Americans under 65 years old who qualify for government paid health care may not vote much. And they certainly can’t afford to hire a lobbying firm. But they are the ones likely to be most affected by changes to how health care is paid for and delivered at the state and national level.

It’s an unsettling idea — denying someone health care because they cannot afford it — but one that will come more and more to the forefront in state and federal budget battles.

At the federal level, the Republican Congress and President Donald Trump are negotiating ways to “repeal” and “replace” Obamacare with a plan that inevitably must reduce spending and coverage for those on government-paid health care for the poor.

Millions of people who were given health care just a few years ago under Medicaid expansion will likely lose some of it or be forced to pay more for it. At best, states will be allowed to reduce coverage for things like mental health and other mandated services in the government programs.

Trump also has threatened to withhold federal funding for the Medicaid programs as a way to get minority party Democrats in Congress to help pass a repeal and replace bill. So far, the Democrats have ignored the threat.

The federal actions will trickle down to the states, as much of the cost of state Medicaid expansion comes from the federal government. If the federal government stops funding Medicaid to the states, Minnesota’s budget surplus of about $1.6 billion would be wiped out in one year.

Few may realize that under federal law, a person cannot be turned away from an emergency room or necessary medical care just because they have no insurance. But studies have shown that most of these folks don’t go to the doctor if they don’t have insurance, and their condition worsens and gets more costly.

The thought was that if we provide them preventive care, we ultimately save in the long run. Studies have borne that out.

But if we really want to move forward with these strategies to reduce health care spending, we should be ready to own up to the idea that we’re telling our people that health care is only a right to those who can afford it.

— Mankato Free Press, April 28