The potential fallout from GOP Medicaid cuts is nothing to crow about

Yahoo

28-05-2025

Capitol Police remove a protester in a wheelchair from the House Energy And Commerce Committee hearing room during the committee markup of part of the budget reconciliation package on May 13, 2025, in Washington, D.C. (Photo byfor Protect Our Care)
All four Arkansas Republicans in the U.S. House reacted with undiluted pleasure last week after they and their colleagues pushed through a budget reconciliation bill, by a single vote, that makes significant changes in Medicaid and the SNAP food assistance program, including shifting costs from federal to state budgets.
French Hill veritably gushed, calling it a 'critical win for families' that restores the 'integrity' of Medicaid and SNAP, while Steve Womack said the bill will ensure that both programs 'remain accessible and effective for those who truly need them.'
Rick Crawford trumpeted that House Republicans were 'making safety net programs better serve those who really need them,' while Bruce Westerman said he and his colleagues are 'making sure that people who are getting those benefits are American citizens and that they should be on those programs.'
Of course, determinations of who is truly in need or worthy of help and terms like 'integrity' and 'accessible' can be loaded, subjective and politically motivated. And all this happy talk discounts several factors that should give the congressmen's constituents significant pause should these provisions ever become law.
According to an analysis from the Congressional Budget Office, the House plan will drain nearly $700 billion from Medicaid over eight years, potentially jeopardizing Arkansas' Medicaid expansion, which has been an unqualified success since it passed in 2013.
The program now provides health coverage for 813,000 Arkansans, including 309,000 children. In 74 of Arkansas' 75 counties, more than 20% of the population is covered by Medicaid, with Benton County as the only exception; in 16 counties, it's more than 30%. In 28 counties, more than half of the children are covered either by Medicaid or the CHIP program for kids from lower-income families, including five counties where the rate is above 60%.
Medicaid expansion has also cut Arkansas' uninsured population from nearly 19% before expansion to 9.2% in 2023, according to figures compiled by the Kaiser Family Foundation. This puts us in the top 10 among states, a rare health metric in which we aren't dragging along near the bottom.
The House bill also, for the first time, shifts part of the cost of SNAP to the states, which could blow a $109 million hole in Arkansas' budget, according to an estimate from the Center on Budget and Policy Priorities, a nonpartisan research and policy institute. A shortfall of that magnitude could lead to significant cuts, or even elimination, of a program that feeds 235,000 Arkansans – in a state already ranked dead last for food insecurity.
Even Republican U.S. Sen. John Boozman, who chairs the Senate Agriculture Committee that oversees SNAP, acknowledged this point after the House bill passed, saying senators needed to consider whether the change was an 'unfunded mandate' that might make 'our governors call us.'
The centerpiece of House Republicans' attack on Medicaid is a work requirement that would have a far-reaching impact on the nearly 243,000 Arkansans currently getting coverage under the Medicaid expansion — ignoring direct experience from right here in Arkansas that shows how putting more rigorous bureaucratic requirements on an already vulnerable population will push eligible people out of the program.
In 2018, with the blessing of the first Trump administration, Arkansas started requiring Medicaid recipients to verify their work histories. Some 18,000 people lost coverage before a federal judge ruled that the reporting requirements were contrary to Medicaid's purpose of helping lower-income people obtain medical care.
Based on what happened in Arkansas seven years ago, the Center on Budget and Policy Priorities estimates that as many as 95,000 enrollees in the state could lose coverage under the House reconciliation bill, which includes reporting requirements that are even more stringent than what Arkansas imposed in 2018. That's equivalent to the population of Fayetteville.
And the most immediate deleterious impact these Medicaid cuts would have if they become law would be on our rural hospitals, most of which are already in significant financial distress.
Medicaid expansion helped rural hospitals' bottom lines by reducing the number of uninsured patients and increasing Medicaid patient numbers, increasing revenues and operating margins (although hospitals argue that reimbursement rates need to be higher to fully meet actual costs). Since the program expanded in Arkansas, just one rural hospital, De Queen Medical Center, has closed, and it was replaced by the opening of Sevier County Medical Center.
By contrast, in the three states bordering Arkansas that haven't expanded Medicaid, 42 rural hospitals closed during the same period, cutting off a lifeline for rural residents.
Nearly 28% of residents in small town and rural Arkansas rely on Medicaid for health care coverage and on their rural hospitals for emergency room visits, surgery or even primary care, as often happens in rural areas with a limited number of health care providers. Reducing the number of people covered by Medicaid will reduce hospital revenues, as patients either skip care or are unable to pay for care they do receive.
And these proposed changes in Medicaid could not come at a worse time, with 35 of the 54 rural hospitals in Arkansas already losing money and 10 at imminent risk of closure, according to a new study from the nonpartisan Center for Healthcare Quality and Payment Reform.
The study didn't specify which hospitals were most in danger of closing. But its data shows 11 rural hospitals in Arkansas running a deficit of more than 20% in costs for providing patient care. Eight of those hospitals are in Crawford's district; two are in Westerman's, and one is in Womack's.
The sobering fact is that only 19 rural hospitals in Arkansas are operating in the black overall, and 14 of those are still losing money on patient care. They are at a tipping point; our congressmen have endorsed a bill that could push them over.
Granted, the bill passed last week is unlikely to get through the Senate without major changes, so perhaps panicking unduly over the damage the House bill would do is premature. Yet the fact that Arkansas' entire House delegation not only went along with this but got out their pom-poms to cheer along illustrates a clear disconnect from the needs of ordinary Arkansans.
It's neither 'big' nor 'beautiful' to alarm people by supporting policies that threaten their health care and food assistance and could close their local hospitals. It also seems politically unwise — except, perhaps, if you're a congressman who does not fear democratic accountability. Then, it's a 'critical win.'