At the moment, Republicans in Congress are eyeing major cuts to Medicaid–a program that provides critical health care to more than 70 million low-income Americans–as part of their push to cut government spending significantly. In January, President Trump had said he would not cut Medicaid, except to address fraud and abuse, report Ben Leonard for Politico and Ryan Levi for NPR. What will become of Medicaid?
Proposed Medicaid cuts are not simply about fraud and abuse. Many Republicans also want to include work requirements as part of Medicaid eligibility. To be clear, lots of people with Medicaid are over 65 or have a disability and are unable to work.
As a result of the Affordable Care Act, 21 million more people have been able to enroll in Medicaid. Their incomes were under $45,000 for a family of four. The federal government covers up to 90 percent of that cost.
What’s on the chopping block in Congress? As much as $230 billion a year in Medicaid cuts over the next ten years to help cover the cost of enormous tax cuts. If it happens, a significant number of the 70 million Americans with Medicaid would lose Medicaid coverage. Some would die needlessly.
Medicaid saves lives. The research shows a nine percent reduction in adult mortality in the four years after passage of Medicaid expansion with the Affordable Care Act.
Some Republicans, including Robert F. Kennedy Jr., claim that Medicaid does not improve people’s health. Those not supporting Medicaid point to one experiment in Oregon, which showed that people with Medicaid had a higher chance of receiving preventive services than people without it. They were less depressed and received fewer medical bills. But, their cholesterol and blood pressure levels were no different from those who did not get Medicaid. [This seems hardly a basis for denying Medicaid’s value.]
Republicans also claim that Medicaid dollars flow too easily to the states. The federal government covers between 50 to 90 percent of Medicaid costs. Republicans say that states game the system to get extra money from the feds.
Could people with Medicaid afford to buy insurance in the private market, as some conservatives claim? It’s hard to imagine, given the high cost of private insurance, including premiums, deductibles and copays. Most Medicaid dollars are spent on older adults and people with disabilities for nursing home care, which Medicare does not cover.
How are the states reacting? Some Republican states are already moving to end Medicaid expansion, reports Anna Claire Vollers for Stateline. Idaho, Montana and South Dakota are leading the way to end Medicaid expansion. If Idaho ends expansion, close to 90,000 people would lose their Medicaid coverage.
Nine states have “trigger” laws that require them to reduce Medicaid spending if the federal government reduces its contribution to Medicaid.
Will big cuts to Medicaid happen this year? It’s possible. If so, it would happen soon, in the reconciliation package. Hospitals and Democrats are pushing back. About 20 percent of hospital revenue comes from Medicaid.
What happens to the cost of individual health insurance if Medicaid is cut significantly? Many states would likely end Medicaid expansion, millions of Americans would be uninsured, and individual health insurance premiums would likely rise a lot. A new report finds that if Montana stopped its Medicaid expansion, as many as 74,000 Montanans would lose coverage and the uninsured could represent as much as half of Montanans. In addition, health insurance premiums would increase as much as eight percent or $767 a year because the people signing up who had had Medicaid are a sicker cohort than the group with private insurance currently. Rural health care would be at risk.
Here’s more from Just Care:
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