A Budget resolution adopted Tuesday by the Republicans of the house Could compromise health insurance coverage of millions of low -income and disabled people who rely on Medicaid if legislators follow their proposed spending reductions, warn the experts.
The budgetary plan instructs the energy and trade committee, which supervises Medicaid, to identify At least $ 880 billion in compulsory spending discounts over the next 10 years. Savings should be used to expand Tax reductions by President Donald Trump 2017who should expire at the end of this year.
Although the resolution does not specifically mention Medicaid, the experts say that it would be impossible for the Republicans to reach this target without significant reduction in the health program, because it is one of the largest sources of federal spending, costing costs more than $ 600 billion per year, According to government data.
“The way mathematics would work is that these cuts should largely leave Medicaid,” said Robin Rudowitz, program director on Medicaid and not assured in Kff, a non -profit group that focuses on health policy. “Medicare is outside the table, and there are simply no other sources of financing so that the energy trade can look.” (During his presidential campaign, Trump swore to preserve Medicare.)
The possible cuts should extend beyond those who have benefited from the expansion of Medicaid 2014 under The Act respecting affordable carepotentially affecting almost all people in the program.
“All those who rely on Medicaid would be at risk,” said Edwin Park, research professor at the McCourt School of Public Policy from Georgetown University in Washington, DC “, the details of the proposal will be important – each state will be affected, and how difficult they will be – but certainly they are all in danger.”
Who covers Medicaid?
Medicaid provides health insurance mainly to people with low incomes, although it covers other groups, including some older adults, pregnant women and disabled people. This includes around 72 million people.
In 2023, Medicaid covered nearly 4 in 10 children, including more than 8 in 10 children in poverty, 1 in 6 adults and almost half of adults in poverty, According to Kff. The program covers more than 1 adults in 4 disabled people and offers coverage for 41% of all births in the United States
“There is a feeling that health insurance and social security are in a way these sacrosecolic programs and that Medicaid is often not grouped in the category,” said Allison Orris, director of Medicaid policy at the Center on budgetary and political priorities, a reflection group. “The survey in recent years shows that two-thirds of adults in the United States have a certain link with Medicaid, and almost three-quarters of the population have a generally favorable vision of the program. And it is because Medicaid really affects people and provides health care at all stages of life. »»
The program is jointly funded by the States and the federal government. States cover the cost of initial care and are then reimbursed by the federal government for at least 50%.
When the Act respecting affordable care has expanded to more persons, the federal government is committed to paying at least 90% of the total costs for people who have registered due to expansion in each state.
The share of people on Medicaid varies according to the state, but the states with the greatest number of registrants include California, New Mexico, Arkansas, Louisiana, Kentucky, Virginia-Western and New York, according to KFF. The program covers almost half of the residents of Puerto Rico, the largest part among states and territories. Only 10 states, including Florida and TexasDo not participate in the expansion of Medicaid.
With less dollars from the federal government, states would support a larger share of Medicaid costs, which many would likely find it difficult to afford, said Orris.
“The cap of federal spending does not make health care needs disappear,” said Orris. “This only moves the risk of higher spending on states and makes states make choices: do they reduce coverage, cut eligibility, cut supplier rates?”
What about Medicaid fraud?
The GOP House budgetary plan is only the first step in a series of negotiations between the legislators of the Chamber and the Senate before a bill could reach the office of Trump.
Republican leaders have argued that the proposed budget cuts would eliminate fraud in Medicaid, but Park, from Georgetown, said that there were no data to support the allegation that fraud is more widespread in Medicaid than in other parts of the health care system, including health insurance and private insurance.
Wednesday, the president of the room Mike Johnson, r-la., said on cnn that the legislators were not going to make discounts of the benefits of Medicaid. “We are going to take care of those who are legitimate beneficiaries of the program,” said Johnson. “We are going to reduce fraud, waste and abuse and this is where we will get the savings to accomplish this mission.”
Park said it was misleading.
“The argument of fraud is used as a framework to justify the Medicaid cuts, but the main proposals that are being studied today to achieve this objective of $ 880 billion are the same Medicaid reductions which have been included in (2017) ACTRACT ACT Abode and replace the invoices that finally failed,” said PARK. “At the time, there had been no questions to the fight against fraud or waste or abuse.”
“The Republicans say:” We are not going to harm the registrants, we are not going to injure people, we will simply face the waste, fraud and “” said Orris. “But I think we have to unpack this and understand that, like any health care program, there are inappropriate payments to Medicaid, which generally result from the paperwork that is not filled. This happens in all programs.
The argument, according to experts, distance attention from the damage that would come to people through age and income spectrum if Medicaid obtains cuts.
“It is very unlikely that the congress said:” Dear states, you must reduce the coverage of disabled people, “said Orris. “All these difficult decisions will be left to take for the States and it is difficult to say that any population would be spared, especially if you enter the field of cuts which are sufficiently large which lead to the closure and the closure of hospitals and to the impact on access to care.”
Without Medicaid coverage, people often have no other options.
“Medicaid is such a complicated program, and it covers so many different facets of the health care system, which many people do not fully appreciate,” said Rudowitz. “We know that most people who lose Medicaid would probably become uninsured and still need health services, and could still come to the clinics, and these providers would probably not be reimbursed.”