G.O.P. Plans to Cut Medicaid Would Save Billions but Leave More Uninsured, Budget Office Says
As Republicans in Congress wrestle with options for cutting Medicaid costs, the Congressional Budget Office has estimated that the leading plans under consideration could yield significant savings — but would also increase the share of Americans who are uninsured.
The office considered several options as Republicans attempt to find hundreds of billions of dollars in cuts from Medicaid spending to help offset the costs of tax cuts they hope to extend. But two leading proposals that would help reach that goal would leave millions without health coverage, according to the office's estimates.
One option, to limit the way states use a tax loophole to increase federal spending on Medicaid, would save $668 billion but cause 3.9 million more Americans to go without health insurance.
Another option, which would lower federal spending on Medicaid beneficiaries who are part of the Obamacare expansion of the program, would save the government $710 billion over a decade, but cause 2.4 million more people to become uninsured.
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Sen. Mark Green's retirement leaves open field for Republicans, a 'longshot' for Democrats
Tennessee is expected to see a special election later this year to replace U.S. Rep. Mark Green, R-Tennessee, and political experts say it could bring an open field of Republican candidates. Regardless of who runs for Green's seat, experts say it would likely be a 'longshot' for any Democratic candidates as the district has a strong Republican hold. Green on June 9 announced his resignation from the 7th Congressional District, just months after his reelection, to pursue an opportunity in the private sector. His district represents a swath of rural counties in middle and west Tennessee, as well as Montgomery County and parts of Davidson and Williamson counties. 'It is with a heavy heart that I announce my retirement from Congress," he said in a statement. "Recently, I was offered an opportunity in the private sector that was too exciting to pass up. As a result, today I notified the Speaker and the House of Representatives that I will resign from Congress as soon as the House votes once again on the reconciliation package." His office didn't respond to an interview request; it's unclear what the private sector opportunity is. Republicans hope to pass what President Donald Trump calls his 'big, beautiful bill' by July 4. If Green vacates his seat after voting on the bill, the state could see a special election this fall. Under Tennessee law, Gov. Bill Lee must order a special election within 10 days of Green's resignation and set a primary election date within 55 to 60 days. The state would then set a subsequent general election within 100 to 107 days. Green was reelected in November. His term expires in January 2027. Green, a 60-year-old doctor and military veteran who lives in Clarksville, was first elected to his seat in 2018. He announced in February 2024 that he would not seek a fourth term, characterizing the country and Congress as nearly irreversibly broken. He changed his mind after a flurry of calls from fellow Republicans and a personal appeal from Trump. John Geer, a longtime political science professor at Vanderbilt University, speculated that Republicans, without any other strong candidates, asked Green to reconsider as he was set to fight off a challenge from former Nashville Mayor Megan Barry. 'They might have been worried a little bit that Megan Barry might win,' he said. Geer said it's unclear who would run for his seat now, but any new candidate will be quickly bolstered by Lee and U.S. Sen. Marsha Blackburn, R-Tennessee. A typical low turnout for special elections could help a Democratic candidate, but Geer said it will depend on the political climate later this year, and the climate is changing fast. 'It's a longshot, but if the public is really angry and there is a Democrat that is viewed as a moderate, there could be a chance,' he said. Kent Syler, a political science and public policy professor at Middle Tennessee State University, said Barry ran a spirited and well-funded campaign against Green but still had relatively low turnout at 38%. Syler said Tennessee's 7th Congressional District contains an interesting mix of urban, suburban and rural voters, which poses a challenge for Democrats since they typically do better in urban areas. 'That dynamic will make it very difficult for a Democrat to take this seat,' he said. 'That being said, this race is going to be far more about Donald Trump than it is about the two candidates.' Green serves as chair of the Homeland Security Committee, and it's unclear how his departure will impact a Congressional investigation into Nashville Mayor Freddie O'Connell for allegedly obstructing U.S. Immigration and Customs Enforcement activity. The investigation is set to be led by the House Homeland Security and Judiciary Committees. A former U.S. Army major, Green was first elected to office in the Tennessee General Assembly, where Trump tapped him in 2017 to serve as Secretary of the Army. The move, however, sparked a backlash over comments he made about LGBTQ+ groups and Muslim religious practices. Green has said comments were misconstrued, but he withdrew his candidacy. During his time in Congress, Green was an advocate for legislation affecting U.S. soldiers and veterans. His first bill after being sworn into Congress was the Protecting Gold Star Spouses Act to allow Coast Guard Gold Star Spouses to continue receiving stipends via the Survivor Benefits Plan. He advocated against the mandated COVID-19 vaccine for military members and fought for those who did not comply to be honorably discharged. Tennessee and Montgomery County Republicans have praised his service as news of his retirement spread. Tennessee GOP Chairman Scott Golden said Green was both a friend to him and the Republican Party. "Congressman Mark Green is a true American patriot,' Golden said. 'He has served in the Army, served as a doctor, served Tennessee in the State Senate, and served our Country in Congress.' Aron Maberry, freshman representative in the Tennessee General Assembly, commended Green's work. "Mark has really fought hard for District 7 and has done a lot of great things in Washington, D.C., and stood with our president," Maberry said. "I'm thankful for his services to our nation, in Tennessee and Montgomery County." This article originally appeared on Nashville Tennessean: Sen. Mark Green's retirement leaves open field for Republicans and a 'longshot' for Democrats
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‘When will enough be enough?' Ohio House Democrats introduce common sense gun legislation
Stock photo of guns. (Photo by Aristide Economopoulos for New Jersey Monitor/States Newsroom.) Ohio House Democrats say they are trying to enact common sense gun laws, but face an uphill battle in the Republican supermajority-controlled Ohio Statehouse. Democratic lawmakers have introduced a series of gun-related bills so far this General Assembly that have seen little, if any movement. The one bill that has had a hearing so far is a bipartisan bill. SUBSCRIBE: GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX 'Republicans are focused on passing laws that they hope will distract you from their failures, while at the same time trying to divide us on common sense issues like gun reform,' Ohio House Minority Leader Allison Russo, D-Upper Arlington, said Tuesday during a press conference. 'Ohio Democrats will not stand idly by while Republicans in power refuse to do something about gun violence.' Ohio had 571 gun-related deaths and over 1,700 incidents of gun violence in 2024, said state Rep. Darnell T. Brewer, D-Cleveland. Ohio ranks 21st in the nation for gun violence and gun deaths rose 42% in Ohio from 2013 to 2022, said state Rep. Cecil Thomas, D-Cincinnati. More than 1,000 Ohioans aged 19 and younger died as a result of gun violence in the last decade, according to the Children's Defense Fund. 'When will enough be enough?' Thomas asked. 'How many children have to die before you act? How many women have to be shot by their partners? How many funerals will it take before this legislation does its job? How many other officers have to be shot before we do something?' Gun-related bills introduced so far by Democratic lawmakers include — House Bill 45 — Prohibit certain firearm transfers without a background check was introduced by Thomas and state Rep. Rachel Baker, D-Cincinnati, in February, but has had no committee hearings in the House Public Safety Committee. House Bill 46 — Enact the Extreme Risk Protection Order Act was introduced by Thomas and state Rep. Michele Grim, D-Toledo, in February, but it has had no hearings so far in the House Public Safety Committee. House Bill 120 — Exempt from sales and use tax sales of firearm safety devices was introduced by Brewer and state Rep. Jennifer Gross, R-West Chester, in February and has had sponsor testimony in the Ohio House Ways and Means Committee. House Bill 235, Authorize tax credit for handgun training and firearms storage was introduced by Brewer and state Rep. Meredith R. Lawson-Rowe, D-Reynoldsburg, in April, but it has had no hearings so far in the House Ways and Means Committee. Brewer said he is introducing the community safety solution agenda which includes: A resolution to encourage responsible gun ownership by promoting safe storage practices to prevent children from accessing guns. A resolution on safe firearm storage education. The safe play act that would create a grant program through the state's unclaimed funds to help communities build safe playgrounds. Close the boyfriend loophole act which prevents individuals convicted of dating violence or under protection order from possessing firearms. An act that would create comprehensive grants for cities that declare gun violence a public health crisis. 'We do not seek to outlaw guns, rather, we want to offer common sense regulations and publicize safe responsible ownership of guns,' Lawson-Rowe said. This summer will mark six years since a mass shooting in Dayton killed nine people and more pro-gun laws have since taken effect in the state. Ohio Gov. Mike DeWine signed a bill into law in 2022 that got rid of all training, background check and permitting requirements to carry a concealed weapon. A 2021 law no longer requires people to retreat before they can justifiably hurt or kill someone with a gun in self-defense. 'What we need now is the political will, something that unfortunately continues to be absent from the Republican-controlled legislature,' said state Rep. Michele Grim, D-Toledo. Russo said she wouldn't be surprised if Ohioans try to pass a ballot initiative addressing gun violence and common sense reforms. 'I'm not aware of current efforts to do that, but you know, given how out of line this legislature is the public on this issue, and the lack of action on this issue, it wouldn't be surprising to see that perhaps in the next couple of years,' she said. Ohioans did that in 2023 by voting to enshrine abortion and reproductive rights in the state's constitution. 'Gun violence has no place in our state and in our communities,' Russo said. 'People deserve better. Our children deserve better.' State Rep. Karen Brownlee, D-Symmes Twp., shared stories of gun violence she heard from children when she worked as a mental health therapist. 'A sibling group aged six to 13 running home from the bus stop to avoid a shooting in the middle of their residential neighborhood,' she said. 'A six-year-old accidentally shooting his three-year-old brother to death with a gun left on the coffee table.' These kids would ask her how to stay safe around guns. 'Sadly, the conversations ended with me explaining that Ohio laws protect guns more than they protect people,' Brownlee said. '… We are fighting against a powerful gun lobby which is more interested in sales than citizens.' A new study from George Washington University showed more than 7,000 children died from firearm related injuries since the 2010 Supreme Court ruling that allowed states to set their own gun laws. Follow Capital Journal Reporter Megan Henry on Bluesky. SUPPORT: YOU MAKE OUR WORK POSSIBLE
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‘Expensive and complicated': Most rural hospitals no longer deliver babies
A mother prepares her infant son for bed. Since 2020, 36 states have lost at least one rural labor and delivery department. In rural counties, the loss of hospital-based obstetric care is associated with increases in births in hospital emergency rooms, less prenatal care and higher rates of babies being born too early. (Photo by) Nine months after Monroe County Hospital in rural South Alabama closed its labor and delivery department in October 2023, Grove Hill Memorial Hospital in neighboring Clarke County also stopped delivering babies. Both hospitals are located in an agricultural swath of the state that's home to most of its poorest counties. Many residents of the region don't even have a nearby emergency department. Stacey Gilchrist is a nurse and administrator who's spent her 40-year career in Thomasville, a small town about 20 minutes north of Grove Hill. Thomasville's hospital shut down entirely last September over financial difficulties. Thomasville Regional hadn't had a labor and delivery unit for years, but women in labor still showed up at its ER when they knew they wouldn't make it to the nearest delivering hospital. 'We had several close calls where people could not make it even to Grove Hill when they were delivering there,' Gilchrist told Stateline shortly after the Thomasville hospital closed. She recalled how Thomasville nurses worked to save the lives of a mother and baby who'd delivered early in their ER, as staff waited for neonatal specialists to arrive by ambulance from a distant delivering hospital. 'It would give you chills to see what all they had to do. They had to get inventive,' she said, but the mother and baby survived. Now many families must drive more than an hour to reach the nearest birthing hospital. Nationwide, most rural hospitals no longer offer obstetric services. Since the end of 2020, more than 100 rural hospitals have stopped delivering babies, according to a new report from the Center for Healthcare Quality & Payment Reform, a national policy center focused on solving health care issues through overhauling insurance payments. Fewer than 1,000 rural hospitals nationwide still have labor and delivery services. A small town tries to revive its hospital in the middle of a rural health crisis Across the nation, two rural labor and delivery departments shut their doors every month on average, said Harold Miller, the center's president and CEO. 'It's the perfect storm,' Miller told Stateline. 'The number of births are going down, everything is more expensive in rural areas, health insurance plans don't cover the cost of births, and hospitals don't have the resources to offset those losses because they're losing money on other services, too.' Staffing shortages, low Medicaid reimbursement payments and declining birth rates have contributed to the closures. Some states have responded by changing how Medicaid funds are spent, by allowing the opening of freestanding birth centers, or by encouraging urban-based obstetricians to open satellite clinics in rural areas. Yet the losses continue. Thirty-six states have lost at least one rural labor and delivery unit since the end of 2020, according to the report. Sixteen have lost three or more. Indiana has lost 12, accounting for a third of its rural hospital labor and delivery units. In rural counties the loss of hospital-based obstetric care is associated with increases in births in hospital emergency rooms, studies have found. The share of women without adequate prenatal care also increases in rural counties that lose hospital obstetric services. And researchers have seen an increase in preterm births — when a baby is born three or more weeks early — following rural labor and delivery closures. Babies born too early have higher rates of death and disability. The decline in hospital-based maternity care has been decades in the making. Traditionally, hospitals lose money on obstetrics. It costs more to maintain a labor and delivery department than a hospital gets paid by insurance to deliver a baby. This is especially true for rural hospitals, which see fewer births and therefore less revenue than urban areas. 'It is expensive and complicated for any hospital to have labor and delivery because it's a 24/7 service,' said Miller. A labor and delivery unit must always have certain staff available or on call, including a physician who can perform cesarean sections, nurses with obstetric training, and an anesthetist for C-sections and labor pain management. You can't subsidize a losing service when you don't have profit coming in from other services. – Harold Miller, president and CEO of the Center for Healthcare Quality & Payment Reform 'There's a minimum fixed cost you incur [as a hospital] to have all of that, regardless of how many births there are,' Miller said. In most cases, insurers don't pay hospitals to maintain that standby capacity; they're paid per birth. Hospitals cover their losses on obstetrics with revenue they get from more lucrative services. For a larger urban hospital with thousands of births a year, the fixed costs might be manageable. For smaller rural hospitals, they're much harder to justify. Some have had to jettison their obstetric services just to keep the doors open. 'You can't subsidize a losing service when you don't have profit coming in from other services,' Miller said. And staffing is a persistent problem. Harrison County Hospital in Corydon, Indiana, a small town on the border with Kentucky, ended its obstetric services in March after hospital leaders said they were unable to recruit an obstetric provider. It was the only delivering hospital in the county, averaging about 400 births a year. And most providers don't want to remain on call 24/7, a particular problem in rural regions that might have just one or two physicians trained in obstetrics. In many rural areas, family physicians with obstetrical training fill the role of both obstetricians and general practitioners. Even before Harrison County Hospital suspended its obstetrical services, some patients were already driving more than 30 minutes for care, the Indiana Capital Chronicle reported. The closure means the drive could be 50 minutes to reach a hospital with a labor and delivery department, or to see providers for prenatal visits. A fifth of Americans are on Medicaid. Some of them have no idea. Longer drive times can be risky, resulting in more scheduled inductions and C-sections because families are scared to risk going into labor naturally and then facing a harrowing hourlong drive to the hospital. Having fewer labor and delivery units could further burden ambulance services already stretched thin in rural areas. And hospitals often serve as a hub for other maternity-related services that help keep mothers and babies healthy. 'Other things we've seen in rural counties that have hospital-based OB care is that you're more likely to have other supportive things, like maternal mental health support, postpartum groups, lactation support, access to doula care and midwifery services,' said Katy Kozhimannil, a professor at the University of Minnesota School of Public Health, whose research focuses in part on maternal health policy with a focus on rural communities. Medicaid, the state-federal public insurance for people with low incomes, pays for nearly half of all births in rural areas nationwide. And women who live in rural communities and small towns are more likely to be covered by Medicaid than women in metro areas. Experts say one way to save rural labor and delivery in many places would be to bump up Medicaid payments. As congressional Republicans debate President Donald Trump's tax and spending plan, they're considering which portions of Medicaid to slash to help pay for the bill's tax cuts. Maternity services aren't on the chopping block. But if Congress reduces federal funding for some portions of Medicaid, states — and hospitals — will have to figure out how to offset that loss. The ripple effects could translate into less money for rural hospitals overall, meaning some may no longer be able to afford labor and delivery services. Abortion-ban states pour millions into pregnancy centers with little medical care 'Cuts to Medicaid are going to be felt disproportionately in rural areas where Medicaid makes up a higher proportion of labor and delivery and for services in general,' Kozhimannil said. 'It is a hugely important payer at rural hospitals, and for birth in particular.' And though private insurers often pay more than Medicaid for birth services, Miller believes states shouldn't let companies off the hook. 'The data shows that in many cases, commercial insurance plans operating in a state are not paying adequately for labor and delivery,' Miller said. 'Hospitals will tell you it's not just Medicaid; it's also commercial insurance.' He'd like to see state insurance regulators pressure private insurance to pay more. More than 40% of births in rural communities are covered by private insurance. Yet there's no one magic bullet that will fix every rural hospital's bottom line, Miller said: 'For every hospital I've talked to, it's been a different set of circumstances.' Stateline reporter Anna Claire Vollers can be reached at avollers@ SUPPORT: YOU MAKE OUR WORK POSSIBLE
