Medicaid info town hall by Pennsylvania state Rep Kosierowski.
I listened to the whole thing in case you can't or don't want to. (Voila, you can thank me later!)
I watched the entire 2 hour town hall livestream hosted by my state representative Rep. Bridget Malloy Kosierowski, who prior to becoming a politician worked as a Registered Nurse.
Kosierowski Hosts Hands Off Our Health Care Town Hall - Pa. House Video - March 10, 2025 Pa. state Rep. Bridget M. Kosierowski will host a “Hands Off Our Health Care" Town Hall to discuss the grave possibilities Pennsylvanians may face with possible federal cuts to Medicare and Medicaid.
Here’s what I heard:
Linda Thomas-Hemak is an actual doctor who runs a local clinic center, said she gets through the day by having faith that these are essential services and cannot be cut. Dr. Thomas-Hemak also said what would happen with healthcare in northeastern Pennsylvania with the medicaid cuts proposed at that size, it would be "an absolute acute crisis like nothing we've ever had before in healthcare" and "a bigger crisis than any other crisis". She mentioned that 50% of America's children are insured by the Medicaid system. She later repeated that the people in DC "work for us" and they simply cannot cut essential services paid for by taxpayer dollars, because it’s needed.
Linda Thomas-Hemak was perhaps not believing that it could happen at the level of cuts they're proposing, or perhaps she seemed concerned with people being overwrought, so some of this may have been elite panic where people in positions of leadership start worrying more about quelling consternation over allowing people to react appropriately to a crisis. Because I don't see any evidence that anyone in DC cares that it can't happen, they're doing lots of things that really can't happen. We’re staring down a Recession and the American president when asked just basically shrugged and said to expect a “period of transition” and then the stock market plunged 900 points. I don’t think anyone should rule anything out just because it’s imprudent or impossible.
Maria Montoro Edwards was at the town hall speaking about Maternal and Family Health Services in Scranton. This is a clinic that does gynecological, and primarily prenatal and postpartum care for a variety of patients in various circumstances. They had a patient who was willing to also speak at this town hall and describe the services received. Maria Montoro Edwards mentioned how the reimbursement is so low and so complex to get from the managed care healthcare systems (privatized Medicaid), and they operate on razor thin margins.
Also at this town hall speaking was Joe Hollander, not a doctor, as I've noticed this guy before quoted in the news. In this case he was talking about things within his purview, the financials and insurance issues that the Scranton Primary Care clinic deals with. He made a point of mentioning the serious situation of covid and "the ending of the covid Public Health Emergency and medicaid unwinding affected Scranton Primary dramatically", and "the uninsured population swelled by 26%" and negatively affected the clinic's finances. Joe Hollander said that patients ought to reach out to representatives and tell them if they're relying on Medicaid and essential services. He said everyone wants fraud waste and abuse to stop but that none of that is happening at anywhere near the numbers that have been proposed. He said: "Enough with the shock and awe, we need to stand up and say we can't have these programs cut, before they start to become matter of fact conversations."
James Cooney spoke representing Allied Services Integrated Health System – a local not-for-profit system providing skilled nursing rehabs, nursing homes, assisted living, independent living, home healthcare, community services, and end of life care. He reported that 1,000 out of their 5,000 patients, residents, and clients have services paid by Medicaid. He said that 1/3 of the services Allied provides are funded by the Medicaid program. 98% of mental health program recipients are Medicaid recipients, and 95% of the people in developmental disability programs are Medicaid recipients, and 77% of residents in nursing home are Medicaid recipients. He tried to dispel the myth that skilled nursing is paid by Medicare, but that's only for short-term needs, and Medicare does not cover long term stays, that's where Medicaid comes in. He explained that if you take all the costs of care that a skilled nursing facility has, for employees, food costs, utilities, pharmacies, bed linens, equipment repairs, and other things, that all goes into the cost of care, just 83% of what it takes to pay for that, is paid for by Medicaid, meaning that they run a deficit because of the reimbursement level not keeping up in Pennsylvania. He reported that Allied Services has a minimum wage floor of $15 per hour for all employees – that's over double the federal minimum wage (there's no other minimum wage in Pennsylvania), and he reported that since the pandemic they've had staffing shortages. So they're already in a problematic situation, and any cuts would be a huge impact, and that existing access issues and facility closings will ramp up.
PA state representative Kyle Donahue pointed out that many people don’t know the Medicaid program is called "Medical Assistance" in Pennsylvania, so many people who have Medical Assistance have no idea that they are Medicaid recipients and that Medicaid cuts will impact their Medical Assistance insurance. And he repeated that there’s a myth that many people assume Medicare or private insurance pays for a lot of long term care, and that's not the case, it's Medicaid.
PA representative Jim Haddock said when he went to Harrisburg he was surprised to find the biggest issue needing to be dealt with is "the healthcare state not only in Pennsylvania but across the country". He pointed out that a judge who was appointed by Ronald Reagan blocked healthcare cuts that were ordered by the White House.
Jim Haddock said that "we don't even know what cuts are coming", and that fear of the unknown means that the University of Pittsburgh put a proactive pause on student enrollment for medical and scientific research. He said unfortunately the university "is making a business decision" because of fear of the unknown. And he mentioned the "big beautiful bill" will affect people's lives and health and he's worried about people getting booted out of nursing homes - something that has happened in our area not too long ago when a nursing home went under financially. And that this is happening while tax cuts on billionaires are on the table. He also brought up the Ireland Potato Famine in relation to a question from the audience about this being a moral issue with politics, and he said he agreed that it's a moral issue.
Someone in the audience started trying to lecture about the Affordable Care Act doing Medicaid expansion and called it confiscating or stealing or some libertarian buzzword I didn’t want to rewind to hear again frankly. He blamed Obamacare as being responsible for all the Medicaid problems. Someone else will have to make sense of his litany of claims, because no, I didn’t understand it. He said: "We don't have the money to fund a lot of these things." I don’t know what he thinks is the alternative? And like so many people who throw that out there — that we just can’t afford to have a humane functional society — he refused to mention the elephant in the room – the billionaire tycoons who have more wealth than anyone could ever use and how they pay less of their wealth in taxes than most people do. Linda Thomas-Hemak responded saying she thinks there has to be Medicaid reform, but she said cutting off people from healthcare is what's going to bankrupt the country. Kosierowski pointed out how many lives have been changed and improved by the ACA and Medicaid expansion.
A member of the audience asked a question to Jim Haddock to clarify what he said about how nobody knows what the Medicaid cut levels will be — the person asked "So it's a state secret?" and then said that when they were in the military there was a term for what's happening, that they called it "a BOHICA moment, meaning Bend Over Here It Comes Again". Rep. Jim Haddock said he might use stronger language.
Another member of the audience mentioned being in a group that calls representatives every Monday. Perhaps they were referring to Mondays with Mccormick, which appears to involve the group Action Together NEPA.
One of the audience said that they were in an hour long zoom with 90 other constituents of Representative Rob Bresnahan last month talking a staffer who claimed Bresnahan would not vote to cut Medicaid, and then he did vote for the proposed cut. And she asked about the CHIP program, and Rep. Kyle Donahue confirmed that it would include cuts to the CHIP program. And I thought about how a lot of people don’t realize that the CHIP program is government funded either.
Kosierowski pointed out that when it comes to “fraud waste and abuse” there are people who steal in all sorts of businesses, and said that when people talk about fraud waste and abuse, it is misrepresented and people think it's the recipients doing something wrong, when in reality it's all perpetrated by businesses and healthcare providers, as happens in all areas of business and both public and private insurance.
There was a person from Duryea Pennsylvania, with a serious health condition that said she needed to show up even though it was very difficult for her because of her health condition, but she thought it was important to go there and plead to her fellow Americans. She asked everyone to consider – who do you want to not have at your Easter table because of cuts to Medicaid?
My personal story:
I utilized services from Maternal and Family Health Services when I needed non-pregnancy related, but necessary urgent healthcare while I was uninsured following the Great Recession over a decade ago. At the time my spouse had called various gynecologists offering to pay CASH UP FRONT for a visit, and we were turned down by a dozen different doctors over a 100 mile radius who refused to accept uninsured patients saying they didn't even want to start the process not knowing if I could pay for the tests or procedures I might need! So they didn't even want to evaluate the situation! It was shocking. So that's why I needed to go to Maternal and Family Health Services. So never assume that just because you have money you'll be able to access services. If the services go away because most of the funding for a particular hospital or healthcare facility comes from Medicaid, and Medicaid is cut – bye bye hospital! Facilities close all the time. I got an ACA marketplace plan in 2014 — I was employed at the time with the government, but without a health insurance benefit. And I now have had employer provided healthcare insurance for a decade, my own and I’m now retired and on my spouse’s employer plan. But after the Great Recession, it took several years for me to recover after having that economic rug pulled out from under me. Not the first time in my life, the economic rug pull happened to me when I was newly an adult in the early 1990s, and again in 2000 with the dot com bust. But the 2008 was the worst (so far) and my financial recovery after the 2008 financial crisis was because of government jobs, and albeit indirectly, the implementation Obamacare. So I take attacks on Medicaid expansion and the ACA very personally.
And I'm just sick and tired of hearing about how we can't pay for medical care for everyone, or maybe anyone. It makes no sense to me why you wouldn’t want a functional civilization that pools resources — this is the basis for the survival of the species to this point. It's a human right to partake of the healthcare possible in a civilized society. And it’s possible specifically because we don't need tycoons hoarding wealth and failing to pay their fair share after extracting everything from our society and using our services, our society’s public goods, our labor, and yet then still having the audacity of thinking they can appoint themselves as monarchs.
Healthcare, not kings, thanks.