Los recortes propuestos a Medicaid podrían afectar seriamente a los hospitales y a los trabajadores de la salud de Nueva York. El presidente Donald Trump y los republicanos del Congreso están proponiendo recortes por 880 mil millones de dólares, poniendo fin al acceso a la atención médica de alrededor de 73 millones de estadounidenses. Más de una cuarta parte de los neoyorquinos utilizan Medicaid como seguro. Amy Lee Pacholk es enfermera de cuidados críticos de cirugía y traumatología en el Hospital SUNY Stony Brook. Ella dice que perder estos fondos significa que los hospitales no pueden mantener niveles adecuados de personal para atender a los pacientes.

"A menudo se toman atajos con la dotacion de personal. Durante mucho tiempo, hemos estado trabajando para lograr estándares mínimos de personal y proporciones seguras de pacientes para que las enfermeras puedan cuidar a los pacientes en entornos seguros tanto para ellas como para los pacientes," Pacholk dijo.

Pero, según un informe de la Asociación de Enfermeras del Estado de Nueva York, entre enero y octubre de 2024, los hospitales no dotaron de personal a las unidades de cuidados intensivos y a los pacientes de cuidados críticos en las proporciones exigidas por el estado más del 50 por ciento del tiempo. Estos recortes pagarán la extensión de los primeros recortes impositivos de la administración Trump. El Instituto de Política Económica señala que los planes de salud del mercado privado pueden costar a las familias un 20 por ciento más que sus ingresos anuales.

En todo el estado, los hospitales proyectan márgenes operativos de 0,0 por ciento. Aunque es una mejora leve, es insuficiente para que los hospitales puedan manejar la atención al paciente. Pero las bajas tasas de reembolso de Medicaid son responsables de los problemas financieros de SUNY Downstate. El 90 por ciento de los pacientes del hospital utilizan Medicaid o no tienen seguro. Pacholk dice que debido a la estructura de reembolso, el hospital no ha recibido lo que le corresponde.


"Solo por la población que va allí no significa que deban cerrar la institución. Simplemente significa que debes facilitar el flujo de dinero de una manera diferente para seguir sirviendo a las personas que viven en la comunidad," explicó Pacholk.

Parte de la propuesta de recorte de Medicaid implicaría agregar requisitos laborales al programa. Pero esto es parte de una idea errónea común sobre los usuarios de Medicaid: que no funcionan. Pacholk dice que estos programas son demasiado importantes como para recortarlos en aras de un recorte presupuestario al estilo de tala y quema.

"¿No es por eso que pagamos impuestos? ¿No es por eso que pagamos un seguro de Medicare? ¿No es para proteger a las personas o para ayudarnos en el futuro si algo sucede y nos volvemos economicamente indigentes? ¿No es ese el motivo? ¿No es el objetivo ayudar a la gente aqui? ¿Por que tenemos que quitar cosas que realmente ayudan a la gente?", se pregunta la enfermera.

About 1.3 million Missourians are currently enrolled in Medicaid and nonprofits around the state have warned proposed federal cuts would be devastating.

In Missouri, children are the largest group served by Medicaid, with 61% enrolled. States could face more than $800 billion in Medicaid cuts and more than $200 billion in the Supplemental Nutrition Assistance Program, known as SNAP or food stamps.

McClain Bryant Macklin, vice president of policy and impact for the Kansas City nonprofit Health Forward Foundation, emphasized how important Medicaid is to the organization.

"From a policy perspective as well as where we tend to lend our funding support is squarely in that direction, and Medicaid access has been our primary policy issue, really since our inception," Bryant Macklin explained. "It's just our number one priority."

Supporters of the cuts argued Medicaid is inefficient because of waste and fraud, and restructuring or reducing funding could improve sustainability.

Bryant Macklin noted the Health Forward Foundation played a key role in advocating for Medicaid expansion in Missouri, contributing to policy changes which extended coverage to thousands of low-income residents. She stressed as a Medicaid expansion state, Missouri will need to find funding from other critical sources, which could result in further challenges.

"State legislators are going to be forced to -- and administrators forced to -- find those dollars elsewhere," Bryant Macklin pointed out. "That elsewhere will be from other key social services that folks are relying upon and that the state has grown accustomed to receiving that federal support."

Those in favor of the cuts said they would give states greater control over Medicaid through block grants, which are fixed amounts of federal funding states can use with more flexibility, to tailor programs to local needs and priorities.

Indiana is losing millions in public health funding as the federal government cuts grants for state and local programs.

In Marion County, officials confirmed the immediate loss of a $450,000 immunization grant, leaving employees searching for ways to continue vaccination efforts amid ongoing disease outbreaks.

Dr. Virginia Caine, director and chief medical officer for the Marion County Health Department, highlighted the cuts during a town hall hosted by Rep. André Carson, D-Ind.

"We are now seeing that they've cut all state and local health departments budgets," Caine explained. "We have to be very concerned about our ability to protect the public."

Caine noted the federal government eliminated $13.1 billion in funding for state and local health departments, part of a broader rollback of pandemic-era grants. Indiana Department of Health legislative director Rachel Swartwood recently commented the state's goal is to ensure no direct services to Hoosiers are interrupted.

State health officials estimate Indiana will lose about $40 million because of the cuts. Additionally, the U.S. Department of Health and Human Services recently announced plans to eliminate 10,000 full-time jobs. The totality of the cuts is very concerning for Caine.

"When we had this fentanyl epidemic with overdoes -- we have the bird flu taking place across this country -- we have to be concerned," Caine emphasized. "Do we have the workforce to come out and meet these demands?"

Marion County officials are evaluating how to fill the funding gap. Caine added the department has 300 positions supported by grants and expressed concern job losses and service reductions could follow if no alternative funding emerges.


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Oregon does not have enough health care workers and the need continues to grow.

Service Employees International Union Local 49 members said retention is a key cause of the shortage and they are lobbying for two bills in Salem to improve job quality across the industry. Over the next 10 years, health care and social services will need to bring in nearly 225,000 workers, according to the Oregon Employment Department.

Matt Swanson, political strategist for SEIU Local 49, said meeting the growing demand will take every possible intervention.

"I heard from many workers about how tired they are," Swanson reported. "How difficult it is to provide quality patient care when there just aren't enough people working."

One bill at the top of the union's priority list would address unchecked workplace violence, which health care workers experience at a higher rate than any other industry. Another would expand funding to allow providers to continue to work while going to school for advanced training.

Felipa Nesta, a licensed practical nurse at Kaiser Permanente, is using existing funding to get a nursing degree while working. She said Senate Bill 27 would help meet the growing demand for health care providers by increasing funding for such programs as well as providing wage replacement, child care, and transportation.

"It would help so more people can get into health care jobs without being buried in debt," Nesta emphasized.

Rachel Dennis, a certified nursing assistant at PeaceHealth Sacred Heart Medical Center, said Senate Bill 537 mandates de-escalation training as well as systems to notify providers of potentially violent patients. It also guarantees counseling and paycheck protection for injured employees. She noted nearly all her coworkers have faced verbal or physical assault on the job.

"I'm tired of seeing my coworkers leave because they're scared to go to work," Dennis stressed.

Both bills have had public hearings and are scheduled for work sessions in Salem.