Trump’s return puts Medicaid on the chopping block
Under President Biden, enrollment rates Medicaid hits record high Uninsured rates hit record lows.
The return of Donald Trump to the White House—and Republican control Senate and House of Representatives — expected to change that.
Republicans in Washington say they plan to use funding cuts and regulatory changes to make deep spending cuts. Reduce MedicaidIt is a government health insurance program costing nearly $900 billion annually that, along with the related Children’s Health Insurance Program, serves approximately 79 million Americans, most of whom are low-income or disabled.
These recommendations include rolling back Affordable Care ActExpanding Medicaid has added about 20 million low-income adults over the past 11 years. Trump has said he wants deep cuts in government spending that may be necessary for Republicans to extend the 2017 tax cuts that are set to expire at the end of this year.
Trump rarely mentions Medicaid during the 2024 campaign. The first Trump administration approved work requirements in several states, but only Arkansas implemented them before a federal judge said they violated the law. The first Trump administration also tried to block funding to states.
House Budget Committee Chairman Jodey Arrington, R-Texas, told KFF Health News that Medicaid and other federal benefit programs need major reforms to help reduce the federal debt. “Without them, we will watch this country tragically slide into fiscal ruin.”
Budget Committee member Rep. Chip Roy, R-Texas, said Congress needs to explore Cut federal Medicaid spending.
“You need massive reform in health care, and that includes undoing a lot of the damage done by the Affordable Care Act and Obamacare,” Roy said. “Frankly, if we do it the right way, we can ultimately provide better Serve.”
Advocates for the poor worry that Republican funding cuts will make more Americans uninsured, making it harder for them to access health care.
“Medicaid is clearly a target for significant cuts,” said Joan Alker, executive director of the Center for Children and Families at Georgetown University. “An existential fight over the future of Medicaid may be coming.”
Medicaid turns 60 in July, ending a disruptive period after pandemic-era coverage protections expired in 2023 and all enrollees must prove they still qualify. According to the latest census data, more than 25 million people lost insurance in the 18 months after “relaxation” began, although the number of people without insurance did not increase significantly.
Matt Salo, former executive director and founder of the American Association of Medicaid Directors, said the damage caused by this relaxation will likely pale in comparison to what happens over the next four years. “We’re going to see even more seismic changes in Medicaid coverage and how it works,” he said.
But Salo said any efforts to scale back the program would face resistance.
“A lot of powerful entities — state governments, managed care organizations, long-term care providers and everyone under the sun who wants to do good and benefit — want to see Medicaid work effectively and be adequately funded,” he said. “They will be very aggressive in resisting what they see as draconian cuts because it could impact their business model.”
Republicans are exploring several strategies to reduce the size of Medicaid:
- Move to block grants. Switching to annual block grants would likely reduce federal funding for states to operate the program while giving states more discretion in how to spend the money. Currently, the government matches a certain percentage of state spending each year with no upper limit. Republican presidents since Ronald Reagan have tried unsuccessfully to block Medicaid. Arrington said he favors ending open-ended federal funding to states and basing the annual amount on how many people in each state participate in the program.
- Cut ACA Medicaid funding. The ACA provides financing through Medicaid, covering Americans who earned up to 138 percent of the federal poverty level last year, or $20,783 per person. The federal government pays 90 percent of the cost for adults covered by Medicaid expansion under the law, which 40 states and Washington, D.C., have adopted. Republicans may try to lower the funding to the same matching rate the federal government pays for everyone else in the program, which averages about 60%. “We should absolutely note that we are subsidizing the healthy, able-bodied Medicaid expansion population more than we are subsidizing the poorest and sickest populations, which is the original intent of the program,” Arrington said. “That’s not right. of.”
- Reduce federal matching funds. Since the inception of Medicaid, federal matching rates have been based on the relative wealth of states’ populations, with poorer states receiving higher matching rates and no state receiving a matching rate below 50 percent. Ten states get the base rate — all but two are Democratic-run states, including New York and California. Republicans may seek to cut the base rate to 40% or lower.
- Add job requirements. During Trump’s first term, federal courts ruled that Medicaid law does not allow coverage to be conditional on a enrollee’s employment or job search. But Republicans may try again. “If we can impose strict work requirements on able-bodied adults, that in itself could be a huge cost savings,” Rep. Tom McClintock, R-Calif., told KFF Health News. Since most medical care Subsidy participants already work, go to school or work as caregivers, and critics say such a requirement would only add more red tape to getting coverage and have little impact on employment.
- Create barriers to entry. About 10 states offer so-called continuous eligibility to certain groups, where people can stay enrolled for years without renewing coverage. This policy has been proven to prevent participants from dropping out of the program in the short term due to hardship or paperwork issues, which could result in unexpected medical bills and debt. The Trump administration may seek to repeal the waiver that allows states to grant consecutive years of eligibility, which would require people in those states to reapply for coverage each year.
Democrats and health experts say if Republican plans to scale back Medicaid go through, low-income people forced to buy private insurance would face challenges paying monthly premiums plus the large copays and deductibles common with commercial plans. Medicaid generally does not have these problems.
Paragon Health Institute is a leading conservative think tank run by former Trump adviser Brian Blase. publish report Says states are spending billions of additional dollars to expand Medicaid under the Affordable Care Act, a boon to the private insurance companies that administer the program while relatively well-off people don’t think they should participate.
Josh Archambault, a senior fellow at the conservative Cicero Institute, said he hopes the Trump administration will hold states accountable for overpaying health care providers and enrolling ineligible people in Medicaid. . Conservatives cite CMS reports that states improperly pay billions of dollars to Medicaid providers each year, although the federal government says this is largely due to a lack of documentation.
He said Republicans would seek to scale back Medicaid for “traditional” groups such as children, pregnant women and people with disabilities. “We need to rebalance a program that most people think is underperforming,” he said. Most Americans, including the vast majority of Republicans and Democrats, have a positive view of the plan, According to opinion polls.
KFF Health News is a national newsroom that produces in-depth journalism on health issues as one of the agency’s core operating programs Cave —An independent source of health policy research, polling, and news.
