During an unscheduled campaign stop Thursday in Iowa, an emergency room doctor confronted Vice President Mike Pence about Medicaid cuts and said they will put his patients' lives at risk.
Dr. Rob Davidson, who is from Michigan, asked the vice president about cuts to Medicaid that were announced Thursday and how they would affect patients. "I'm an emergency doctor. I'm worried about plans they talked about last week about maybe cutting Medicare and then the rollout today of cutting Medicaid," he said.
"I work in one of the poorest counties in Michigan, and my patients depend on expanded Medicaid. So how's that going to affect my patients?" Davidson asked.
Davidson, who is the executive director of the Committee to Protect Medicare, was referring to the Healthy Adult Opportunity, which was announced by the federal Centers for Medicare and Medicaid Services (CMS). According to a press release, the initiative is "designed to give states unprecedented tools to design innovative health coverage programs tailored to the unique needs of adult beneficiaries, while holding states accountable for results and maintaining strong protections for our most at risk populations."
Eagan Kemp, a health care policy advocate for Public Citizen, a nonprofit consumer advocacy organization, called the initiative a "nefarious program."
"Even after promising numerous times not to cut Medicaid, Trump's plan will ensure that many working families who are currently covered by Medicaid will face cuts to their services, wait lists for needed care, and the risk of medical debt and bankruptcy from trying to pay for illness," Kemp said in a statement.
In their encounter in Des Moines, the vice president told Davidson he hadn't heard about the plan. The doctor later tweeted: "When I told him he is putting my patients' lives at risk, @VP deflected and denied knowledge of the policy."
"The head of CMS announced the plan to let states file for waivers so they can get block grants," Davidson replied to Pence. "So that would essentially cut the amount of money going to the states. So it would cut federal Medicaid funding. Is that a good idea?"
Pence said that the Obama administration gave Indiana a grant when he was governor to expand Medicaid coverage.
"Right, but now they're talking about scaling back the Medicaid expansion that we got with the Affordable Care Act, and 680,000 Michiganders, 600,000 in Iowa, a lot of people got health care," Davidson said.
When Pence said he thought Davidson was oversimplifying things, Davidson responded that whether his patients can get coverage is what matters most. "People I see in the emergency department that can't get primary care doctorsonce they got Medicaid, they can get primary care doctors. They stay out of the ER," he said. "They actually work more. They actually contributed to our community more. Now, if a couple people telling you, 'You can't get your health care,' that's going to be a real negative in their lives."
In another video, Pence suggests following a model that he used when governor of Indiana. "We expanded coverage. We used consumer-directed health care. People were able to take more ownership of their own health care and expand it," he said. He also said that Medicaid has a lot of problems that need to be improved.
Speaking of Medicaid, Davidson told Pence, "It's been a godsend to the patients I serve in one of the poorest counties in the state of Michigan. It's their lifeline."
"I think our provision is for state-based innovation and reform to improve opportunities," the vice president responded.
"Reform and innovation in the setting of cuts equals less people with health care," Davidson said, but Pence disagreed. The doctor told him, "I encourage you to make sure we don't cut those folks off of Medicaid, because they need it."
Davidson told Newsweek that he wanted to tell the vice president what kind of impact he saw these changes having on his patients.
"Anytime you take money out of a system upon which so many people depend, you have to wonder, if no one is making up the difference, you're either going to cut people from the rolls of Medicaid or you're just going to have more cost-sharing for those individuals," Davidson told Newsweek.
He continued: "The folks I take care of are folks [like] a mom who brought her kid in at 3 in the morning with an ear infection, because they have one vehicle between three families and that was the only time it was available. These are folks living so much on the margin, and a difference of 50 to 100 bucks for them equals not having access to any health care. I wanted to make sure he understood what these kind of changes mean."
Davidson said the block grant plan gives states much leeway to cut people from their Medicaid rolls, to increase co-pays or to get rid of transportation for non-emergency-type visits, such as those for chemotherapy or physical therapy. "It just has honest-to-goodness real world impact on the front lines where I work," he said.
The White House did not immediately respond to requests for comment.