Delaware can't afford the Medicaid penalty in the Reconciliation Bill. Here's why | Opinion

• A proposed Senate bill would penalize states offering Medicaid coverage for outpatient dialysis for undocumented immigrants.
• Outpatient dialysis is more cost-effective than emergency dialysis, saving taxpayer money.
• The proposed penalty would increase healthcare costs and strain emergency rooms.
• The authors urge Congress to remove the penalty from the bill.

The U.S. Senate is considering a Reconciliation Bill that would reduce the federal Medicaid match from 90% to 80% for states that cover certain healthcare services for undocumented immigrants. While this may sound like a way to cut federal spending, in reality, it will increase healthcare costs, strain emergency rooms, and make healthcare worse for Delawareans and Americans across the country.

Outpatient dialysis costs about $90,000 per year. Emergency inpatient dialysis can exceed $300,000 annually due to complications and hospital stays. That extra cost falls on hospitals, state budgets, and ultimately, you, the taxpayer. That’s why 20 states, both Democratic and Republican-led, have chosen to provide outpatient dialysis through Medicaid. It’s not about immigration policy. It’s about saving money, improving public health, and relieving pressure on already overburdened emergency rooms. In short: it’s not done as a gesture of generosity, but because it is fiscally responsible.

Patients with kidney failure need dialysis three times a week to survive. Undocumented people typically can’t access private insurance or Medicaid. That doesn’t mean they go without care; it means they show up in emergency rooms when their condition has become life-threatening. Under federal law, hospitals must treat anyone in an emergency, regardless of their immigration or insurance status. So, these patients receive emergency dialysis in hospitals, but only after they’ve become critically ill. This approach isn’t just less humane; it’s much more expensive.

The proposed Medicaid penalty would make it harder for states like Delaware to provide this more efficient care. It would push states back into relying on the most expensive, least effective form of treatment. This means higher healthcare costs, increased strain on emergency rooms, and longer wait times for all patients—including American citizens.

The Senate must remove the Medicaid penalty from the Reconciliation Bill

Delaware isn’t a high-immigration state, but we are still responsible for the health and safety of everyone who lives here. And we have a duty to spend tax dollars wisely. This provision in the bill undercuts both goals. Immigration enforcement is a separate issue and should remain under federal jurisdiction. However, denying states the tools to deliver the most cost-effective care to people who are already here doesn’t fix immigration; it just makes our healthcare system worse for everyone.

We urge Congress to remove this Medicaid penalty from the Reconciliation Bill. States and ultimately their residents should not be punished for choosing the most fiscally responsible and medically sound path forward. When it comes to dialysis, ensuring access to and coverage of outpatient care is the right thing to do for our communities, our hospitals, and our state budgets.

Dr. Neil Hockstein is chair of the Delaware Health Care Commission. Matt Meyer is the 76th governor of Delaware.