Cutting Medicaid And SNAP Is A Risky Strategy. Here's Why

Forbes

15-05-2025

A patient has his blood pressure checked at a Remote Area Medical (RAM) mobile dental and medical ... More clinic in Grundy, Virginia on October 7, 2023 (Photo by)
Other than confirming Trump's cabinet, the 119th Congress has not accomplished much. That could soon change if they enact the 'big, beautiful bill' President Trump has demanded since he regained the White House. The budget language House Republicans have drafted aims to reshape large portions of the federal government and the U.S. economy, which are reeling from a string of executive orders and actions, including DOGE-directed terminations of more than 250,000 scientists, analysts and other federal employees.
The bill touches nearly every aspect of government operations. Still, three elements stand out: 1) In addition to renewing Trump's 2017 tax cuts, which cost $4 trillion over the past decade and skewed towards the rich, it adds a few more; 2) It boosts federal spending by hundreds of billions of dollars to expand the border wall, strengthen maritime border protection, acquire military aircraft, ships and new missile defense technology; 3) To partially offset these tax cuts and new spending, the bill cuts $715 billion from Medicaid over the next 10 years, and billions more from the Supplemental Nutrition Assistance Program (SNAP).
Ironically, the proposed cuts won't save money—they'll shift the costs to state governments, municipalities and the rest of us. Millions of Americans who depend on Medicaid for their healthcare, including low-income rural and urban families, pregnant women, children, the elderly and the disabled, will pay the highest price of all. By cutting Medicaid and SNAP at a time of economic uncertainty for our nation, Republicans have embraced a risky strategy.
Jointly operated by federal and state governments, Medicaid covers 72 million people nationwide. It provides access to a wide range of healthcare services, from prenatal and preventive care to childhood vaccinations and hospital stays. About 42 percent of U.S. births are covered by Medicaid and it is a vital source of funding for rural and urban hospitals, nursing homes, clinics and other healthcare facilities.
Every year, 72 million Americans get health insurance and health care thanks to Medicaid
The budget bill does not directly target covered benefits. Instead, it requires able-bodied recipients without dependents to document, every 6 months, that they engage in at least 80 hours a month of work, education or service. Those who fail to do so will lose their coverage. The bill also adds cost-sharing requirements that will be difficult for many low-income Americans to meet. The Congressional Budget Office (CBO) estimates that the work requirement alone will save $301 billion over 10 years, mainly by pushing roughly 8.6 million Americans into the ranks of the uninsured.
Although requring beneficiaries to work is politically appealing, it is difficult to do in practice. Only 8% of able-bodied, working-age Medicaid recipients are unemployed. The rest work, have substantial child or elder care responsibilities, or are disabled.
Rebecca Hooker, executive director of an emergency food program in West Virginia is not a fan. 'It's easy to say, 'Just get a job,' but what do you do when there are no jobs or people don't want to hire you?' she told a reporter for the Washington Post. 'It's easy to say, 'Eat healthy.' But what do you do if you have to drive for 45 minutes to find healthy food and don't have a car or can't afford to fix the one you have?'
Based on previous adoptiong of this concept, most Medicaid beneficiaries who lose coverage will do so for the wrong reasons. In Trump's first term, Arkansas enacted work requirements. 'It was—in a word—a mess,' said Camille Richoux of Arkansas Advocates to The Economist. By the time a judge intervened, 18,000 people had lost coverage. Researchers found that most were eligible, but had missed a reporting deadline or messed up their paperwork. It's hard enough for those of us with home offices and a computer to keep our records straight. It's nearly impossible for individuals who are struggling at the bottom of the economic ladder.
When beneficiaries lose coverage, their needs and those of their children don't go away. States have an interest in keeping their populations as healthy as possible. However, the bill Republicans have crafted will not only shift more costs to the states; it will limit their ability to raise revenue through provider taxes. Congressional Republicans are also considering a plan to force states to cover 5 to 25 percent of SNAP funding and boost their share of its administrative costs to 75%. Previously, states paid half of the program's overhead and were not required to contribute to benefits. Since states cannot run deficits, these provisions will force them to make painful tradeoffs. Will they cut funding for Medicaid and SNAP, push beneficiaries off the rolls, or reduce state support for other priorities such as education and economic development?
Cutting Medicaid will not only harm millions of low-income individuals. It may force many rural hospitals and clinics to close. In affected communities, everyone will have to travel longer distances for care, which may only be available in a crowded emergency room. As an ER doctor, I know that when patients delay seeking care (whether due to lengthy travel or worry about the cost), they often become sicker and more expensive to treat.
When hospitals treat uninsured patients, the bills often go unpaid. Previously, they offset this expense by increasing the rates they charge patients with commercial health insurance. But in recent years, insurance companies have grown so powerful that few agree to go along. As more hospitals sink into the red, they'll be forced to lay off employees, thin staffing to unsafe levels, shut down entire floors, or close their doors. In urban areas, Children's and public hospitals that treat large numbers of Medicaid patients will be severely challenged, as will teaching hospitals with busy trauma or obstetrical programs. No community can afford to lose these services. Ultimately, everyone's care will be compromised.
Cuts to SNAP will produce similar ripple effects. Inability to pay for food will not only harm the health and well-being of low-income families with young children – it will hurt local farmers, food wholesalers and retailers who serve low-income shoppers. Faith-based organizations and local food pantries are already doing the best they can. They won't be able to make up the difference.
Speaker of the House Mike Johnson (R-LA) talks to reporters during a news conference at the U.S. ... More Capitol Visitors Center on February 14, 2024 (Photo by)
House Republicans have alternatives. They could defer or delay renewing Trump's tax cuts for the wealthy, but this would enrage the President. They could enact policies to reduce healthcare costs for everyone, including middle-class families who rely on employer-sponsored health insurance, but this would enrage powerful players in the healthcare industry. Because cuts to Medicare or Social Security were quickly taken off the table, they've picked the path of least resistance – imposing work requirements and other measures to reduce federal spending on two programs that are vital to the health and well-being of tens of millions of low-income Americans and thousands of rural communities. Even then, their 'big beautiful bill' will add more than $2.5 trillion to our national debt over the next ten years, according to nonpartisan budget experts.
Medicaid beneficiaries have little political power, but they do have the right to vote. Time will tell if Speaker Johnson and his colleagues made the right call.