Letter to District 12: Week of 12/30
Friends,
The New Year is a time for reflection and renewal. We choose to leave behind what no longer serves us, and find new ideas to address our challenges. One of the biggest challenges facing Delaware right now is Medicaid funding cuts. These cuts threaten our financial well-being and the quality of our healthcare. I wanted to share more about what is happening, how it affects all of us, and what we can do together.
Medicaid is health insurance that provides coverage for people who couldn’t otherwise afford it. Delaware will spend $1.1 billion on Medicaid this year, out of a $6.5 billion operating budget. (1) Costs increase every year. The federal government gives us over $2 billion annually to keep this system afloat.
As life becomes less affordable and good jobs become harder to find, more people are relying on Medicaid. The federal answer to this was in the “One Big Beautiful Bill” – the federal plan is to decrease costs by disenrolling people who can’t fulfill work requirements, while making the requirements too difficult to attain for people who are already struggling. Exemptions for disability are vague and undefined.
This bill cuts almost $1 trillion from Medicaid over the next 10 years. Delaware stands to lose between $3 - $5 billion of federal funds – about half of our annual operating budget. More than 50,000 Delawareans will lose their coverage. (2)
This is a big problem. In Delaware, Medicaid pays for 43% of all births, insures 39% of our children, and funds 54% of nursing home care. Medicaid is the largest funding source for mental health and substance use services. (3) Many rely on Medicaid for preventative and primary care. If we get this wrong, people will suffer and the financial impact will threaten even further tax increases.
You may be asking yourself – especially if you have a good job and health insurance - if this really affects you. It does. Here’s how:
• Hospitals will become overcrowded. A doctor cannot discharge a patient without a safe discharge plan. Often, that requires a specialized facility like a rehabilitation or nursing facility, or even another hospital entirely. These are largely paid for with Medicaid funds. Without these funds, people will get stuck in the hospital. Increased costs will ultimately go to the taxpayer, one way or another. Access to your doctors will decrease – even for those with health insurance. Overwhelmed healthcare staff will become more prone to mistakes when they deliver your care.
• We will end up spending a lot more money. It costs more to treat an illness than to prevent it, and people without coverage cannot access preventative care. Without mammograms, we miss cases of breast cancer. Cuts to PrEP coverage will increase HIV transmission rates. Untreated high blood pressure can lead to strokes and permanent disability. Poorly managed diabetes can lead to amputated limbs and failing kidneys. All of these consequences are more costly to manage, and devastating for the person suffering them.
• Some of our hospitals may close. Many of Delaware’s hospitals operate on a shoestring budget already. Hospitals may be forced to close or cut services.
So what are we going to do about this? Some things are already being done:
• Governor Meyer applied for up to $1 billion in federal funds to transform rural health in Delaware. This is a good start. It won’t cover everything though, and it relies on the Trump administration looking favorably on Delaware – let’s not hold our breath.
• The Delaware Health and Social Service (DHSS) Medicaid office is implementing three reforms to keep people enrolled. These include improvements to the online sign-up portal (ASSIST), development of an “ex parte” system where DHSS can keep people auto-enrolled, and the development of a work program that meets eligibility requirements.
• The Protect Medicaid Act of 2024, sponsored by then-State Sen. Sarah McBride, imposes a tax on net revenues from hospitals with the intent to increase federal dollars received. This is a good thing.
I will bring ideas that will directly improve delivery of care. Here are a few:
• We need to aggressively fund preventative care. We will become more efficient, we will be healthier, and we will save money. As one example, I will introduce legislation to fund statewide HIV preventative services, including PrEP, if and when federal funding is cut. Each prevented case of HIV infection saves Delaware between $500,000 to $1.2 million in lifetime costs. (4)
• I will introduce legislation that protects funding to Planned Parenthood of Delaware. Planned Parenthood provides primary and preventative care services, including testing and treatment for sexually transmitted infections, cancer screenings, and mental healthcare. Planned Parenthood is now banned from taking any Medicaid funds, even though none of these funds can go to abortion care to begin with. They are trying to shut them down for good, and we cannot let that happen.
• The Delaware Healthy Mother and Infant Consortium (DHMIC) has made great strides in reducing infant mortality rates over the last twenty years. We need fresh data on infant mortality in light of increasing social inequity. Delaware needs to be a safe place to have a baby, and that will require access to prenatal, perinatal, and postnatal care. This includes mental healthcare.
• I will introduce legislation that affirms that psychiatric hospitals are specialty hospitals under federal EMTALA law, which will compel them to accept patients regardless of their psychiatric acuity or housing status. This will get people the care they need faster, keep our communities safer, and reduce patients boarding in our emergency rooms and hospital wards while reducing costs to Medicaid.
• The language Delaware uses in its healthcare policies – which ensure we comply with CMS and Medicaid regulations – needs updating. This language is sometimes keeping people stuck in hospitals, costing the taxpayer money, and preventing our doctors from getting people the care they need. I’m going to partner with the right people and get that fixed.
As Delaware faces these critical funding cuts, it will be important to have a physician in the General Assembly who knows how healthcare is delivered. My entire career has focused on delivering world-class care in an increasingly complex healthcare landscape. We can do more with less, and we can increase access while decreasing costs.
I would be honored to represent District 12 as Delaware’s only elected physician. Now more than ever, it’s time to send a doctor to Dover.
Until next time,
Dr. Rob Bahnsen
Candidate for State Representative, District 12
PS - If any of you need help signing up for Medicaid, please call us! We can direct you to the right people. You can start with Delaware ASSIST, which is a one-stop shop for many services including Medicaid.
https://assist.dhss.delaware.gov
References
(1) Delaware’s Fiscal Year 2026 Budget - https://budget.delaware.gov/budget/fy2026/index.shtml
(2) “‘Stretched thin’: Medicaid cuts threaten Delawareans’ access to health care in rural areas” WHYY article - https://whyy.org/.../delaware-rural-health-care-medicaid.../
(3) “Medicaid is Vital to Delaware” Fact Sheet - https://ccf.georgetown.edu/.../Medicaid-is-Vital-to...
(4) “A public health and economic case for HIV care, treatment and prevention” Fact Sheet - https://www.hivma.org/.../public-health-and-economic...