CLAREMONT — As Republicans in Washington signal plans to eliminate hundreds of billions in Medicaid funding, Upper Valley health care providers, lawmakers and organizers paint a grim picture of what these cuts could mean for residents.

On April 10, U.S. House Republicans approved a budget framework, committing to seek at least $1.5 trillion in cuts to federal programs and services. While GOP legislators and President Donald Trump have said Medicaid services will not be dramatically effected, Democrats argue it’s impossible to meet the proposal’s goals without cuts to the program.

“Thinking about taking away health services people rely on for a tax break for the wealthiest Americans makes no sense,” U.S. Sen. Jeanne Shaheen, D-N.H., said during a visit to Valley Regional Hospital in Claremont on Wednesday.

Medicaid and the Child Health Insurance Program, or CHIP, provide healthcare benefits to low-income Americans. Jointly funded by the states and federal government, Medicaid and CHIP covers more than 156,000 Vermonters and 184,000 New Hampshire residents.

Currently, the federal government puts in 90 cents for every dollar New Hampshire spends on its Medicaid expansion program known as Granite Advantage. While the details of the cuts have yet to be finalized, Republicans have proposed lowering this federal match to 50 cents for each dollar.

New Hampshire has a trigger law which would repeal Granite Advantage within 180 days of the federal government dipping below its current 90% match. If the proposal passes, nearly 60,000 New Hampshire residents would lose coverage, according to the nonprofit the New Hampshire Fiscal Policy Institute.

“Before it comes to that, call your legislators, call the governor, call everybody you can think of and let them know that that’s not acceptable,” Shaheen said.

The Valley Regional visit was a stop on Shaheen’s “Medicaid Impact Tour,” a series of visits to hospitals across the state this week to “highlight the disastrous impact that Republican-led cuts to Medicaid would have on New Hampshire’s health care system and working families,” a Monday news release from Shaheen’s office said.

Without health insurance, residents would have to make decisions between putting food on the table and going to the doctor, Dr. Juliann Barrett, Valley Regional’s chief medical officer, pointed out during a roundtable discussion with Shaheen. “It would have a drastic impact on preventative services,” Barrett said.

Routine checkups, cancer screenings and measuring lead levels in infants are examples of lifesaving preventative care that Barrett said she believes many would be forced to go without. “We just won’t see patients come in,” she said.

She predicted this would result in people avoiding the hospital until they face a severe health issue, leading to overcrowded emergency rooms, more expensive treatments and, ultimately, higher mortality rates.

Medicaid doesn’t just help pay for hospital visits. Services in schools, such as occupational and speech therapy also receive dollars from the program. “Taxpayers will have to pick up the bill through education property taxes,” Barrett said.

“One of the reasons Republicans give for cutting Medicaid is to save money, but it costs money,” Shaheen said.

Republicans argue the cuts are necessary to prevent a tax increase for most American families, claiming that unless Congress acts, the individual and estate tax cuts that GOP lawmakers passed in 2017 will expire at the end of this year.

Elizabeth Austin, executive director of Good Neighbor Health Clinic and Red Logan Dental Clinic, a White River Junction nonprofit providing free health care and dental services to uninsured and underinsured Upper Valley residents, also pointed out the economic impacts of cutting Medicaid.

“Health care is one of the largest employers in rural communities,” she said in a phone interview on Wednesday.

While government cuts are not yet final, Austin’s clinics are preparing for an influx of patients by expanding services, bringing in volunteers, increasing hours and engaging in public outreach campaigns.

“It can’t be exaggerated how much this is going to affect overall public health,” Austin said. “We all know someone who will be affected by this.”

People in recovery from addiction are among those who would be hardest hit by federal Medicaid cuts. “It’s hard to overstate how potentially devastating it could be for someone with a substance use disorder to lose insurance,” said Luke Archibald, the section chief of the addiction treatment program at Dartmouth Hitchcock Medical Center.

More than half of the approximately 450 monthly patients at the addiction treatment center are insured by Medicaid, Archibald said. “Regardless of insurance status, we will provide treatment,” he said. “But it’s not legal for us to bill some folks and not others. Ultimately, there will be charges made.”

Patients could work with the hospital’s financial aid office, but medical debt could be a huge concern. “An unknown cost will keep many people from entering treatment or continuing treatment,” he added.

Additionally, much of the program’s treatment involves medication. “The average person on Medicaid now won’t be able to afford the out-of-pocket expense of medication if there’s not insurance coverage,” Archibald said.

The addiction treatment program already operates in the red and if it no longer receives Medicaid reimbursements, “difficult decisions might need to be made and services might have to be curtailed in some way,” Archibald said.

The Vermont Workers’ Center, a Burlington-based nonprofit, has fought for universal health care for almost two decades. Members of the organization help Vermonters sign up for Medicaid and appeal the decision if they lose coverage.

“We’ve been bringing in folks to share their health care stories and connect with each other around our need for a health care systems that actually serve us,” said Mads Walker, a field organizer for the organization, which describes itself as “everyday people fighting for economic justice and human dignity” on its website.

With the fear of potential cuts looming, Walker, a Wilder resident, has heard from Vermonters on Medicaid worried about not being able to afford insulin, wondering what to do if they lose health insurance for their children, and the future of gender-affirming care.

“It’s the baseline for people to access the care they need to stay alive,” Walker said.

The group will host a forum on the impact of the potential cuts from 2 to 4 p.m. on Sunday at JAM (Junction Arts & Media) at 5 South Main St. in White River Junction.

“Everyone has a personal connection to the health care crisis,” Walker said. “The way we can get everyone access to their human right to health care is to come together in this experience we all share of looking for justice in a for-profit health care system.”

To RSVP for the event go to: uvjam.org/event/healthcare-is-a-human-right.

Emma Roth-Wells can be reached at erothwells@vnews.com or 603-727-3242.