The results would likely lead to drastic reductions in the numbers of kids, disabled, parents and adults needing nursing care in the program, as well as a likely drastic reduction in the scope of services covered for people who remain in the program (e.g. no dental or hospital services covered) Total cuts under the AHCA over the next decade amount to $834 billion – about a quarter of the program (2) About 14 million people would lose coverage under the changes in the next decade.
The Senate: The Senate has managed to take the House bill and make it worse. Instead of implementing drastic Medicaid cuts in 2020, Senators are phasing in cuts more slowly, then making up for it by cutting the program more drastically after 2026. They do this by linking federal caps to the general inflation rate in urban areas (Consumer Price Index or CPI-U) instead of the medical inflation rate (CPI-M). Since medical costs grow more quickly than the costs of most things in the economy, moving from CPI-M to CPI-U.3 The result is a long-term 37 percent cut to Medicaid instead of a 25 percent cut. Yeah, it's really that simple. And remember, the primary reason to cut Medicaid is so that people making more than $250,000 a year can reap a collective $600 billion in tax cuts.
How do I turn that into an easy talking point? Delaying drastic cuts to Medicaid still means you are making drastic cuts to Medicaid, especially when those delayed cuts are deeper.
Phoning a Congressperson's office (4) - What to do:
- Coordinate the topic, ask and timing with a group
- Call your Senator
- Call your other Senator
- Call your U.S. representative
- Go ahead and call both their Washington and their local offices
- Be polite but persistent
- Be specific to one topic
- Have one ask (e.g. Vote no on the current attempt to repeal the Affordable Care Act)
- Take notes on what you are told
- Report the results back to the group and social media
TACTICS CHANGE: You should specifically target Senators health staffers. So, leave a message on the main phone line, but also ask to speak with the health staffer. The Indivisible Guide has a nicely targeted list https://www.indivisibleguide.com/resource/senate-health-care-staffers/ which directly lists the staffers by name and their direct phone lines. Leave a message with them, and then follow up by e-mail. This is also a person, if they are in a local office, who you can request a meeting with. Bring a few friends.
To find contact info for your reps and Senators look here: www.callmycongress.com.
The script I suggest below is the simplest. Indivisible suggests trying to get in touch with a policy staffer, which has the advantage of taking up the time of senior staff members and hitting closer to the representative himself. However, even flooding the zone of junior staffers and interns is useful. See https://www.indivisibleguide.com/ for more information.
Sample Script: "Hi, my name is X I'm a constituent of Senator Y, may please speak with [name of staffer who handles health policy?"]
- Give your name and address if asked (you don't have to, but doing this confirms you're in their district and gives you credibility)
- Ask who you are speaking with, record their name and title.
- "I'm upset that Congress is trying to pass the Better Care Reconciliation Act. I'm concerned about its long-term caps on Medicaid, which will destroy the core functions of the program. [If you have a story here – this is a good place to put it] "Can I count on Senator Y to stand behind the Affordable Care Act and not cut Medicaid?
- Write down answer
- Thank them if they say yes
- Stand your ground politely but firmly if they hand you a talking point, say "no," or try to hide behind the idea that they can't express and opinion for the Congressperson.
Their bad talking points include:
-
- "We're not going to take Medicaid away from anyone" - Your answer: The CBO report for the Senate Bill says that 14 million people will lose coverage and research suggests that more than 14,000 more people will die every year (5)
- "We're going to replace it with something better" - Your response: ask them what they have in mind. Tell them that Medicaid provides comparable access to employer insurance for a lot cheaper and provides excellent outcomes given the population has many more health problems.
- "We want to give states more flexibility talking point" - Your response: Ask them where states will get the money to provide better programs, considering that Medicaid is already extremely efficient.
- "We don't know what's going on or in the bill" - Your response: Senator XX should demand an open process for developing the bill
- "We're not cutting Medicaid, we're actually giving more money to Medicaid than currently given" - Your response: tell them that they are cutting the program from its current projected funding levels, which will still drastically hurt people.
- Make sure to:
- Thank the staffer for their time
- Report back to the group and post on social media about your encounter.
- Praise the Senator if they commit to protecting the ACA
- Keep organizing!
NOTE: PUSH PORTMAN OF OHIO, CAPITO OF WEST VIRGINA, HELLER OF NV, MORAN OF KANSAS, COLLINS of MAINE and MURKOWSKI OF ALASKA HARD (but politely – especially Murkowski, Moran, Heller and Collins) ON THIS. NOTE II: JUST TELL CRUZ OF TEXAS, PAUL OF KENTUCKY, LEE OF UTAH AND JOHNSON OF WISCONSIN TO VOTE "NO.
(1) Kaiser's on it, per usual.
http://www.kff.org/medicaid/issue-brief/factors-af...
(2) And that's not even counting the Trump budget for fiscal year 2018, which proposes another 20 percent cut to Medicaid over the next decade.
(3)
https://www.theatlantic.com/politics/archive/2017/... (with links to Congressional Budget Office Analysis)
(4) The Indivisible Guide has several techniques for working a phone call. The script I suggest below is the simplest. They suggest trying to get in touch with a policy staffer, which has the advantage of taking up the time of senior staff members and hitting closer to the representative himself. However, even flooding the zone of junior staffers and interns is useful. See https://www.indivisibleguide.com/ for more
(5) That's the low estimate. It's could be several times higher: see https://dash.harvard.edu/bitstream/handle/1/273059... df?sequence=1