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Yahoo
7 days ago
- Business
- Yahoo
'Big Beautiful Bill' dings states that offer health care to some immigrants here legally
Jun. 3—The Republican budget bill the U.S. House approved last month includes a surprise for the 40 states that have expanded Medicaid: penalties for providing health care to some immigrants who are here legally. Along with punishing the 14 states that use their own funds to cover immigrants who are here illegally, analysts say last-minute changes to the bill would make it all but impossible for states to continue helping some immigrants who are in the country legally, on humanitarian parole. Under the bill, the federal government would slash funding to states that have expanded Medicaid and provide coverage to immigrants who are on humanitarian parole — immigrants who have received permission to temporarily enter the United States due to an emergency or urgent humanitarian reason. The federal government pays 90% of the cost of covering adults without children who are eligible under Medicaid expansion, but the bill would cut that to 80% for those states, doubling the state portion from 10% to 20%. That's the same penalty the bill proposes for states that use their own money to help immigrants who are here illegally. Ironically, states such as Florida that have extended Medicaid coverage to immigrants who are here on humanitarian parole but have not expanded Medicaid under the Affordable Care Act would not be harmed by the bill, said Leonardo Cuello, a Medicaid law and policy expert and research professor at the Center for Children and Families at Georgetown University's McCourt School of Public Policy. It is "wildly nonsensical and unfair" to penalize expansion states for covering a population that some non-expansion states, such as Florida, also cover, Cuello said. "It would appear that the purpose is more to punish expansion states than address any genuine concern with immigrant coverage." West Virginia is one of the states where lawmakers are nervously watching U.S. Senate discussions on the proposed penalty. Republican state Rep. Matt Rohrbach, a deputy House speaker, said West Virginia legislators tabled a proposal that would have ended Medicaid expansion if the federal government reduced its share of the funding, because the state's congressional representatives assured them it wasn't going to happen. Now the future is murkier. Cuello called the proposed penalty "basically a gun to the head of the states." "Congress is framing it as a choice, but the state is being coerced and really has no choice," he said. There are about 1.3 million people in the United States on humanitarian parole, from Afghanistan, Cuba, Haiti, Nicaragua, Ukraine and Venezuela as well as some Central American children who have rejoined family here. The Trump administration is trying to end parole from some of those countries. A Supreme Court decision May 30 allows the administration to end humanitarian parole for about 500,000 people from Cuba, Haiti, Nicaragua and Venezuela. Not many of those parolees qualify for Medicaid, which requires a waiting period or special status, but the 40 states with expanded Medicaid could be penalized if immigrants qualify for the program, said Tanya Broder, senior counsel for health and economic justice policy at the National Immigration Law Center. It would appear that the purpose is more to punish expansion states than address any genuine concern with immigrant coverage. — Leonardo Cuello, Georgetown University research professor Meanwhile, an increasing number of states and the District of Columbia already are considering scaling back Medicaid coverage for immigrants because of the costs. The federal budget bill, named the One Big Beautiful Bill Act, is now being considered by the Senate, where changes are likely. The fact that so many states could be affected by the last-minute change could mean more scrutiny in that chamber, said Andrea Kovach, senior attorney for health care justice at the Shriver Center on Poverty Law in Chicago. By her count, at least 38 states and the District of Columbia would be affected by the new restrictions, since they accepted some options now offered by Medicaid to cover at least some humanitarian parolees without a five-year waiting period. "They're all going to be penalized because they added in parolees," Kovach said. "So that's 38 times two senators who are going to be very interested in this provision to make sure their state doesn't get their reimbursement knocked down." The change to exclude people with humanitarian parole was included in a May 21 amendment by U.S. Rep. Jodey Arrington, a Texas Republican who chairs the House budget committee. Arrington's office did not reply to a request for comment, though he has stressed the importance of withholding Medicaid from immigrants who are here illegally. "[Democrats] want to protect health care and welfare at any cost for illegal immigrants at the expense of hardworking taxpayers," Arrington said in a May 22 floor speech urging passage of the bill. "But by the results of this last election, it's abundantly clear: The people see through this too and they have totally rejected the Democrats' radical agenda." Some states already are considering cutting Medicaid coverage for immigrants, though Democratic lawmakers and advocates are pushing back. Washington, D.C., Democratic Mayor Muriel Bowser has proposed phasing out a program that provides Medicaid coverage to adults regardless of their immigration status, a move she says would save the District of Columbia $457 million. Minnesota advocates protested a state budget deal reached last month with Democratic Gov. Tim Walz to phase out health care coverage for adults who are here illegally, a condition Republican lawmakers insisted on to avoid a shutdown. Similarly, Illinois advocates are protesting new state rules that will end a program that has provided Medicaid coverage to immigrants aged 42-64 regardless of their legal status. The program cost $1.6 billion over three years, according to a state audit. The state will continue a separate program that provides coverage for older adults. "Our position is that decision-makers in Illinois shouldn't be doing Trump's work for him," said Kovach, of the Shriver Center on Poverty Law. "Let's preserve health coverage for immigrants and stand up for Illinois immigrant residents who have been paying taxes into this state for years and need this coverage." Illinois state Sen. Graciela Guzmán, a Democrat whose parents are refugees from El Salvador, said many of her constituents in Chicago may be forced to cancel chemotherapy or lifesaving surgery because of the changes. "It was a state budget, but I think the federal reconciliation bill really set the tone for it," Guzmán said. "In a tough fiscal environment, it was really hard to set up a defense for this program." Oregon Democratic Gov. Tina Kotek is among the governors holding firm, saying that letting immigrants stay uninsured imposes costs on local hospitals and ends up raising prices for everyone. "The costs will go somewhere. When everyone is insured it is much more helpful to keep costs down and reasonable for everyone. That's why we've taken this approach to give care to everyone," Kotek said at a news conference last month. Medicaid does pay for emergency care for low-income patients, regardless of their immigration status, and that would not change under the federal budget bill. Franny White, a spokesperson for the Oregon Health Authority, said her state's Medicaid program covers about 105,000 immigrants, some of whom are here illegally. She said the policy, established by a 2021 state law, can save money in the long run. "Uninsured people are less likely to receive preventive care due to cost and often wait until a condition worsens to the point that it requires more advanced, expensive care at an emergency department or hospital," she said. California was among the first states, along with Oregon, to offer health insurance to immigrants of all ages regardless of their legal status. But it now is considering cutting back, looking to save $5 billion as it seeks to close a $12 billion budget deficit. In May, Democratic Gov. Gavin Newsom proposed freezing enrollment of immigrant adults who are here illegally, and charging them premiums to save money. "It's possible that other states will decide to cut back these services because of budgetary concerns," said Drishti Pillai, director of immigrant health policy at KFF, a health policy research organization. If the federal budget bill passes with the immigrant health care provision intact, states would have more than two years to adjust, since the changes would not take effect until October 2027. "We have time to really understand what the landscape looks like and really create a legal argument to make sure folks are able to maintain their health care coverage," said Enddy Almonord, director for Healthy Illinois, an advocacy group supporting universal health care coverage. Editor's note: This story has been updated to clarify remarks from Tanya Broder at the National Immigration Law Center. Stateline reporter Tim Henderson can be reached at [email protected]. YOU MAKE OUR WORK POSSIBLE.
The Herald Scotland
18-05-2025
- Health
- The Herald Scotland
What to know about the proposed Republican cuts to Medicaid
The proposal is part of a massive policy package that aims to implement President Donald Trump's campaign promises, including an array of tax cuts that will cost an estimated $4 trillion over the next 10 years. Under pressure from ultraconservatives in the Republican conference, congressional leaders are trying to find ways to offset that revenue loss with commensurate cuts to federal spending. Health insurance benefit programs are one of the largest federal spending categories. Trump has said Medicare cuts are off the table, so changes to Medicaid became a central focus of potential cost savings for Republicans. One in five Americans are on Medicaid nationwide, including around 40% of all children. While the lawmakers did not include some of the more draconian cuts to Medicaid they had considered, the proposed changes are significant. They would save the federal government at least $625 billion and cause 7.6 million Americans to lose their health insurance over the next 10 years, according to initial estimates by the nonpartisan Congressional Budget Office. However, the impacts are likely greater, as the agency was unable to analyze the effects of at least 10 provisions in the bill by the time the estimates were released. The CBO also estimates 1.3 million people who are both on Medicaid and Medicare, which provides health care for seniors, would lose Medicaid coverage. That means some benefits that Medicaid covers but Medicare does not, such as long-term care, would be lost. "Medicaid is absolutely critical for children, for families, for people with disabilities and seniors," said Joan Alker, executive director of the Center for Children and Families at Georgetown University. "There's a great deal at stake here." Both Republicans and Democrats alleged the other side was lying about its impacts during a tense House committee hearing May 13 to debate the proposal. Republicans argued the changes are intended to eliminate "waste, fraud and abuse" from the program and said it would not hurt the people who most need Medicaid, while Democrats argued the proposal would dramatically reduce access to essential healthcare. "Medicaid was created to provide health care for Americans who otherwise could not support themselves, but Democrats expanded the program far beyond this core mission," said Rep. Brett Guthrie, R-Kentucky, chair of the House Energy and Commerce Committee that has spearheaded the Medicaid portion of the legislation. "We are cutting money and health care from people and families who are suffering to pay for tax cuts for the rich," said Rep. Alexandria Ocasio Cortez, D-New York. So what's really in the legislation? Here's what you need to know. Changes to Medicaid expansion Medicaid was originally designed to provide health coverage for low-income Americans. The Affordable Care Act, also known as Obamacare, expanded Medicaid to cover low-income adults who are not seniors in every state and made people eligible if they were making up to 138% of the federal poverty level. That law also said the federal government would pay for 90% of the cost of the expansion, with the other 10% made up by states. But states needed to adopt the expansion in order for it to be offered to their residents. Another law passed under former President Joe Biden created a financial incentive for states to do so. This bill would eliminate that incentive. Right now, 41 states and Washington, DC, have adopted the Medicaid expansion. The bill would also allow states to charge up to $35 per service for these adults covered under Medicaid expansion who make between 110% and 138% of the federal poverty level, which is currently $35,365 to $44,367 annually for a family of four. Work requirements The biggest change under the proposed bill would be the implementation of work requirements for adults enrolled in Medicaid expansion. "Large shares - almost half of the (bill's) estimated savings - are coming from provisions to require states to impose work requirements," said Robin Rudowitz, vice president at the nonpartisan health policy organization KFF. "We know from other analyses and earlier estimates of these provisions that they do result in significant coverage loss." Even people who have jobs or are disabled can lose coverage if they don't clear the bureaucratic hurdles. For example, a Medicaid work requirement program in Arkansas resulted in around 25% of those subject to the requirement losing coverage, primarily because they failed to regularly report work status or prove their eligibility for an exemption. Guthrie said during the committee debate that Republicans are not trying to model Arkansas, listing a the bill's multiple exemptions. Under the proposed legislation, people ages 19 to 64 would be required to show that they are working, doing community service or participating in an educational program for at least 80 hours a month. Some adults - such as pregnant women, people with disabilities, and people who are caregivers of dependent children - would be exempt. It would also explicitly prevent the policy from being waived for certain states. These changes would only go into effect in January 2029, after Trump's term is over, though GOP hardliners are pushing leadership for those to go into effect sooner. Increased eligibility checks Right now, states are required to check whether Medicaid enrollees are still qualified for benefits once every year. The Republican proposal would increase the frequency of those checks to every six months. States would also be required to proactively obtain updated contact information for Medicaid participants, including checking enrollee addresses to prevent enrollment in multiple states and regular review of the Master Death File to see if enrolled people have died. States are also required to provide Medicaid coverage for qualified medical expenses up to 90 days before someone applies for coverage. The bill would limit that retroactive coverage to just one month before a person applies. Medicaid providers would also be checked every month to determine whether they are still eligible to provide services under the program and would also be checked against the Master Death File. The bill also includes provisions aimed at reducing the price of prescription drugs by adding new requirements for pharmacy benefit managers to prevent them from overpricing medication. Discouraging coverage for undocumented children It is already illegal for undocumented immigrants to get federal Medicaid benefits. However, states are required to provide Medicaid coverage to otherwise qualified applicants for 90 days while their immigration status is being verified. The proposed legislation would end the requirement for states to provide coverage during that 90-day period. States would still be allowed to do so if they choose, but the bill bars states from receiving matching funds during that period. Fourteen states use their own funds to provide health coverage to undocumented children, and seven states do so for adults. The bill would punish states for using their own money to provide those services by reducing the expansion match rate from 90% to 80%. Planned Parenthood in the crosshairs Medicaid recipients are currently allowed to get services from any qualified provider, including clinics like Planned Parenthood, though federal funds cannot be used to directly pay for abortions. The bill would bar Medicaid from paying for services of any kind at nonprofits that are primarily engaged in family planning or reproductive health and provide abortions. That could be a sizable blow to Planned Parenthood and the women it serves: Around one in 10 female Medicaid beneficiaries between the ages of 15 and 49 receive family planning services at Planned Parenthood, according to KFF. In addition to abortions, Planned Parenthood clinics offer birth control, pregnancy testing, STD testing, and basic gynecological services. Another provision in the bill would bar federal matching funds for "gender transition procedures" for Medicaid or CHIP enrollees under age 18, including puberty blockers, hormone treatment or surgery. Financing restrictions Right now, states are allowed to raise money to pay for their portion of Medicaid spending through local government, state government, and health care-related taxes known as "provider taxes." The proposed legislation would bar states from creating new provider taxes or increasing the rates of any existing taxes. People who support limiting provider taxes argue they are used to artificially inflate the amount of money the federal government pays into the program. Experts say restricting provider taxes would likely force states to make difficult choices to make up additional costs. "There are very big cuts to Medicaid here, and states will not have any good choices to make up these lost federal funds," said Alker of Georgetown. "States have to either raise taxes, cut people off, or restrict access and benefits."
Yahoo
28-02-2025
- Health
- Yahoo
How 7 states could thwart GOP plans to overhaul Medicaid
Republicans are facing a nationwide backlash over the fate of Medicaid — but the potential program cuts are most threatening in seven conservative-leaning states where voters have cast ballots to expand the entitlement in recent years. It's a growing problem as Republicans hunt for enough savings to pay for the White House's proposed tax cuts. Republican Sen. Mike Rounds of South Dakota, which has enrolled more than 24,000 people in Medicaid since voters expanded the insurance program for low-income people in 2022, told POLITICO he's been arguing against some of his own party's proposals. One would reduce significantly how much funding for the program comes from the federal government. 'That's not a cost cutting measure — that's a cost transfer,' he said. 'And when you've got partnerships with the states, you shouldn't be doing that without having them involved in the discussion.' Republicans face similar skepticism across red and purple swaths of the country where voters have used ballot initiatives to expand Medicaid since Congress last targeted the safety net health insurance program in 2017 – not only in South Dakota, but also in Idaho, Nebraska, Maine, Oklahoma, Missouri and Utah. President Donald Trump won all of those states except Maine. And even there, he won an electoral vote by defeating Kamala Harris in the state's 2nd Congressional District, where nearly a third of people are enrolled in Medicaid. The president's conflicting guidance to Congress about whether and how much to cut from the program suggests he is aware of the political peril. Additional states could expand Medicaid in the coming years, making future rollbacks even more challenging. There's currently a campaign underway in Florida to put expansion on the ballot in 2026, underscoring the popularity of Medicaid even in the most MAGA-friendly states. 'Cutting Medicaid seems to be popular with some Republican elites and some right wing think tanks that are getting funded by some right wing billionaires, but they're unquestionably not popular with the Republican voters,' Joan Alker, the executive director of the Center for Children and Families at Georgetown University's McCourt School of Public Policy, told reporters at a briefing on Medicaid this week. 'We've seen many polls recently asking voters to rank what they wanted … and cutting Medicaid was literally the last on the list for voters of all stripes.' Coalitions on the ground in the seven states that passed Medicaid expansion initiatives — made up of powerful hospital associations, grassroots advocacy groups and other strange bedfellows — are now re-mobilizing to defend them. They're sending people to town halls. They're publishing op-eds in local newspapers. They're flooding the phone lines of their members of Congress. And they're mulling a revival of some of the more aggressive tactics activists used to protest attempts to repeal the Affordable Care Act in 2017. 'We're going back to the old playbook,' said Matt Slonaker, the executive director of the Utah Health Policy Project who spearheaded the state's ballot initiative campaign in 2018. 'It's always hard to get folks to act, but they seem to be really, really ready to do this right now.' With pressure mounting to find hundreds of billions in savings, lawmakers who are usually on board with slashing government spending remain on high alert about the blowback they could face in their states over Medicaid. And as they struggle to keep their members united behind Trump's budget plan, GOP leadership is taking notice. House Speaker Mike Johnson on Wednesday night backed away from some of the most sweeping changes the GOP had been debating, including capping the funds states get for each Medicaid enrollee and rolling back federal support for expansion states, even as he dismissed outrage his members have recently faced over threatened cuts at fiery town halls across the country as the work of 'paid protesters.' 'All this attention is being paid to Medicaid because that's the Democrats' talking point,' Johnson said. 'We're talking about finding efficiencies in every program, but not cutting benefits for people who rightly deserve them.' Pro-expansion health care groups in these seven red and purple states mounted expensive and time-consuming ballot initiative campaigns to circumvent conservative state legislatures and governors who refused to expand Medicaid, and some of those same state officials are currently working to roll back the expanded coverage their constituents enacted. That's left Republicans on Capitol Hill from Medicaid-expansion states as the loudest — and in some cases the only — effective voices of opposition to the proposed cuts now that Democrats are locked out of power. And while some House Republicans who represent red districts are feeling the heat, senators will have to answer to their entire state. 'I don't quite think Republicans know the backlash they're in for,' said Brad Woodhouse, a former Democratic National Committee official who now runs the progressive health care advocacy group Protect Our Care. 'And it's going to be a particularly bitter pill in these states that have used ballot initiatives because in those cases, the voters have really spoken about their preference.' Republican Sens. Josh Hawley of Missouri and Susan Collins of Maine — both of whom hail from states that expanded Medicaid by ballot measure — crossed the aisle earlier this week to support a Democratic amendment to the Senate budget resolution that would have blocked tax cuts for the wealthy if any Medicaid funding is cut. Hawley, who represents about 326,000 people who became eligible for Medicaid under the state's 2021 expansion, has said he wouldn't support 'severe' cuts to Medicaid — specifically cuts that would lead to reduced benefits — calling it a 'red line' for securing his vote. The politics are especially tricky for representatives of more rural states where Medicaid has been a lifeline for hospitals struggling to keep the lights on — hospitals that in some instances are among the state's biggest employers. In Idaho, for example, voters approved expanding Medicaid in 2018 with 61 percent support, extending coverage to about 90,000 more residents. But if federal funding for Medicaid decreases as a result of the current negotiations in Washington, the state legislature has the power to intervene and potentially repeal the expansion. Idaho House Minority Leader Ilana Rubel, a Democrat, is among those warning that such an outcome would threaten the state's remaining rural hospitals. 'That's a disaster, not only for the people on Medicaid, but for the people on private insurance,' Rubel said. 'Because when you live in these rural areas, you know you can have the best insurance in the world, but if the hospital in your area has gone out of business and you fall off a ladder or have a heart attack, there will be nobody to help you.' Yet not every Republican from an expansion state is worried about the sweeping reforms hardliners in their caucus are pushing for. Sen. James Lankford of Oklahoma, where more than 245,000 people became eligible for coverage after the state voted to expand Medicaid in 2020, echoed Speaker Johnson's argument that the final budget would not impact individuals' health care benefits and said he hadn't heard from concerned citizens about it. 'I have not heard anyone talking about cutting off Medicaid to people,' he said. 'It has been dealing with formulas. It's been dealing with fraud.' Utah Sen. John Curtis told POLITICO this week that after discussing the matter with Republican Gov. Spencer Cox, he's not sweating the political implications. He said he's 'not near as concerned' about cuts to the safety net program as he is 'about the fiscal irresponsibility that we're facing,' adding that he's 'in total harmony with our state leaders on this.' Medicaid enrollment in Utah grew nearly 60 percent after a ballot measure expanding the program passed in 2018. But Utah is among the nine states that has a 'trigger' law in place to automatically end Medicaid expansion or require major changes to the program if federal funds decline, threatening coverage for millions of people. For Curtis, that's a feature rather than a bug. 'Our state is one of more fiscally responsible states, in my opinion, and they saw this coming,' he said.
Politico
28-02-2025
- Health
- Politico
How 7 states could thwart GOP plans to overhaul Medicaid
Republicans are facing a nationwide backlash over the fate of Medicaid — but the potential program cuts are most threatening in seven conservative-leaning states where voters have cast ballots to expand the entitlement in recent years. It's a growing problem as Republicans hunt for enough savings to pay for the White House's proposed tax cuts. Republican Sen. Mike Rounds of South Dakota, which has enrolled more than 24,000 people in Medicaid since voters expanded the insurance program for low-income people in 2022, told POLITICO he's been arguing against some of his own party's proposals. One would reduce significantly how much funding for the program comes from the federal government. 'That's not a cost cutting measure — that's a cost transfer,' he said. 'And when you've got partnerships with the states, you shouldn't be doing that without having them involved in the discussion.' Republicans face similar skepticism across red and purple swaths of the country where voters have used ballot initiatives to expand Medicaid since Congress last targeted the safety net health insurance program in 2017 – not only in South Dakota, but also in Idaho, Nebraska, Maine, Oklahoma, Missouri and Utah. President Donald Trump won all of those states except Maine. And even there, he won an electoral vote by defeating Kamala Harris in the state's 2nd Congressional District, where nearly a third of people are enrolled in Medicaid. The president's conflicting guidance to Congress about whether and how much to cut from the program suggests he is aware of the political peril. Additional states could expand Medicaid in the coming years, making future rollbacks even more challenging. There's currently a campaign underway in Florida to put expansion on the ballot in 2026, underscoring the popularity of Medicaid even in the most MAGA-friendly states. 'Cutting Medicaid seems to be popular with some Republican elites and some right wing think tanks that are getting funded by some right wing billionaires, but they're unquestionably not popular with the Republican voters,' Joan Alker, the executive director of the Center for Children and Families at Georgetown University's McCourt School of Public Policy, told reporters at a briefing on Medicaid this week. 'We've seen many polls recently asking voters to rank what they wanted … and cutting Medicaid was literally the last on the list for voters of all stripes.' Coalitions on the ground in the seven states that passed Medicaid expansion initiatives — made up of powerful hospital associations, grassroots advocacy groups and other strange bedfellows — are now re-mobilizing to defend them. They're sending people to town halls. They're publishing op-eds in local newspapers. They're flooding the phone lines of their members of Congress. And they're mulling a revival of some of the more aggressive tactics activists used to protest attempts to repeal the Affordable Care Act in 2017. 'We're going back to the old playbook,' said Matt Slonaker, the executive director of the Utah Health Policy Project who spearheaded the state's ballot initiative campaign in 2018. 'It's always hard to get folks to act, but they seem to be really, really ready to do this right now.' With pressure mounting to find hundreds of billions in savings, lawmakers who are usually on board with slashing government spending remain on high alert about the blowback they could face in their states over Medicaid. And as they struggle to keep their members united behind Trump's budget plan, GOP leadership is taking notice. House Speaker Mike Johnson on Wednesday night backed away from some of the most sweeping changes the GOP had been debating, including capping the funds states get for each Medicaid enrollee and rolling back federal support for expansion states, even as he dismissed outrage his members have recently faced over threatened cuts at fiery town halls across the country as the work of 'paid protesters.' 'All this attention is being paid to Medicaid because that's the Democrats' talking point,' Johnson said. 'We're talking about finding efficiencies in every program, but not cutting benefits for people who rightly deserve them.' Pro-expansion health care groups in these seven red and purple states mounted expensive and time-consuming ballot initiative campaigns to circumvent conservative state legislatures and governors who refused to expand Medicaid, and some of those same state officials are currently working to roll back the expanded coverage their constituents enacted. That's left Republicans on Capitol Hill from Medicaid-expansion states as the loudest — and in some cases the only — effective voices of opposition to the proposed cuts now that Democrats are locked out of power. And while some House Republicans who represent red districts are feeling the heat, senators will have to answer to their entire state. 'I don't quite think Republicans know the backlash they're in for,' said Brad Woodhouse, a former Democratic National Committee official who now runs the progressive health care advocacy group Protect Our Care. 'And it's going to be a particularly bitter pill in these states that have used ballot initiatives because in those cases, the voters have really spoken about their preference.' Republican Sens. Josh Hawley of Missouri and Susan Collins of Maine — both of whom hail from states that expanded Medicaid by ballot measure — crossed the aisle earlier this week to support a Democratic amendment to the Senate budget resolution that would have blocked tax cuts for the wealthy if any Medicaid funding is cut. Hawley, who represents about 326,000 people who became eligible for Medicaid under the state's 2021 expansion, has said he wouldn't support 'severe' cuts to Medicaid — specifically cuts that would lead to reduced benefits — calling it a 'red line' for securing his vote. The politics are especially tricky for representatives of more rural states where Medicaid has been a lifeline for hospitals struggling to keep the lights on — hospitals that in some instances are among the state's biggest employers. In Idaho, for example, voters approved expanding Medicaid in 2018 with 61 percent support, extending coverage to about 90,000 more residents. But if federal funding for Medicaid decreases as a result of the current negotiations in Washington, the state legislature has the power to intervene and potentially repeal the expansion. Idaho House Minority Leader Ilana Rubel, a Democrat, is among those warning that such an outcome would threaten the state's remaining rural hospitals. 'That's a disaster, not only for the people on Medicaid, but for the people on private insurance,' Rubel said. 'Because when you live in these rural areas, you know you can have the best insurance in the world, but if the hospital in your area has gone out of business and you fall off a ladder or have a heart attack, there will be nobody to help you.' Yet not every Republican from an expansion state is worried about the sweeping reforms hardliners in their caucus are pushing for. Sen. James Lankford of Oklahoma, where more than 245,000 people became eligible for coverage after the state voted to expand Medicaid in 2020, echoed Speaker Johnson's argument that the final budget would not impact individuals' health care benefits and said he hadn't heard from concerned citizens about it. 'I have not heard anyone talking about cutting off Medicaid to people,' he said. 'It has been dealing with formulas. It's been dealing with fraud.' Utah Sen. John Curtis told POLITICO this week that after discussing the matter with Republican Gov. Spencer Cox, he's not sweating the political implications. He said he's 'not near as concerned' about cuts to the safety net program as he is 'about the fiscal irresponsibility that we're facing,' adding that he's 'in total harmony with our state leaders on this.' Medicaid enrollment in Utah grew nearly 60 percent after a ballot measure expanding the program passed in 2018. But Utah is among the nine states that has a 'trigger' law in place to automatically end Medicaid expansion or require major changes to the program if federal funds decline, threatening coverage for millions of people. For Curtis, that's a feature rather than a bug. 'Our state is one of more fiscally responsible states, in my opinion, and they saw this coming,' he said.
Los Angeles Times
27-02-2025
- Business
- Los Angeles Times
Column: The family-values hypocrisy of cutting Medicaid
Hello and happy Thursday. MAGA Republicans love babies, as they are quick to claim — the more the better! As long as they don't have to take care of them. Fathers that 'run like water' are nothing new, as the old John Prine song says. Neither are the looming threats to Medicaid in the current Republican budget — up to $88 billion a year in cuts for the next decade — which 186 male Republican House members (and 31 female Republicans, to be fair) just voted for. The lone GOP dissent was Kentucky Rep. Thomas Massie, whose state would be pummeled by the reductions. The vote this week represents another cruel example of how certain conservatives have a long history of talking about family values while simultaneously abandoning actual families. Because guess who benefits the most from Medicaid and CHIP, the Children's Health Insurance Program? 'Stripping this funding jeopardizes the safety of moms and babies,' said Joan Alker, executive director and co-founder of the Center for Children and Families at Georgetown University McCourt School of Public Policy. 'The consequences would be devastating.' House Republicans voted Tuesday to pass a budget proposal that keeps tax cuts (especially for rich folks) from the Trump 1.0 era by cutting costs in other areas. While Medicaid isn't explicitly mentioned, it is de facto on the chopping block. That's because the proposal instructs the House Energy and Commerce Committee to find ways to cut spending by $880 billion over 10 years. That committee oversees spending for Medicaid and Medicare among other, smaller programs. Finding that large of a sum of money to save would almost certainly require digging it out of Medicaid. (Republicans wouldn't dare touch Medicare.) Separately, Republicans are also looking to slash food assistance. The budget instructs the House Agriculture Committee to also make cuts in programs it handles, which likely means gutting the Supplemental Nutrition Assistance Program, or SNAP. Doing so would literally take food away from kids. Republicans are claiming that the Elon Musk-driven Department of Government Efficiency, which is not a government department at all, will find enough fraud and abuse in the system to prevent these cuts, and Trump has promised not to touch Medicaid, if you still believe in Trump promises. 'Look, Medicaid has never been on the chopping block,' House Speaker Mike Johnson (R-La.) said during a news conference, according to the Hill. But he also recently said: 'Medicaid is hugely problematic because it has a lot of fraud, waste and abuse. Everybody knows that. We all know it intuitively.' So far, Musk's crew has had to walk back multiple claims of saving billions of dollars after public scrutiny has found errors in its accounting and data, and it has not offered any dollar figure for fraud found specifically in Medicaid. Actual government entities that do fight fraud haven't found the level of abuse in Medicaid that would be required to fund the tax cuts, either — although there is fraud. The Government Accountability Office, which investigates such things for Congress, found that in 2024, Medicaid made about $31 billion in 'improper payments.' Alker points out that most of this fraud doesn't involve covered individuals running a scam, but rather provider organizations — labs, medical groups, etc.— billing too much or for services not provided. Another option for cutting expenses would be to shift more Medicaid costs to the states, which would also be a de facto cut in services, since states, even California, likely couldn't afford to keep the plan as-is without that federal money. Or federal legislators could even try again for a work requirement to qualify for Medicaid, a beloved but flawed favorite of Republicans and Project 2025 adherents, as my colleague Michael Hiltzik aptly pointed out not long ago. But the truth is aiming at Medicaid is really about targeting poor people, especially women, who have long been painted as unworthy 'welfare queens' by Republicans. It's a term Ronald Reagan brought to prominence during his unsuccessful primary bid in the presidential campaign in 1976, and Republicans have been leaning on its poverty-porn images of racially tinged female laziness and duplicity ever since. 'We've seen this movie before,' Alker said. 'This is the third time that I have personally seen this movie.' So no, Medicaid cuts hitting women harder isn't an accident. It's a plan. Medicaid and CHIP provide health insurance for about half of all American kids, according to Alker, who has worked on the issue for more than 20 years. Her numbers are slightly higher than some other statistics because they include people who are partially covered by the program. After the Affordable Care Act opened up eligibility to more people in 2014, Medicaid has grown to cover about 28% of all Americans. In California, that number jumps to 37%. That's about 73 million low-income or medically vulnerable people (such as those with disabilities) receiving the insurance in 2024, according to the Government Accounting Office. 'I think that reflects the reality that healthcare is increasingly unaffordable for people who are not rich,' Alker said. For children, that coverage isn't just providing lifesaving care, but all the basic stuff that keeps kids healthy. Vaccinations, wellness checks, sports physicals that are required before joining a high school team. For many if not most of the parents that are relying on Medicaid to pay for those services, they would simply be out of reach without it. So we're not just talking about skipping the emergency room after a fall. We're also talking about not being able to play on the football team, or catching (and spreading) measles because the shot was too expensive. Those are community harms, that go beyond a single kid and preventing them is 'absolutely essential for American's future,' Alker said. 'It's really just how you want care for children to work,' she said. And Medicaid is increasingly paying for reproductive care, prenatal services and births for low-income women — the kind of routine visits that prevent more costly problems down the line. About 41% of all births are covered by Medicaid, Alker said. Older women, especially elderly women, also rely on Medicaid. Medicare, the insurance that many senior citizens use, does not cover the long-term-care costs of aides at home, nursing homes or memory care facilities. Those price tags, which can run into the tens of thousands monthly, are out of reach of most Americans, frankly. But Medicare does cover that cost, and currently is paying for nursing home care for 5 out of 8 residents. It also pays for nearly half of all long-term services and supports used by Americans, including such things as medical devices and at-home medical visits. And guess what: Women live longer than men, so there are more women receiving those benefits. For the insult to injury on Medicare cuts, it's not just the women receiving the benefits that would be hurt by cuts — but also the women providing them. Because throughout the United States, women — often immigrant women — are the people who are working as caretakers, both in homes and in facilities. Cutting Medicaid would cut their employment. So in coming weeks, when you hear the 187 Republican men (and 31 Republican women) in the House tap dancing around how cuts to Medicaid may in fact be OK, remember that it's easy for men to say. Because it's women and children who will lose out first — and most — with this bad budget deal. The must-read: As G.O.P. Eyes Medicaid Cuts, States Could Be Left With Vast Shortfalls The what happened: They voted for Trump, but now they're losing their U.S. government jobs The L.A. Times special: Newsom launches another podcast, teases conversations with 'MAGA' leaders Stay Golden,Anita Chabria P.S. I apparently am terrible at tech! Last week, I (tried) to put a sign up below to receive alerts when I publish my column, since I won't be doing this newsletter regularly in the future. But somehow, I messed up. So here we go again — please click here and do join this list if you'd like to continue following my columns (and I hope you do). Was this newsletter forwarded to you? 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