A version of this op-ed ran on June 30 on MSNBC.com.

The reconciliation bill making its way through Congress includes cuts to Medicaid that are so massive that even some Republicans have criticized them. In a remarkable address Sunday, Sen. Thom Tillis asked his fellow GOP lawmakers what he should say to North Carolinians who lose health-care coverage “What do I tell 663,000 people in two years, three years,” he asked, “when President Trump breaks his promise by pushing them off of Medicaid because the funding’s not there anymore?”

But the toll is even worse than lost coverage. These cuts will cost more than 51,000 people their lives every year.

That’s not hyperbole. It’s a predictable result when you cut off health insurance to people who are old, poor and sick. And it’s based on analyses and projections from researchers at the University of Pennsylvania, Harvard and Yale.

Medicaid insures one in five Americans, typically low-income and often disabled. The latest version of the bill in front of the Senate includes more than $1 trillion in proposed cuts to the Medicaid program over 10 years. If enacted, these cuts would be the largest in Medicaid’s 58-year history and would harm the health of millions.

Consider one deeply vulnerable group of 13 million Americans, known as dual-eligible individuals because they rely on both Medicare and Medicaid. These people automatically get subsidies that lower the cost of their medications. 

When they lose Medicaid, they lose access to low-cost drugs, increasing the likelihood that chronic conditions go untreated.

Using Medicare data on dual-eligible individuals, we calculated the effects of losing drug subsidies on beneficiaries’ mortality. Based on this research, we estimated that 18,200 dual-eligible individuals  would die each year from the loss of Medicaid coverage. 

Among the hardest hit would be those with chronic conditions like heart disease, HIV and chronic lung disease. 

The budget bill also will delay for a decade the new rule for minimum staffing at nursing homes that would improve quality of care. Based on studies of the relationship between nurse staffing hours and resident mortality, our colleagues at Penn project another 13,000 deaths per year among residents.

Medicaid funding cuts will force governors and state legislators to make politically unpalatable decisions, because states, unlike the federal government, must balance their budgets yearly. States will likely be forced to curtail benefits or install policies that limit the amount of time individuals can receive Medicaid.

Hospitals, clinics and other caregivers will suffer as well with rural and urban facilities bearing the brunt, forcing them to trim operations or close altogether. 

A full accounting of these impacts won’t be known for several years as they depend on how states adjust over time to funding cuts. Therefore, the full effects of Medicaid cuts could be even more extensive than current forecasts of coverage loss and mortality suggest.

What can be done to reduce unnecessary Medicaid loss? Halting the proposed cuts would be a start.

For the full op-ed, go here.

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