Graphic via Shutterstock / Courier Graphic via Shutterstock / Courier

The viral video of an ER doctor confronting the vice president shines a spotlight on just who will be affected by cuts to the largest public insurance program in the U.S.

Last Thursday, the Trump administration released a new guidance to allow states to use waivers and block grants to cut federal funding to Medicaid. Hours later, a Michigan doctor got the rare opportunity to let a prominent member of the administration know how he felt about the change.

The new initiative, named the Healthy Adult Opportunity, aims to curb federal spending. Critics, however, say giving states the opportunity to adopt a different funding method that caps spending instead of sticking with the current reimbursement model will ultimately reduce access to quality and affordable health care for patients.

In the video that came out Jan. 30, Dr. Rob Davidson, an emergency department doctor in western Michigan, is seen confronting Vice President Mike Pence about the new initiative.

“I’m an emergency doctor. I’m worried about the plans [Trump] talked about last week to maybe cut Medicare, and then the rollout today of cutting Medicaid,” said Davidson, who also serves as the executive director for the Committee to Protect Medicare. “I work in one of the poorest counties in Michigan and my patients depend on expanded Medicaid, so how is that going to affect my patients?” 

Pence tells Davidson that he hadn’t heard about the cuts to Medicaid. After explaining the new rule to the Vice President, Davidson asks if it was a good idea. Instead of answering, Pence pivoted to a talking point about how Indiana expanded Medicaid while he was governor. 

Davidson keeps pressing Pence about how the cuts in funding would harm the more than 650,000 Michiganders who receive coverage through Healthy Michigan, the state’s Medicaid expansion program.

“People I see in the emergency department that can’t get primary care doctors, once they got Medicaid they could get primary care doctors. They stay out of the ER, they actually work more, they actually contributed to our community more,” Davidson says. “Now, if you tell those people, ‘Sorry, you don’t get your health care’—that’s going to be a real negative in their lives.”

The conversation continues into a second video, where Pence again deflects into his record as governor of Indiana. In response, Davidson reiterates how important the program is for beneficiaries. 

“It’s been a godsend to the patients I’ve served in one of the poorest counties in the state of Michigan,” Davidson says. 

After pivoting to the classic Republican talking point about state’s rights and “innovation” and “flexibility,” Pence ultimately tells Davis he disagrees with the doctor’s opinion—which was less an opinion than a fact. 

The video, which has since garnered more than three million views on Twitter, shines an important spotlight on Republicans’ ongoing attacks on Medicaid, an issue that is particularly salient in Michigan. In 2014, Michigan expanded Medicaid through the Affordable Care Act, and Healthy Michigan now provides coverage to 654,249 beneficiaries. Just last month, however, the state implemented work requirements, which will affect more than 238,000 of those beneficiaries. The new law targets people between the ages of 19 to 62 whom the state considers able-bodied enough to work. 

Those Michiganders now risk losing their coverage if they don’t work, volunteer, go to school, or provide a valid reason why they cannot. The Michigan Department of Health and Human Services (MDHHS) estimates that the rule will cause more than 100,000 Michiganders to lose their Medicaid coverage. 

“It’s been a godsend to the patients I’ve served in one of the poorest counties in the state of Michigan.”

The work requirements have been criticized by patient advocacy groups who argue that forcing people to work to retain their health care will only harm them. 

“People need health care to be healthy enough to work in many cases, and once people have their health needs met, then they can become a productive member of society,” Linda Jordan, an attorney at the Flint-based Center for Civil Justice, told COURIER. 

A new study from the University of Michigan’s Institute for Healthcare Policy and Innovation supports Jordan’s claim. Researchers from the University of Michigan’s Institute for Healthcare Policy and Innovation conducted two surveys of more than 3,100 people with Healthy Michigan coverage and found that an additional 6 percent of Medicaid beneficiaries reported working or going to school by the beginning of 2018 in their second survey, about a year after they were first interviewed.

Together, the work requirements and the new block grant proposal could lead to massive losses in coverage in Michigan. The work requirement is the subject of an ongoing lawsuit, and Jordan expects the Trump administration’s block grant proposal to face legal challenges as well.

Jordan also said the block grant proposal was emblematic of Trump’s other attacks on the healthcare system and the social safety net at large. 

“It’s just been one attack after another. They attacked food assistance, they attacked health care, they attacked social security,” Jordan said. “I think this is the latest attempt to undermine our current system and take health care away from people who really need it.”

She also said she was heartened by Davidson’s video, and hoped it was the start of a larger public dialogue to increase the spotlight on this issue.

“More people need to follow Dr. Davidson’s example and really ask these questions.”