Internists Say Changes to Medicaid Program Will Put Health Care at Risk for Vulnerable Patients

Statement attributable to:
Robert McLean, MD, MACP
President, American College of Physicians

Washington, DC (January 30, 2020) — The American College of Physicians (ACP) is greatly concerned that the new Healthy Adult Opportunity plan announced by the administration today will put access to health care at risk for Medicaid beneficiaries.  ACP strongly opposes transforming Medicaid’s existing financing structure into a block grant approach because it will increase the number of people without health insurance coverage for essential health care services. Likewise, the per-capita cap option will restrict crucial health care funding.

The Medicaid program is meant to provide a safety net for those most in need. For states that apply for the new demonstration project there would be a cap on the federal funding provided to cover adults under age 65 who are primarily eligible for Medicaid through Medicaid expansion, giving those states only a fixed amount of money no matter the need in the state. Just as troubling, they would also no longer need to ensure that their program is providing those beneficiaries with the same benefits and coverage. Fewer patients will be covered, and those who remain covered will have less access to health care services.

We are concerned that enacting a cap on Medicaid funding leaves states unprepared to respond quickly to potential public health crises. In the event of an economic downturn, states would be unable to quickly accommodate people who might be unexpectedly and suddenly dealing with a loss of insurance and employment. States will have more ability to impose premiums and cost-sharing on adult Medicaid beneficiaries under these changes. We know that imposing cost-sharing dissuades low-income beneficiaries from seeking needed care.

We are also concerned that this may encourage states, in a cost-saving effort, to cut prescription drug benefits. They also will be permitted to cut non-emergency transportation benefits that could be vital to those seeking necessary care in rural or remote locations.

Further by restricting federal funding available to states, they may reduce payments to physicians under Medicaid. Currently, many state Medicaid programs reimburse at much lower rates than Medicare and commercial payers. Encouraging states to further reduce payments to physicians will have a particularly adverse impact on primary care physicians, making it more difficult for them to continue seeing Medicaid beneficiaries.

As a physician I worry about what will happen to my patients who depend on Medicaid for their health care. Medicaid programs across the country are vital in the effort to ensure that our nation’s most vulnerable population has access to health coverage. ACP calls on the Centers for Medicare and Medicaid Services to reverse this guidance that would drastically weaken coverage under the Medicaid program for low-income adults and instead focus on policies that would strengthen it.

Our current healthcare system with problems of accessibility and affordability already leaves too many patients behind. ACP is greatly concerned this Medicaid change will exacerbate these problems. Our patients deserve better.

Contact: Jackie Blaser, (202) 261-4572,

About the American College of Physicians

The American College of Physicians is the largest medical specialty organization in the United States with members in more than 145 countries worldwide. ACP membership includes 159,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on Twitter, Facebook, and Instagram.