I am an emergency doctor, and I have many, many times seen patients transferred to my department by ambulance when their conditions could easily have been treated by one experienced nurse at their long-term care facility. The problem has always been one of inadequate staffing.If either the American Health Care Act or its evil twin, the Senate's Better Care Reconciliation Act, becomes law, the situation will become much worse. Today the federal government reimburses each state a percentage of money spent under the Medicaid program. The federal commitment is open-ended. Currently, the feds pay about 63 percent of Florida's Medicaid costs. The AHCA and the BCRA, instead, would provide a fixed amount per year by using a "per capita cap." The dollar value of this fixed amount then diminishes yearly.This throws the problem of paying for Medicaid squarely on the states. Florida is 48th in spending on Medicaid recipients. The state spent $4,893 per enrollee in 2011, way below the national average of $6,502. Consequently, in a capped program, we would start way back and fall further behind year after year.There are 73,000 Floridians in nursing home beds. In addition, there are 92,000 assisted living facility beds in our state. Medicaid covers about 60 percent of all long-term care in Florida. The rationale for gutting Medicaid has been stated as "providing flexibility" for states in managing their programs. This is nonsense.When the next recession hits or the Zika epidemic widens and worsens, the state will quickly run out of money to deal with the increased number of people needing Medicaid coverage and the number needing increased care. Then the state's flexibility will be zero. Florida will have to abruptly raise taxes or cut eligibility and reimbursement for care.So, Florida cuts eligibility and cuts reimbursement to providers and nursing homes. Nursing homes will then cut nursing staff and the number of beds for Medicaid-covered clients. They won't throw Granny in the street; they will send her to a hospital and then refuse to take her back. Families across Florida who cannot afford $85,000 to $100,000 out of pocket, per year, will suddenly find their elderly or disabled loved ones no longer eligible for nursing home beds or care under Medicaid.Why would anyone want to gut Medicaid in order to brutalize the elderly and their families? The answer is as bizarre as the question: to give a tax cut to people who don't need the money. The $880 billion cut from the federal Medicaid program will, in part, be used to give a tax break of $7 million per year to each of the 400 richest families in the country.Paul F. Robinson, a medical doctor with a doctorate, is an emergency specialist in Tarpon Springs. He is a Copello Fellow with the National Physicians Alliance.