The California Medical Association (CMA) and a coalition of 9 other state medical associations have joined together to oppose the Republican Senate health care reform bill, the Better Care Reconciliation Act of 2017 (BCRA). CMA and the other associations are concerned that the Medicaid funding cap and inflation index would not keep pace with rising costs beyond physicians’ control. The California Department of Health Care Services estimates that the Senate bill would cut California’s Medi-Cal program by $114 billion.

"The proposal places an untenable burden on state budgets and an uncompensated care burden on physicians who are on the frontlines caring for these patients every day," the coalition wrote in a letter to Senate leaders. "We need Congress' help to better care for our patients."

The coalition has offered to work with Congress to improve our health care system and ensure access to high-quality, affordable care and coverage.

The BCRA would convert federal Medicaid financing to a per-capita cap or a block grant beginning in 2020. It sets the total medical assistance expenditures for a state as the sum of the per-enrollee amounts for the elderly, people with disabilities, children and pregnant women. Under the proposed per-capita cap, the base-year expenditure amount is based on spending between January 2014 and September 2017. The per-enrollee per-capita amounts would increase by medical Consumer Price Index (CPI) for adults and children, and medical CPI plus 1 percent for the elderly and people with disabilities for 2020-24. In later years, the inflation index is reduced.

This financing formula would result in a more than 3 percent cut to Medicaid every year. In only five years, the cumulative cut could total more than 15 percent.

“These inflation-based Medicaid growth rates are unsustainable for states and physicians. States cannot absorb these tremendous costs," the coalition letter said. "They will be forced to reduce physician payment rates that already are 50 percent less than Medicare rates in many of our states. Access to care is a challenge for Medicaid patients now, and this proposal will only make it worse.”

Rather than imposing across-the-board funding cuts, the coalition urges the Senate to consider alternatives to promote efficient Medicaid models of care, such as medical homes, that more effectively address rising health care costs and better address patient needs.

Other cosigners of the letter include the state medical societies of Arizona, Florida, Louisiana, New Jersey, New York, North Carolina, Oklahoma, South Carolina and Texas.