County officials voice concern for SNAP, Medicaid amid reconciliation vote

Key Takeaways

Ahead of the Senate and House's budget reconcilliation votes, county officials from five states traveled to Capitol Hill June 24, to advocate against its provisions related to the social safety net programs.  

The bill will push new unfunded mandates related to SNAP benefits (which were fully federally funded for 60 years) onto counties, particularly in the 10 states where counties are tasked with administering the food assistance program. Roughly 14.6 million individuals receive SNAP benefits in those states, collectively representing 34.3% of total participants. 

Representatives from five out of the 10 states — Minnesota, New York, North Carolina, Wisconsin and Virginia — spoke to members of Congress on June 24 about the grave consequences the changes would have on their constituents and county budgets.

In Meeker County, Minn., about 20% of people are on Medicaid and 17% of households receive SNAP benefits. 

County costs related to the social safety net programs would increase by more than $1 million if the legislation is enacted, according to Meeker County Commissioner Steve Schmitt, one of those who traveled from his county to Capitol Hill.

“I was more than willing to set some time aside and get out to D.C. to let them know what our concerns are,” Schmitt said. “Because when you’re that far removed from the county government level, a lot of times they don’t know the impacts — whether that be through workload or direct financial cuts or adjustments — so, it was good to get out there and let them hear a voice … I think not being in the room would be a critical mistake.”

Schmitt said he was glad to have an opportunity to share how the provisions would negatively affect people in Meeker County.

“One of the meetings that stood out to me was we were talking about property tax increases, and one of the staffers said, ‘Why are you mentioning property taxes?’ They weren’t making the connection,” Schmitt said. “And it’s like, ‘Well, property taxes — that’s our only revenue source,’ so the light bulb went on at that point, and they realized more of the concern that we had, the urgency.”

The county would have to raise property taxes and/or cut existing funding for things such as upkeep to its 40 lakes and 10 county parks, along with events such as county fairs, to cover the additional costs, he said.

“Those good things that add to the benevolence of the community — that’s really our only other place, besides [increasing] property taxes, to cut,” Schmitt said. “And people will notice that quite quickly.”

Boone County, Mo. Commissioner Janet Thompson came to Capitol Hill to share with members of Congress how changes to Medicaid would impact her county, particularly the 17% of people who rely on the program. 

If the Medicaid provisions are enacted, “we are going to have a population where health is not the norm, it’s the exception,” Thompson said. “And that, to me, is something that we have to talk about. We have to be candid with people about the impact that this will have on our population. And do we care? We sure as all get out should. We should care about the health of the people in our communities.” 

The provision that requires “Medicaid expansion adults” to pay up to $35 per service (with exemptions for certain services, including prenatal care and emergency services) would increase uncompensated care at county-owned hospitals and emergency departments. 

Boone County “already gets phone calls from folks in the hospital association saying, ‘Can you help us, because of the uncompensated care burden that’s happening in our hospital?’ because there’re people who have been essentially dumped on the hospital because there’s no place for them to go,” Thompson said. 

“Well, that burden is going to rise in every community. We’ll get more and more of those phone calls, visits from constituents and from the hospital association, saying, ‘What do we do about it?’

“So, you can laugh and say, ‘Well, buy a lottery ticket.’ But it’s ludicrous to think that the counties will be able to sustain that.”

The provision could also lead to low-income families delaying or forgoing treatment due to unaffordable out-of-pocket costs. Dental care is an example of a healthcare service that will no longer be covered for Medicaid expansion adults. 

“My mom was a public health physician, and her idea was always, ‘How can you treat something that’s a low-level cost before it becomes a chronic disease?’” Thompson said. “… ‘You treat the bad tooth, so that you don’t have cardiac disease from the infection from that tooth.’ That’s what we’re looking at.”

A rural hospital in the neighboring Audrain County, Mo. closed in 2022 — in large part due to uncompensated medical care and not having enough federal support, Thompson noted — which led to those patients flooding into Boone County’s hospital system. Thompson said she’s not sure the hospitals can endure further strain. 

“When I look at this [legislation], I don’t know whether the University Hospital and Boone Hospital will be able to survive, because of the provisions that put so much burden on the state, on the providers, on everybody,” Thompson said. 

“I really worry about our ability to deliver health care in our state and in my county, in particular. Boone County has been known for forever as being a sort of beacon of medical care. That’s no longer the case, and that certainly won’t be the case when the provisions of this bill hit.”