The Health of People and Communities Served by Grantmakers is at Risk

Thursday, September 21, 2017

By Patrick Ness, Public Policy Director with the Amherst H. Wilder Foundation

If you care about older adults, children, people with disabilities or chronic health conditions, and very low-income adults, then you need to care about the fact that United States Senate has until September 30th to act on the most sweeping health care overhaul  in over 50 years. In many respects a health care change even bigger in impact than ObamaCare, the Graham-Cassidy-Heller-Johnson (GCHJ) plan would repeal the core of the Affordable Care Act, while also restructuring and reducing the traditional Medicaid program passed in 1965.

If GCHJ is passed by the Senate, the current system of care – hospitals, clinics, nursing homes, home and community-based services, and nonprofit social service providers – would be undermined. Local economies – particularly rural communities – would face new and additional challenges.  The trickle-down impact of deep federal funding cuts to states, nonprofits and philanthropy would be immense.

According to an analysis conducted by Avalere, the GCHJ amendment would lead to a $215 billion reduction in federal funding to states through 2026, and a $4 trillion reduction over a 20-year period.

Minnesota would be disproportionately impacted, with a projected $13 billion reduction from 2020-2027. By 2036, the projected loss of federal health care funding to Minnesota is $82 billion, a 34% reduction. All states would see a reduction in federal funds relative to current law by 2036.

Fitch Ratings, a leading provider of credit ratings, released an analysis on the potential impact of the health care bill. Excerpts include:

  • [ACA repeal and changes to Medicaid]…could have implications for states’ credit quality and for the credit quality of related public finance entities that depend on state funding.
  • Imposing capped federal spending shifts the risks for higher costs, whether due to new treatment regimes, health emergencies, or other events, away from the federal government and to states, providers, and enrollees.
  • Medicaid changes that significantly reduce federal funding to states will cause states to consider a mix of spending cuts or revenue increases to maintain long-term fiscal balance. In a time of already muted revenue growth, spending cuts could affect K-12 and higher education the most, as those are the other largest areas of state spending outside of Medicaid.

Health care represents nearly 20% of the U.S. economy. We are at an historic moment in our national dialogue, and the coming days will impact not only the well-being of millions of Americans, but also the fiscal stability of American families, health care providers, nonprofits, local governments, and the overall economy for generations to come. The Congressional Budget Office will only be prepared to release a partial fiscal analysis of the GCHJ amendment prior to the deadline for a vote next week – and will be unable to provide projected loss of health care coverage to Americans. It is reckless and irresponsible to vote for such sweeping legislation without a more full understanding of the human and economic impact.

Minnesotans who care about community health, family security and productive work places are now contacting their United States Senators and Representative. They are saying “no” to this new health bill and calling for a more thoughtful, measured approach to our health care policy-making.


Patrick Ness is the Public Policy Director with the Amherst H. Wilder Foundation, member of MCF's Government Relations and Public Policy Committee, and co-convener of This Is Medicaid, a Minnesota-based coalition seeking to protect Medicaid.  Follow the coalition on Facebook, @thisismedicaid on Twitter, and



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