A budget resolution was adopted by House Republicans, which could easily jeopardize the health insurance coverage of plenty of people of low income, as well as disabled people who still rely on Medicaid. That’s the scenario bound to happen if lawmakers follow through with the most recent proposed spending cuts.
The budget plan also asks the Energy and Commerce Committee, which is currently in charge of overseeing Medicaid, to find a minimum of $880 billion in mandatory spending cuts over the next 10 years. These savings are expected to be used to extend President Donald Trump’s 2017 tax cuts, which are also set to expire at the end of 2025.
As the resolution doesn’t really mention the program, experts believe it would be a bit unfeasible for Republicans to hit such a target without significant cuts to the health program, especially since it’s one of the biggest sources of federal spending, costing over $600 billion per year, according to government data.
As Robin Rudowitz, director of the program on Medicaid and the uninsured at KFF, a nonprofit group that mainly focuses on health policy, “the way the math works is that such cuts would mainly need to come out of Medicaid.
The program is off the table, and we still don’t have enough sources of funding for the Energy Commerce to look into.” But mind you, it’s just worth noting that during the presidential campaign, Trump has sworn to preserve Medicare.
These cuts are still expected to extend beyond those who took benefit from the 2014 Medicaid expansion, especially under the Affordable Care Act. This could potentially affect almost everyone involved in the program.
“Everyone who really relies on Medicaid might be at risk,” as Edwin Park, a research professor at the McCourt School of Public Policy at Georgetown University in Washington, D.C., explained. “Specifics of the proposal might really come into play—each state will eventually be hit, and how hard they will really depend, but all are at risk.”
Who does Medicaid cover?
Medicaid offers health insurance, especially to people with low incomes, even if it covers other groups, such as older adults, pregnant women, as well as people with disabilities. That can also include 72 million people. Back in 2023, Medicaid covered almost 4 in 10 children, including more than 8 in 10 children in poverty, 1 in 6 adults, and more than half of adults in poverty, as KFF reported. The program covers more than 1 in 4 adults with disabilities, offering coverage for 41% of all births in the United States.
“There’s this idea that Medicare and Social Security are this kind of sacrosanct establishments, and Medicaid is not exactly lumped into this category,” as Allisson Orris, the director of Medicaid policy at the Center on Budget and Policy Priorities, described the situation.
“Polling over the last few years, it can be clearly seen that two-thirds of adults in the United States registered some kind of connection to Medicaid, and almost three-quarters of the population has a generally favorable view of this program. That’s mainly because Medicaid truly touches people, providing health care at any stage in life.”
Did you know that the program is co-funded by each state and the federal government alike? They cover the upfront cost of care, then they are reimbursed by the federal government for a minimum of 50%.
When the Affordable Care Act allowed Medicaid to reach more people, the federal government committed to paying minimum 90% of the total costs for the people who enrolled, because of the expansion in each state. The overall share of people on Medicaid depends on state, but the states with the highest increase in enrollees include California, New Mexico, Arkansas, Louisiana, Kentucky, West Virginia, and New York.
The program also covers almost half of Puerto Rico residents, the largest share among states and territories. Only 10 states, such as Florida and Texas, don’t really participate in Medicaid’s expansion.
What about fraud in Medicaid?
The GOP House budget plan is the first step in a long series of negotiations between House and Senate lawmakers, before any bill can reach Trump’s desk. Republican leaders have argued that the proposed budget cuts could potentially eliminate fraud in Medicaid.
However, according to a representative in Georgetown, there’s no current data to support the claim that fraud is more prevalent in Medicaid than in any other parts of the health care system, whether Medicare or other private insurance.
House Speaker Mike Johnson, R-La., stated to CNN that lawmakers weren’t planning to make any cuts to Medicaid benefits. “We will take care of those who are rightful beneficiaries of the program,” Johnson assured. “We will cut the fraud, waste, and abuse and that’s where we will get the savings to accomplish this mission.”
However, many think that’s simply misleading. For once, the fraud argument is now being used to justify Medicaid cuts. However, the major part of the proposals under consideration at the moment, targeting the $880 billion, is the same Medicaid cuts that were once included in the (2017) Affordable Care Act repeal and replace bills that already failed. Back in the day, there was no talk about combating fraud or waste, or abuse, for that matter.
Republicans now say, “We won’t hurt enrollees; we won’t hurt people; we just deal with the waste, fraud, and abuse.” However, we should still unpack that and fully understand that just like any healthcare program, there might be a series of improper payments in Medicaid, which could generally result from paperwork not being effectively filled out. That can happen across all programs. The argument is meant to shift the focus away from the harms that would automatically come to people across the age and income spectrum if Medicaid gets these cuts.
The chances of Congress saying, “Dear states, you need to cut the coverage for people with disabilities” are slim. All these hard decisions will eventually be left for states to make. So far, it’s hard to say if anyone will be spared, especially if you get into the realms of cuts that are, well, big enough to lead to hospitals closing and impacting access to care.
Without the proper Medicaid coverage, people will be left with no other options. Medicaid is one of the most complicated programs, and it definitely covers all kinds of facets of the healthcare system, many of which people don’t truly appreciate.
We also know that most people who lose Medicaid would more than likely become uninsured, and from there onwards would still require healthcare services, and might still show up to clinics. Those providers would likely not be reimbursed.
Public opinion
Since Congress considers implementing changes to the Medicaid program as part of the whole budget conversation, the latest KFF Health Tracking Poll finds that fewer than one in five adults (17%) want to witness Medicaid funding decrease. Most of them think funding should either go up (42%) or remain the same (40%).
Most Democrats, Republicans, independents, Trump voters, and adults who are living in rural areas stated that Medicaid funding should remain the same, even if one-third of Republicans want spending to decrease. The public’s staunch opposition to Medicaid cuts is bound to reflect the fact that most people have a connection to this program
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