Bookman: There's no way to cut $800 billion from Medicaid without hitting bone

Yahoo

05-06-2025

Opinion writer Jay Bookman argues that Trump administration officials are being dishonest when they say cuts to Medicaid won't lead to people losing benefits. the_burtons/Getty Images
After repeatedly promising on the campaign trail that he would never cut Medicaid benefits, Donald Trump is pushing a 'big, beautiful' spending bill that would slash Medicaid and other health care spending by $800 billion over the next decade.
And if you still believe the administration, they're going to make those cuts without anyone losing benefits. As White House official Russell Vought put in last week, 'This bill will preserve and protect the programs, the social safety net, but it will make it much more common sense. No one will lose coverage as a result.'
If your BS detector isn't ringing by now, you need to take it in for repair.
Confronted with the absurdity of claiming that you can cut $800 billion without canceling health care coverage, Trump officials retreat to their fallback position. Yes, they admit, they'll be cutting benefits, but only for those who don't deserve it.
'Medicaid does not belong to people who are here illegally, and it does not belong to capable and able-bodied men who refuse to work,' another White House official told Politico. 'So no one is getting cut.'
Once again, though, your BS detector ought to be blaring. Under existing federal law, undocumented immigrants are already barred from getting Medicaid. They're promising to cut benefits to people who are already not getting those benefits. So no savings there.
And the truth is, most of the able-bodied men who are too lazy to work are also too lazy to worry about jumping through the hoops needed to get Medicaid health-care coverage. Such men do exist, no doubt, but in numbers far too small to generate $800 billion in savings.
To get savings on that scale, you have to look elsewhere. And the truth is that millions of lower-income Americans, many of them working people, would be stripped of their health insurance if the bill becomes law. In Georgia alone, the projections are that as many as 200,000 people would lose coverage. And because Medicaid plays a larger health care role in rural communities, where the population is older and private sector jobs less likely to offer health insurance, the impact would be greater in those areas, putting additional financial strain on rural hospitals and health-care providers already struggling to stay open.
(If Congress also refuses to extend subsidies for the Affordable Care Act later this year, as seems likely, the total number of Georgians who lose health insurance could top 700,000.)
And no, the money saved by such measures would not be used to reduce the nation's deficit. It would instead be used to finance tax cuts, the overwhelming majority of which would benefit the wealthy.
A big chunk of the projected savings, an estimated $280 billion, would come from instituting work requirements for Medicaid recipients. The model for that nationwide requirement is supposedly the Pathways program instituted here in Georgia in 2020 by Gov. Brian Kemp.
By most measures, however, that program has proved a massive disappointment. According to the original projections by the Kemp administration, some 25,000 low-wage Georgians should have been enrolled in Medicaid through the program in its first year of operation.
The actual number was 4,300.
By the end of its second year of operation, which comes next month, total enrollment was projected to be almost 50,000. As of April 25, it was 7,400, according to reporting by ProPublica and The Current. The monthly reporting requirements, record-keeping and bureaucratic red tape proved so discouraging that many Georgia applicants gave up in frustration, choosing instead to take the risk that they would not need coverage.
If it seems odd that such a program would be embraced as a model by the GOP, it might be a matter of perspective. It might be that your idea of a failure is somebody else's idea of a success, because the two of you have different goals in mind.
In this case, if your goal is to provide at least a bare-bones health insurance plan to lower-income Americans, then Georgia's Pathways program has failed. However, if your goal is to discourage and obstruct as many Americans as possible from participating in that coverage, because you want to generate $800 billion in savings so the rich can get more tax cuts, then it starts to look a whole lot better.
Those yachts aren't going to buy themselves.
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