Nurses’ Union Warns of Drastic Changes Under Medicaid Cuts

Healthcare providers are bracing themselves for what they expect will be the devastating impacts of federal cuts to Medicaid and other public benefits.

“What was done by this congress and the president is a partial repeal of the Affordable Care Act,” Rep. Travis Nelson (D-Portland) told The Skanner. “All of the work that President Obama did to expand Medicaid and bring more people onto Medicaid, that is what Republicans at the federal level are attempting to undo.”

House Resolution 1, passed last week, ratchets up funding for Immigration and Customs Enforcement (ICE) while making substantial cuts to social safety net programs, including the Supplemental Nutrition Assistance Program (SNAP) and Medicaid. Under HR 1, Medicaid recipients will be subject to new work requirements and will also be required to confirm eligibility more frequently, which increases the risk of recipients losing coverage due to missed paperwork. 

“There’s a good chance we’ll see a lot of the people who were brought onto OHP and the Medicaid rolls in Oregon and other states (impacted) – that the folks who will lose their healthcare will be the ones who would not have qualified pre-Obamacare,” Nelson, a former vice president of the Oregon Nurses Association, said. 

About 607,000 BIPOC Oregonians are enrolled in the Oregon Health Plan, comprising 42% of the program’s recipients. Analysts have predicted 280,000 OHP recipients may lose coverage under the severe cuts – including an estimated 100,000 Oregonians of color. 

It is a deep blow to a state that has consistently expanded its Medicaid program.

“In Oregon, we’ve done a really good job at ensuring people have some form of healthcare,” Nelson said. “It’s 96% of Oregonians, and a big chunk of that is (the Oregon Health Plan). The Medicaid program in our state is something that’s envied by many states in the country.”

Last year, the state also began providing rental assistance through Medicaid, recognizing housing as a health need. 

“Trump and the Republicans at the federal level were using this really sneaky language, in my opinion,” Nelson said.

“They would say, ‘No, we’re not cutting Medicaid, we’re just cutting waste, fraud and abuse, and getting people off who don’t deserve it.’ To them, things like waivers, the provider tax to help keep rural hospitals open and expanding Medicaid to bring more people in, are waste, fraud and abuse.”

Tamie Cline, president of the Oregon Nurses AssociationIn a recent statement, the Oregon Nurses Association called out Rep. Cliff Bentz, the lone Republican in Oregon's congressional delegation, for voting in support of HR 1 – a move the union condemned as “disgraceful.” The Skanner spoke with Tamie Cline, president of the Oregon Nurses Association, and Scott Palmer, chief of staff for ONA, to discuss the new risks to healthcare access, and how Medicaid recipients might prepare.

This interview has been edited for length and clarity. 

The Skanner: Broadly speaking, what can Oregonians expect with these cuts to Medicaid funding?

Tamie Cline: OHP currently covers 1.4 million people, that includes children, seniors, people with disabilities, but it also includes working adults across the state, those that don’t make enough income to just out and out buy expensive insurance. 

Among the people at risk are 300,000 children that are currently enrolled in the Oregon Health Plan. And it’s not just that the children would lose it, it’s that if their parents were to lose it or fall behind on the reporting requirements, the child would lose it. And 200,000 adults with disabilities rely on it, and many of those are on limited incomes. So just that added bureaucracy and the cuts to the home- and community-based services could be detrimental

In Eastern Oregon, 65% of the people are on the Oregon Health Plan and so half of Oregon’s hospitals are already operating in the red, and the report that just came out (of at-risk rural hospitals), and Silverton Hospital, Providence Seaside Hospital, St. Charles Madras and Good Shepherd Medical Center in Hermiston, where I work, are those most likely to shut down entirely because of the loss of the Medicaid funds. So this isn’t just a health crisis issue, it’s a threat to the survival of our local community.

Just because you lose medical coverage, doesn’t mean you don’t get sick.

I work at a hospital that has a lot of Medicaid and Medicare, and I also have a lot of low-income, so we have people that come into the hospital but wait for their treatment. So a simple foot diabetic ulcer turns into an amputation because they don’t seek care soon enough. When they drop the insurance, people are going to come in in excruciating pain with no other choice, but they’re going to wait until their pain is completely out of control, or they’re going to wait til a simple pregnancy that would be an easy delivery becomes an emergency c-section in the middle of the night.

The Skanner: You recently spoke with Rep. Cliff Benz about the bill?

Cline: I went to the capitol as a matter of fact (two weeks) ago, and talked with Rep. Cliff Benz about the bill and about what exactly it was going to do to Oregon. He’s very aware of the numbers that it will affect. He repeated them to me, as a matter of fact.

He’s also very aware that he doesn’t care. He said to me that this was a big ugly mess, and that nobody in the room knows what’s actually in it, but that this is something that needs to be done...And I told him, if there’s Medicare and Medicaid fraud, we need to explore that. This is not the way.

This is the largest attack on healthcare ever in the history of the United States. 

Scott Palmer, chief of staff for ONA
Scott Palmer: This is so important for people to remember: Medicaid and Medicare isn’t a benefit that you get paid. It’s not like unemployment insurance. Medicaid and Medicare pays directly for services. So if I’m getting chemotherapy and I can’t afford my own health insurance, the government provides resources for that. The only way for the government to save money on Medicaid and Medicare is to stop people from getting services. The only way we’re going to make these savings is if we refuse to give people care they need. And I don’t think people understand that. I think they think it’s fraud.

We know that a lot of people on the right and Republicans who supported this bill were saying the only people who are going to lose their healthcare are illegal immigrants. It’s completely fact-free. 

The Skanner: How do you see these cuts impacting nurses and other frontline workers?

Cline: Number one, I believe that moral injury will increase. The definition is doing something you have to do that you know morally is wrong to you. So, during Covid we were not allowed to touch. A lot of us had to choose between patients – who was going to survive and who was not going to survive. And so it was a moral injury, because morally a nurse wants to save everyone. But when you have to make that decision, it becomes a moral injury.

When we start to look at people losing their insurance, coming into the hospital sicker. We’re extremely short-staffed because a lot of our nurses and healthcare providers actually left the bedside during Covid and they haven’t returned. We’re already working as a shorter staff, with sicker people than the pre-covid because we’re still taking care of a population that has not completely recovered because we have Covid every year now.

Imagine the influx of those people who can’t be seen in a clinic that's no longer there, they have to travel outside the areas they live, you put them in an emergency room and they’re waiting 24 hours to be seen, and the family starts getting angry and the anger starts to escalate – who’s going to be the one that’s on the other side of the anger? It’s going to be the healthcare provider.

The Skanner: What can Medicaid recipients do to prepare?

Palmer: The first thing is to remember that a lot of these changes are not going to happen immediately, that the bill has some staggered rollouts.

Some of the worst implications of this bill are things like funding for ICE.

And we’re likely to see some of the most horrific aspects of the bill not related to healthcare rolled out first. We know that some of the implications for Medicaid, might not happen for 18 months until after the midterms.

So it’s important to really make sure, number one, if you are getting coverage through the Oregon Health Plan, really make sure that your contact information is up-to-date. Keep your eyes open for renewal letters, make sure that you respond immediately to anything you get in the mail that’s regarding coverage or paperwork. 

Talk to your healthcare provider now. Find out if your clinic, particularly in rural areas, is expecting to see any changes in services due to the bill. Start to really think about where your nearest hospital or clinics are, in addition to the one you go to now. Start considering, what would your family’s plan would be if your local hospital or emergency room were to be closed. Where would you go? How long would it take to get there?

Make sure you have copies of your medical records. If you have a clinic that might shut down or the services might change, it could be difficult to get access to your medical records. 

And then start now really telling your story. It’s important. 

The Skanner: How do you mean?

Palmer: A lot of people are unaware of the impacts or elements of the bill, so now is a really good time for people to say, look, I have a kid who’s autistic, I have a kid who’s reliant on the Oregon Health Plan, I have grandparents that are in nursing homes that are likely to close. 

Just because people aren’t watching the news, they may not know about the changes to Medicaid, so really telling your story now and letting people know about what the implications are will really help raise the stakes and raise awareness, and will allow people to start applying pressure to their local and elected officials to make the changes we need at the state level, and to apply pressure at the federal level.

Personalize it, how is this going to impact you? Telling people on social media, having conversations, it’s so important for people to just really get their heads wrapped around what the implications of this bill are going to be.