Last week, the Republican-controlled US House of Representatives passed a reconciliation bill, which includes an estimated $715 billion in Medicaid cuts over the next 10 years. These cuts will help cover the cost of reducing taxes for ultra-wealthy Americans. In an opinion piece for The New York Times, Pamela Heard and Donald Moynihan explain how the bill is designed to push millions of low-income Americans off of Medicaid, even though they qualify for coverage.
Proof of Medicaid eligibility twice yearly: The House reconciliation bill requires people on Medicaid, between the ages of 19 and 65, with incomes above the federal poverty level, to prove, through paperwork, twice a year, that they continue to qualify for Medicaid. Imposing this paperwork burden on some of our nation’s most vulnerable citizens is tantamount to pushing them off the program. In addition to the difficulty of producing all the needed documents, it can be extraordinarily challenging to contact Medicaid offices. And, without funding to increase staffing, there are sure to be huge backlogs. States are not likely to hire more people to review people’s applications twice a year.
More burdensome Medicaid application process: The House bill also undoes a series of Biden administration rules which make it easier for people who are eligible for Medicaid to enroll in Medicaid.
Harsh work requirements: The bill requires people between the ages of 19 and 64, qualifying for Medicaid because they live in states that expanded eligibility, to document that they meet complex work requirements and work a minimum of 80 hours a month. As a result, the Center on Budget and Policy Priorities projects that between 9.7 million to 14.4 million people could lose Medicaid coverage in 2034. They could not enroll in Medicaid unless they already were working. As of now, there are a small cohort of people who are exempt from these requirements, including caregivers of dependent children, people with disabilities and people who are pregnant.
Copays at the doctor’s office: The House bill requires people with Medicaid living above the federal poverty level to pay a copay of up to $35 at the doctor’s office, for most services, beginning in October 2028. The bill includes a family out-of-pocket cap of 5 percent of income. Copays keep people with limited incomes from getting needed care. And, copays do not save money. One study in NBER found that a small prescription drug copay led to a high proportion of preventable deaths. More than 20 percent of people stopped taking their heart medications. They had heart attacks and strokes.
Penalties on states that erroneously enroll people on Medicaid: As if all these new burdens on America’s poorest citizens are not enough, the House bill provides states with a disincentive to enroll people in Medicaid. As drafted, if states enroll people in Medicaid erroneously, they will face stiff penalties. It’s fair to assume, states’ response to this provision will be to require Medicaid applicants to provide even more proof of their eligibility. If this provision becomes law, it would make it even harder for people to qualify for Medicaid.
What’s perhaps most troubling about all these provisions is that they are not focused on the public good. They impose additional burdens on the most vulnerable Americans and don’t penalize the bad actor Medicaid insurers and providers one iota. Yet, it is the insurers and the providers whom the Office of the Inspector General has found to engage in waste and fraud.
The bill still needs to pass the Senate. At least for now, several Republican Senators are saying they will not sign it as is. Some believe it is not harsh enough, and others say it is too harsh.
Here’s more from Just Care:
- Republican Josh Hawley argues against Medicaid cuts
- Federal cuts to Medicaid will have devastating consequences for older adults and people with disabilities
- Congress could end overpayments to big insurers in Medicare Advantage and save $1 trillion, without gutting Medicaid
- People with both Medicare and Medicaid can get Traditional Medicare at little cost
- People with Medicare and Medicaid in Special Needs Plans at extra risk
