What do you really know about Medicaid? Take our quiz and find out.
What do you really know about Medicaid? Take our quiz and find out.
Medicaid will be at the center of talks this week on Capitol Hill as House Republicans consider how to cut a program that is the primary source of health insurance coverage for low-income populations. Paid for by the federal government and states (as well as D.C.), Medicaid is a lifeline for many groups, including children and seniors.
Members of the Energy and Commerce Committee, which has jurisdiction over health care, are charged with finding $880 billion in savings, which they can't do without touching Medicaid. Yet some lawmakers say they won't vote for a bill that scales back a program on which many of their constituents rely.
How much do you know about how Medicaid works? Test your knowledge with our quiz:
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Yahoo
12 minutes ago
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‘Expensive and complicated': Most rural hospitals no longer deliver babies
A mother prepares her infant son for bed. Since 2020, 36 states have lost at least one rural labor and delivery department. In rural counties, the loss of hospital-based obstetric care is associated with increases in births in hospital emergency rooms, less prenatal care and higher rates of babies being born too early. (Photo by) Nine months after Monroe County Hospital in rural South Alabama closed its labor and delivery department in October 2023, Grove Hill Memorial Hospital in neighboring Clarke County also stopped delivering babies. Both hospitals are located in an agricultural swath of the state that's home to most of its poorest counties. Many residents of the region don't even have a nearby emergency department. Stacey Gilchrist is a nurse and administrator who's spent her 40-year career in Thomasville, a small town about 20 minutes north of Grove Hill. Thomasville's hospital shut down entirely last September over financial difficulties. Thomasville Regional hadn't had a labor and delivery unit for years, but women in labor still showed up at its ER when they knew they wouldn't make it to the nearest delivering hospital. 'We had several close calls where people could not make it even to Grove Hill when they were delivering there,' Gilchrist told Stateline shortly after the Thomasville hospital closed. She recalled how Thomasville nurses worked to save the lives of a mother and baby who'd delivered early in their ER, as staff waited for neonatal specialists to arrive by ambulance from a distant delivering hospital. 'It would give you chills to see what all they had to do. They had to get inventive,' she said, but the mother and baby survived. Now many families must drive more than an hour to reach the nearest birthing hospital. Nationwide, most rural hospitals no longer offer obstetric services. Since the end of 2020, more than 100 rural hospitals have stopped delivering babies, according to a new report from the Center for Healthcare Quality & Payment Reform, a national policy center focused on solving health care issues through overhauling insurance payments. Fewer than 1,000 rural hospitals nationwide still have labor and delivery services. A small town tries to revive its hospital in the middle of a rural health crisis Across the nation, two rural labor and delivery departments shut their doors every month on average, said Harold Miller, the center's president and CEO. 'It's the perfect storm,' Miller told Stateline. 'The number of births are going down, everything is more expensive in rural areas, health insurance plans don't cover the cost of births, and hospitals don't have the resources to offset those losses because they're losing money on other services, too.' Staffing shortages, low Medicaid reimbursement payments and declining birth rates have contributed to the closures. Some states have responded by changing how Medicaid funds are spent, by allowing the opening of freestanding birth centers, or by encouraging urban-based obstetricians to open satellite clinics in rural areas. Yet the losses continue. Thirty-six states have lost at least one rural labor and delivery unit since the end of 2020, according to the report. Sixteen have lost three or more. Indiana has lost 12, accounting for a third of its rural hospital labor and delivery units. In rural counties the loss of hospital-based obstetric care is associated with increases in births in hospital emergency rooms, studies have found. The share of women without adequate prenatal care also increases in rural counties that lose hospital obstetric services. And researchers have seen an increase in preterm births — when a baby is born three or more weeks early — following rural labor and delivery closures. Babies born too early have higher rates of death and disability. The decline in hospital-based maternity care has been decades in the making. Traditionally, hospitals lose money on obstetrics. It costs more to maintain a labor and delivery department than a hospital gets paid by insurance to deliver a baby. This is especially true for rural hospitals, which see fewer births and therefore less revenue than urban areas. 'It is expensive and complicated for any hospital to have labor and delivery because it's a 24/7 service,' said Miller. A labor and delivery unit must always have certain staff available or on call, including a physician who can perform cesarean sections, nurses with obstetric training, and an anesthetist for C-sections and labor pain management. You can't subsidize a losing service when you don't have profit coming in from other services. – Harold Miller, president and CEO of the Center for Healthcare Quality & Payment Reform 'There's a minimum fixed cost you incur [as a hospital] to have all of that, regardless of how many births there are,' Miller said. In most cases, insurers don't pay hospitals to maintain that standby capacity; they're paid per birth. Hospitals cover their losses on obstetrics with revenue they get from more lucrative services. For a larger urban hospital with thousands of births a year, the fixed costs might be manageable. For smaller rural hospitals, they're much harder to justify. Some have had to jettison their obstetric services just to keep the doors open. 'You can't subsidize a losing service when you don't have profit coming in from other services,' Miller said. And staffing is a persistent problem. Harrison County Hospital in Corydon, Indiana, a small town on the border with Kentucky, ended its obstetric services in March after hospital leaders said they were unable to recruit an obstetric provider. It was the only delivering hospital in the county, averaging about 400 births a year. And most providers don't want to remain on call 24/7, a particular problem in rural regions that might have just one or two physicians trained in obstetrics. In many rural areas, family physicians with obstetrical training fill the role of both obstetricians and general practitioners. Even before Harrison County Hospital suspended its obstetrical services, some patients were already driving more than 30 minutes for care, the Indiana Capital Chronicle reported. The closure means the drive could be 50 minutes to reach a hospital with a labor and delivery department, or to see providers for prenatal visits. A fifth of Americans are on Medicaid. Some of them have no idea. Longer drive times can be risky, resulting in more scheduled inductions and C-sections because families are scared to risk going into labor naturally and then facing a harrowing hourlong drive to the hospital. Having fewer labor and delivery units could further burden ambulance services already stretched thin in rural areas. And hospitals often serve as a hub for other maternity-related services that help keep mothers and babies healthy. 'Other things we've seen in rural counties that have hospital-based OB care is that you're more likely to have other supportive things, like maternal mental health support, postpartum groups, lactation support, access to doula care and midwifery services,' said Katy Kozhimannil, a professor at the University of Minnesota School of Public Health, whose research focuses in part on maternal health policy with a focus on rural communities. Medicaid, the state-federal public insurance for people with low incomes, pays for nearly half of all births in rural areas nationwide. And women who live in rural communities and small towns are more likely to be covered by Medicaid than women in metro areas. Experts say one way to save rural labor and delivery in many places would be to bump up Medicaid payments. As congressional Republicans debate President Donald Trump's tax and spending plan, they're considering which portions of Medicaid to slash to help pay for the bill's tax cuts. Maternity services aren't on the chopping block. But if Congress reduces federal funding for some portions of Medicaid, states — and hospitals — will have to figure out how to offset that loss. The ripple effects could translate into less money for rural hospitals overall, meaning some may no longer be able to afford labor and delivery services. Abortion-ban states pour millions into pregnancy centers with little medical care 'Cuts to Medicaid are going to be felt disproportionately in rural areas where Medicaid makes up a higher proportion of labor and delivery and for services in general,' Kozhimannil said. 'It is a hugely important payer at rural hospitals, and for birth in particular.' And though private insurers often pay more than Medicaid for birth services, Miller believes states shouldn't let companies off the hook. 'The data shows that in many cases, commercial insurance plans operating in a state are not paying adequately for labor and delivery,' Miller said. 'Hospitals will tell you it's not just Medicaid; it's also commercial insurance.' He'd like to see state insurance regulators pressure private insurance to pay more. More than 40% of births in rural communities are covered by private insurance. Yet there's no one magic bullet that will fix every rural hospital's bottom line, Miller said: 'For every hospital I've talked to, it's been a different set of circumstances.' Stateline reporter Anna Claire Vollers can be reached at avollers@ SUPPORT: YOU MAKE OUR WORK POSSIBLE
Yahoo
12 minutes ago
- Yahoo
Cuts to Medicaid for Ohioans with disabilities could take away home care and job help
(iStock / Getty Images Plus) As the Ohio Senate moves forward with its budget proposal, advocates for Medicaid are hoping changes can be made to avoid significant impacts to low income residents, elderly Ohioans, and people with disabilities. Funding from Medicaid allows 3 million Ohioans access to health care services, including more than 770,000 who receive them through the Medicaid expansion program instituted in 2014. That expansion program allows people who weren't eligible for the traditional Medicaid programs but were still in categories of need to access health care. The existence of that program dropped the uninsured rate in Ohio to historic levels, according to the Health Policy Institute of Ohio. Along with health care, Medicaid dollars help with services that aren't necessarily connected to medical treatment, like home care, employment help, transportation, and a direct care provider who helps with all of those things. 'In many cases, if there wasn't Medicaid dollars behind it, I know of many people whose ability to live outside of a hospital or in the community would be threatened,' said Jules Patalita, a disability rights advocate for Sylvania-based The Ability Center. So advocates were disappointed to see the Ohio Senate maintain a provision from both the Ohio House's and Gov. Mike DeWine's budget proposals that would eliminate the Medicaid expansion group if the federal government reduces their level of support (currently at 90%) by even 1%. 'This would be a substantial loss for many working Ohioans,' said Kathryn Poe, researcher for the think tank Policy Matters Ohio. SUBSCRIBE: GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX Also included in the Senate's budget proposal is the elimination of a Medicaid waiver that 'would have provided continuous coverage for kids up to age 3,' Poe said, and a separate section of the budget that would 'allow the state to pause, eliminate or change other funds related to all other federal grants, should Congress adjust or eliminate funding for that program.' Poe did praise the Senate proposal for removing a House-submitted provision limiting Medicaid reimbursement for doulas to only six Ohio counties. 'This will ensure that Ohio parents continue to have access to culturally appropriate birthing resources and management,' Poe said. Concerns about loss of access don't just extend to physical health concerns or daily home services, but also to behavioral health services, on which 47% of Ohio adults on Medicaid rely, according to Kerstin Sjoberg, president and CEO of Disability Rights Ohio. 'If you don't have access to some sort of insurance like Medicaid, it's going to be almost impossible to get those services,' Sjoberg said. The state-level discussions come as federal budget reconciliation also touches on Medicaid funding as the Trump administration and Republicans in Congress attempt to slash federal spending by $880 billion over the next decade, particularly from public assistance programs like the Supplemental Nutrition Assistance Program (SNAP) and Medicaid. U.S. House Speaker Mike Johnson and other leaders have talked about 'abuse' or 'fraud' as sources of revenue loss for the country in public programs, something those who engage with users of programs like Medicaid push back on. 'In reality, Medicaid is one of the most cost-effective and widely used safety nets in the country,' said the advocacy group Innovation Ohio in a call-to-action email over the congressional budget proposals. 'If this bill becomes law, the result will be fewer people with health care, more families pushed into poverty and deeper inequality. Rural hospitals could shut down.' According to a study by the Commonwealth Fund, Ohio could be one of the hardest hit economies if Medicaid cuts at the federal level come to fruition, cuts that could mean 29% more Medicaid spending by states or cuts to other programs, like education, to offset the Medicaid losses. One thing that will have to be addressed whether or not the cuts are realized in the state and federal budgets is the workforce that helps those who use Medicaid for home care and other services. Patalita said the word 'crisis' has been used in talking about the shortage of direct care providers, similar to the shortage of child care workers needed to provide adequate access to that service. 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'This failure by agencies to provide benefits adds to the worker shortage and forces those requiring home care to carry the burden of decreased access to care, especially those in rural areas,' the study found. Eliminating Medicaid funding, including the expansion group, will make life harder for those Ohioans who need the services, Sjoberg said, 'but it will also make it necessary that the direct care workforce is supported in other ways.' SUPPORT: YOU MAKE OUR WORK POSSIBLE
CNN
23 minutes ago
- CNN
US foreign aid cuts threaten decades of progress on driving down malaria
Cuts to US-funded malaria programs are adding to a host of issues confronting Congolese mother Mwayuma Idi Feza, whose city, Goma, is at the center of the country's intensifying conflict and run by a vicious militia. 'I have a child who is sick. He has had malaria for a week and a few days now,' Feza, 36, told CNN of her 1-year-old son, whose fever she suspects is caused by the mosquito-borne illness. She is also experiencing symptoms of the disease, she said. 'I'm feeling cold. I feel bitterness in my mouth.' The single mother is out of work and said she can barely afford food, much less malaria treatment for her and her baby. Malaria is a preventable and curable disease, but it still claims hundreds of thousands of lives around the world each year. Infants, children under five and pregnant women are most likely to die from a malaria infection. It's a leading cause of death in the Democratic Republic of Congo (DRC), which bears the world's second-highest malaria burden after Nigeria, according to the World Health Organization (WHO). In 2022, some 24,000 people were estimated to have died of the disease in the central African nation. More than half those deaths were of children under 5. Since the Trump administration started slashing foreign aid early this year, an estimated 36% of US Agency for International Development (USAID) funding for malaria programs has been cut, according to the Center for Global Development, a DC-based think tank. But the true level of aid cuts remains uncertain. In the DRC, that money funded the supply of antimalarials to 'many health zones' across the country, 'including intermittent preventive treatment for pregnant women,' according to Michel Itabu, a former spokesperson for the country's National Malaria Control Program (PNLP), referring to a WHO-recommended program in areas where malaria is endemic. 'The PNLP is already feeling the effects' of the funding cuts, Itabu told CNN. Such preventive programs might have protected Idi Feza and her baby son – instead, if infected, they are both at risk of serious illness or even death. The US government has long been the largest donor to global efforts to combat malaria. For decades, USAID spearheaded a program called the President's Malaria Initiative (PMI) to drive down mortality and eliminate malaria in 30 of the hardest-hit nations, most of which are in Africa. Launched by George W. Bush in 2005, the program helped reduce malaria deaths by more than 60% – saving millions of lives. CNN spoke to several people who previously worked on the initiative but were recently laid off amid Trump's dismantling of USAID. Most PMI staff have been let go or had their work halted by stop-work orders, and the Trump administration's proposed budget called for a 47% cut to the program. 'One of the reasons that we don't have malaria in the US is because we fund and track malaria worldwide, for global health security.' Former USAID contractor, speaking anonymously for fear of reprisals Every aid worker who spoke to CNN emphasized that people would die in the short term as a result of the disruption to malaria prevention and treatment efforts. Longer term, they said the funding cuts would destroy years of American progress in driving down the prevalence and severity of the disease. US-backed surveillance systems that were once the backbone of efforts to monitor malaria and other disease outbreaks around the world have also been cut, former US government workers told CNN, underscoring long-term concerns. 'One of the reasons that we don't have malaria in the US is because we fund and track malaria worldwide, for global health security,' one former USAID contractor told CNN in February, speaking anonymously for fear of reprisals. She warned that locally acquired malaria cases, like Florida experienced in 2023, could become more common 'if we're not funding driving down the parasite elsewhere.' Aid workers and nonprofits have repeatedly made the case that malaria programs and US disease monitoring make America 'safer, stronger and more prosperous,' which was Secretary of State Marco Rubio's stated framework for assessing US foreign assistance. For example, USAID and the US military have long invested in malaria vaccine research to both reduce the global disease burden and protect US soldiers serving abroad. Spencer Knoll, US policy and advocacy director at the nonprofit Malaria No More, said in testimony to the US House Appropriations Subcommittee in April that 'the world's most dangerous infectious diseases – including Ebola, Marburg, and pandemic influenza – often present first as fevers, and malaria detection programs can stop outbreaks in their tracks.' The nonprofit also argued that US assistance prevents other countries like China and Iran from making further inroads in Africa in terms of soft power. 'Everything that comes from USAID… was very intentionally branded, with this logo that says 'from the American people.' People know where it was coming from,' said former PMI contractor Annē Linn, who lost her job in January. 'When all of a sudden everything stops, that just tears down trust – not just from our government to other governments, but within countries' own health systems.' Between 2010 and 2023, the US contributed more than one-third of the world's malaria financing, according to WHO. As of last year, the US was also the largest contributor to the Global Fund, which works to fight AIDS, tuberculosis and malaria. It's unclear what the future level of US funding for the independent, public-private program will be, following the Trump administration's proposal to halve US matching contributions. The Trump administration's funding cuts 'could reverse decades of progress earned, in part, through longstanding investments from the United States of America and other global partners,' WHO warned in a statement earlier this year. 'Although funding for some USA-supported malaria programs have been reinstated, the disruptions have left critical gaps.' The US State Department did not respond to questions from CNN about the stop-work orders and where specifically budget cuts to the PMI would be felt. Former aid workers emphasized concerns about lack of investment to tackle several global threats related to malaria, including drug resistance, increasingly insecticide-resistant mosquitoes and new, invasive types of mosquitoes that are moving into urban areas with high populations. 'The timing for all of this couldn't be worse. Malaria is seasonal, and so having interruptions during times of seasonality sets us back significantly,' said Nathaniel Moller, formerly a senior innovation adviser at the PMI, whose job was cut in January. He warned that with less funding for measures like bed nets and preventative medicine, the baseline of cases will rise this year, enabling further spread of the disease down the road. 'You missed that window, and you can't just go back to that initial baseline… it's going to go up,' Moller said, noting that the rainy season is already underway in parts of east, central and southern Africa. 'We risk losing years of investments and seeing the caseload increase significantly.' That bad timing is particularly evident in Malawi, where recent flooding and cyclones have driven up malaria infections, the country's National Malaria Control Manager Lumbani Munthali told CNN. He added that cuts to USAID funding for malaria interventions have put the country in 'a difficult situation' because 'it's not easy to close the gaps that have been created.' More than 2,000 people died of malaria in Malawi last year. Some 9 million were infected. 'Malawi has made significant progress in reducing malaria deaths because of the technical and financial support from the US government,' Munthali said. That funding went towards procuring millions of malaria tests kits annually and providing insecticide-treated bed nets and antimalarial medication for pregnant women and nursing mothers. 'We are trying to close those gaps but may not close them completely,' Munthali said, as Malawi adjusts to the sharp drop-off in US foreign aid. About 64% of Malawi's USAID funding has been cut across all programs, according to the Center for Global Development's analysis. In 2023, the most recent year for which PMI figures are available, Malawi received $24 million for its fight against malaria. It's not yet clear exactly how much it will lose this year, Munthali said. Cuts to other areas of US foreign aid, like malnutrition programs, will have overlapping effects in Africa, aid workers also warned. 'Kids that are acutely malnourished will be more vulnerable to other diseases,' like measles, cholera and malaria, according to Nicolas Mouly, an emergency coordinator for Doctors Without Borders, or Médecins Sans Frontières (MSF), who works in northwest Nigeria. He said funding gaps for malnutrition programs that were already present in 2024 have deepened significantly this year. Malaria infection can also lead to malnutrition, fueling what MSF has called 'a vicious cycle.' Nigeria's health minister, Muhammad Ali Pate, told CNN that the government has mobilized domestic funding for its health sector, including $200 million recently approved by parliament to lessen the effects of losing USAID funding. 'When the change in US government occurred and the policy was made, we considered it as another opportunity for reset and for us to increase our domestic funding so that we can meet the responsibility of the health of our population,' he said. 'At the end of the day, the responsibility of the health of Nigerians is on the Nigerian government. It is never a primary responsibility of the US government.' MSF doesn't rely on US government funding, but the organization said its programs have been burdened with additional patients following US cuts to other humanitarian actors in the region. 'We won't have the capacity to treat all of them,' Mouly said. Aid organizations prepare for the annual peak of malnutrition – when fall harvests have yet to arrive and rainy seasons have increased malaria cases – by stockpiling ready-to-use therapeutic food sachets. But for this year's lean season, Mouly said there is 'uncertainty' about their availability. 'We can expect a very critical situation,' Mouly said, emphasizing that children will die as a result. 'We've not seen anything like this in terms of disruption of global aid. It's very difficult.' Lauren Kent reported and wrote from London. Nimi Princewill reported from Abuja, Nigeria.
