Hello LeadingAge Missouri Members. With our nation’s 249th Birthday this Friday, my perspective this first week of July must be on our republic and democracy.
We celebrate the Fourth of July to commemorate the day in 1776 when our forefathers, already at war with Great Britain, formally declared independence from the British monarchy. In the Declaration of Independence, we told King George we were divorcing him to freely rule ourselves. How we would do that was decided a decade later in our Constitution, which – as described by Abraham Lincoln nearly a century later – delivers a government “of the people, by the people, and for the people.” Clearly, our experiment with democracy is evolutionary.
The second reason my perspective this week is on our republic and democracy is because our representative government is hard at work. LeadingAge, LA MO, and our members have been aggressively communicating with Congresspersons to influence policies impacting our field. This includes Medicaid reforms and Immigration – both addressed in this Missouri Messenger.
As I write, the Senate just passed its version of Budget Reconciliation that will – as does the House Reconciliation bill passed in May – significantly alter financing for the Federal/State Medicaid partnership. According to the non-partisan Congressional Budget Office, the Senate’s version of the “One Big Beautiful Bill” will cause 11.8 million people to lose Medicaid health insurance by cutting nearly $1 trillion from federal Medicaid spending. $130 billion of those Medicaid cuts are from additional Senate restrictions on state provider taxes and state directed payments.
Applied to Missouri, the Missouri Budget Project (based on analysis done by Manatt and Missouri Foundation for Health) projects the Senate bill will cause 170,000 Missourians to lose Medicaid health insurance and that Missouri will receive $21 billion less (a 12% reduction) in federal Medicaid support over 10 years. By 2034, when the Senate provisions are fully implemented, Missouri will receive one-fifth less ($3 billion) in annual Medicaid funding. Hospitals will shoulder most of Senate bill’s Medicaid cuts – indeed, the provider tax restrictions do not apply to Missouri’s nursing home “bed tax” – but nursing homes and HCBS will be affected. A $3 billion budget hole can’t be easily filled in Missouri. Medicaid funding reductions and process changes will affect Missouri nursing homes and HCBS Medicaid reimbursement and eligibility for senior living residents and employees. For this reason, LeadingAge and LA MO remain opposed to the Medicaid reforms in both the Senate and House bills.
Because the Senate bill expands the House Reconciliation bill, the House must now pass the Senate version to become law. The House passed its bill with a one-vote margin. The Senate just passed its bill with Vice President Vance breaking a tie-vote. One can assume the democratically elected Republican majority in the House will persuade enough of its members to vote “yes” on the Senate version (all Democrats are presumed “no” votes), but who knows for sure? Several House Republicans have publicly expressed displeasure with the Senate’s larger Medicaid cuts. For that reason, and so our Representatives know where we stand, all LeadingAge members are encouraged to communicate with your Congresspersons. Here is a link to easily, quickly share opposition to the Medicaid cuts and include your personal perspectives to influence the House vote, which may be occurring as you read this! Act now! Congress is attempting to meet a self-imposed July 4th deadline to pass the One Big Beautiful Bill that contains President Trump’s domestic policy agenda – paid for chiefly by reducing federal Medicaid expenditures.
Democracy has historically been messy, and it seems particularly messy now. But America and Americans, especially those providing and receiving aging services, are committed and resilient. The One Big Beautiful Bill doesn’t appear beautiful to many. But many wonderful new things were despised or feared at first. Whatever the Budget Reconciliation brings will be met with perseverance, experimentation, and innovation. Aging services providers meet challenges head on, and LeadingAge will be here to help them. That’s the American way! Happy Birthday America!
Yours in service,
