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CBS News
23-05-2025
- Health
- CBS News
Republicans aim to punish states that insure unauthorized immigrants
What to know about Medicaid cuts in the House-passed Republican budget bill President Trump's signature budget legislation would punish 14 states that offer health coverage to people in the U.S. without authorization. The states, most of them Democratic-led, provide insurance to some low-income immigrants — often children — regardless of their legal status. Advocates argue the policy is both humane and ultimately cost-saving. But the federal legislation, which Republicans have titled the "One Big Beautiful Bill," would slash federal Medicaid reimbursements to those states by billions of dollars a year in total unless they roll back the benefits. The bill narrowly passed the House on Thursday and next moves to the Senate. While enacting much of Mr. Trump's domestic agenda, including big tax cuts largely benefiting wealthier Americans, the legislation also makes substantial spending cuts to Medicaid that congressional budget scorekeepers say will leave millions of low-income people without health insurance. The cuts, if approved by the Senate, would pose a tricky political and economic hurdle for the states and Washington, D.C., which use their own funds to provide health insurance to some people in the U.S. without authorization. Those states would see their federal reimbursement for people covered under the Affordable Care Act's Medicaid expansion cut by 10 percentage points. The cuts would cost California, the state with the most to lose, as much as $3 billion a year, according to an analysis by KFF, a health information nonprofit that includes KFF Health News. Together, the 15 affected places cover about 1.9 million immigrants without legal status, according to KFF. The penalty might also apply to other states that cover lawfully residing immigrants, KFF says. Two of the states — Utah and Illinois — have "trigger" laws that call for their Medicaid expansions to terminate if the feds reduce their funding match. That means unless those states either repeal their trigger laws or stop covering people without legal immigration status, many more low-income Americans could be left uninsured. The remaining states and Washington, D.C., would have to come up with millions or billions more dollars every year, starting in the 2027 fiscal year, to make up for reductions in their federal Medicaid reimbursements, if they keep covering people in the U.S. without authorization. Behind California, New York stands to lose the most federal funding — about $1.6 billion annually, according to KFF. California state Sen. Scott Wiener, a Democrat who chairs the Senate budget committee, said Mr. Trump's legislation has sown chaos as state legislators work to pass their own budget by June 15. "We need to stand our ground," he said. "California has made a decision that we want universal health care and that we are going to ensure that everyone has access to health care, and that we're not going to have millions of undocumented people getting their primary care in emergency rooms." California Gov. Gavin Newsom, a Democrat, said in a statement that Mr. Trump's bill would devastate health care in his state. "Millions will lose coverage, hospitals will close, and safety nets could collapse under the weight," Newsom said. In his May 14 budget proposal, Newsom called on lawmakers to cut some benefits for immigrants without legal status, citing ballooning costs in the state's Medicaid program. If Congress cuts Medicaid expansion funding, the state would be in no position to backfill, the governor said. Newsom questioned whether Congress has the authority to penalize states for how they spend their own money and said his state would consider challenging the move in court. Utah state Rep. Jim Dunnigan, a Republican who helped spearhead a bill to cover children in his state regardless of their immigration status, said Utah needs to maintain its Medicaid expansion that began in 2020. "We cannot afford, monetary-wise or policy-wise, to see our federal expansion funding cut," he said. Dunnigan wouldn't say whether he thinks the state should end its immigrant coverage if the Republican penalty provision becomes law. Utah's program covers about 2,000 children, the maximum allowed under its law. Adult immigrants without legal status are not eligible. Utah's Medicaid expansion covers about 75,000 adults, who must be citizens or lawfully present immigrants. Matt Slonaker, executive director of the Utah Health Policy Project, a consumer advocacy organization, said the federal House bill leaves the state in a difficult position. "There are no great alternatives, politically," he said. "It's a prisoner's dilemma — a move in either direction does not make much sense." Slonaker said one likely scenario is that state lawmakers eliminate their trigger law then find a way to make up the loss of federal expansion funding. Utah has funded its share of the cost of Medicaid expansion with sales and hospital taxes. "This is a very hard political decision that Congress would put the state of Utah in," Slonaker said. In Illinois, the GOP penalty would have even larger consequences. That's because it could lead to 770,000 adults' losing the health coverage they gained under the state's Medicaid expansion. Stephanie Altman, director of health care justice at the Shriver Center on Poverty Law, a Chicago-based advocacy group, said it's possible her Democratic-led state would end its trigger law before allowing its Medicaid expansion to terminate. She said the state might also sidestep the penalty by asking counties to fund coverage for immigrants. "It would be a hard situation, obviously," she said. Altman said the House bill appeared written to penalize Democratic-controlled states because they more commonly provide immigrants coverage without regard for their legal status. She said the provision shows Republicans' "hostility against immigrants" and that "they do not want them coming here and receiving public coverage." U.S. House Speaker Mike Johnson said this month that state programs that provide public coverage to people regardless of immigration status serve as "an open doormat," inviting more people to cross the border without authorization. He said efforts to end such programs have support in public polling. A Reuters-Ipsos poll conducted May 16-18 found that 47% of Americans approve of Mr. Trump's immigration policies and 45% disapprove. The poll found that Mr. Trump's overall approval rating has sunk 5 percentage points since he returned to office in January, to 42%, with 52% of Americans disapproving of his performance. The Affordable Care Act, widely known as Obamacare, enabled states to expand Medicaid to adults with incomes of up to 138% of the federal poverty level, or $21,597 for an individual this year. Forty states and Washington, D.C., expanded, contributing to the national uninsured rate dropping to historic lows. The federal government now pays 90% of the costs for people added to Medicaid under the Obamacare expansion. In states that cover health care for immigrants in the U.S. without authorization, the Republican bill would reduce the federal government's contribution from 90% to 80% of the cost of coverage for anyone added to Medicaid under the ACA expansion. By law, federal Medicaid funds cannot be used to cover people who are in the country without authorization, except for pregnancy and emergency services. The other states that use their own money to cover people regardless of immigration status are Colorado, Connecticut, Maine, Massachusetts, Minnesota, New Jersey, Oregon, Rhode Island, Vermont, and Washington, according to KFF. Ryan Long, director of congressional relations at Paragon Health Institute, an influential conservative policy group, said that even if they use their own money for immigrant coverage, states still depend on federal funds to "support systems that facilitate enrollment of illegal aliens." Long said the concern that states with trigger laws could see their Medicaid expansion end is a "red herring" because states have the option to remove their triggers, as Michigan did in 2023. The penalty for covering people in the country without authorization is one of several ways the House bill cuts federal Medicaid spending. The legislation would shift more Medicaid costs to states by requiring them to verify whether adults covered by the program are working. States would also have to recertify Medicaid expansion enrollees' eligibility every six months, rather than once a year or less, as most states currently do. The bill would also freeze states' practice of taxing hospitals, nursing homes, managed-care plans, and other health care companies to fund their share of Medicaid costs. The Congressional Budget Office said in a May 11 preliminary estimate that, under the House-passed bill, about 8.6 million more people would be without health insurance in 2034. That number will rise to nearly 14 million, the CBO estimates, after the Trump administration finishes new ACA regulations and if the Republican-led Congress, as expected, declines to extend enhanced premium subsidies for commercial insurance plans sold through Obamacare marketplaces. The enhanced subsidies, a priority of former President Joe Biden, eliminated monthly premiums altogether for some people buying Obamacare plans. They are set to expire at the end of the year. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
Yahoo
15-05-2025
- Health
- Yahoo
Amid rising costs, lawmaker wants to restart conversation about universal health care
Mainers spend more than $18.5 billion annually on health care, nearly 20% of the state's Gross Domestic Product, according to a 2024 report from the Maine Center for Economic Policy. (Photo:) One legislator is pushing to explore the possibility of a publicly funded universal health care system for Maine, which would expand coverage to more than 59,000 currently uninsured residents. During a public hearing on Wednesday, proponents stressed the urgent need for a better health care system, though the state's affordable health care office said there is 'no path forward' for establishing such a program right now. One bill, LD 1269, proposes a comprehensive study to analyze the costs and feasibility of a universal health care plan. Another, LD 1883, offers a detailed blueprint for a state-wide system called the All Maine Health Program that would provide comprehensive coverage to all Maine residents. If passed, Maine would be the only state in the country to shift to a universal health care system. During the hearing before the Health Coverage, Insurance and Financial Services Committee, Rep. AnnMarie Mastraccio (D-Sanford), who introduced both bills, said a state-wide system has not been studied comprehensively since 2002, and that 'it's time to update those numbers and evaluate our options.' She is aiming to address rising health care challenges including the closure of hospitals in rural Maine, the uncertainty around Medicaid funding, and overall health care costs increasing. Mainers spend more than $18.5 billion annually on health care, nearly 20% of the state's Gross Domestic Product, she said. 'Maine's current health care system is fragmented, inefficient and economically unsustainable,' Mastraccio said.'As legislators, we have a responsibility to make data-driven decisions that promote a sustainable, equitable health care infrastructure that begins with understanding the true costs and potential savings of a universal, publicly funded system.' Dozens of health care providers, advocates and Mainers who have struggled with medical costs testified in support of the bills, highlighting the urgent need for reform. They pointed to the lack of access to providers in rural areas, racial disparities in health care access in the state and the financial strain on both patients and providers because of the patchwork system of insurance coverage. 'The burden of this poor health infrastructure falls disproportionately on women of color, Black and Indigenous women and low income and rurally located women,' said Lily James, advocacy coordinator for the Maine Women's Lobby. For example, 65% of pregnant Black Mainers receive adequate prenatal care in 2022, compared to 87% of white Mainers, according to Maine Department of Health and Human Services data. And 22% of pregnant Mainers have to travel more than 45 minutes to access a birthing hospital, according to a 2023 report that James cited. 'The All Maine Health Program would be life changing, and in many cases, life saving for so many Mainers and will pave the way for the desperately needed changes to Maine's health care infrastructure,' James said. A November 2024 report from the Maine Center for Economic Policy found that, based on current demographics and insurance coverage, the cost of such a program would roughly equal the amount Mainers spend now, between $17.8 and $19.3 billion. Testifying on behalf of the plan, James Myall, a policy analyst for MECEP who authored the report, said that, unlike the current system, the cost of a universal system could be offset by other revenue streams, such as federal grants or increasing taxes on the wealthiest Mainers. 'This means that most Mainers will pay less under the proposed plan than under the status quo, while also being free of the stresses that come from being unable to afford copays and deductibles, worrying about in-network coverage, or switching insurance providers,' he told lawmakers. Meg Garratt-Reed, director of Maine's Office of Affordable Health Care, which was established by the Legislature in 2021, testified against both bills, saying the state isn't in a position to implement them with the current financial constraints and the amount of change that would be required to implement the program. While she acknowledged that Maine's health system is flawed and praised the intent behind the bills, she said a single-payer program would be too costly and complex to set up right now. The All Maine Health Program aims to save money by removing insurance companies from the system, which would reduce administrative costs like billing as well as shareholder profits. But Garratt-Reed said those savings wouldn't be enough to offset the added expenses in the plan. The bills would expand what's covered, increase payments to providers, and do less to limit unnecessary or overly costly treatments — all of which would drive up overall spending. She also said the bills would move away from the current cost-control system used by Medicare and MaineCare, Maine's Medicaid system, which set fixed prices for services. Instead, the state would have to negotiate rates with each provider — a more complex and less efficient process that could lead to even higher costs. The proposal also relies on using federal money (such as Medicaid and Medicare funds) to pay for the new system — but federal law doesn't let states reallocate money designated for specific programs without special permission, she said. And the federal government is very unlikely to give that permission, Garratt-Reed said, especially under the current political situation, pointing to congressional Republicans' proposal to drastically cut Medicaid funding. 'I think we can all agree that our current health care system is flawed, and that many people suffer because of those flaws. However much we may wish that we could recreate our nation's health care system from the ground up, we have a responsibility to those people to pursue solutions that have real potential to ease their suffering,' she said. 'The reality is there is no path forward for implementing such a program in Maine now or in the immediate future.' SUPPORT: YOU MAKE OUR WORK POSSIBLE
Arab News
06-04-2025
- Health
- Arab News
Aid cuts could leave more women dying in pregnancy and birth, UN says
LONDON: Cuts to aid budgets are threatening to undermine years of progress in reducing the number of women dying during pregnancy and childbirth, and could lead to a rise in deaths, the United Nations has warned. Globally, there was a 40 percent decline in maternal deaths between 2000 and 2023, a report by UN agencies including the World Health Organization (WHO) showed on Monday, largely due to better access to essential health services. That could now go into reverse, the WHO said in a statement accompanying the report which did not mention specific cuts but came in the wake of a foreign aid freeze by the US government and the ending of funding through the United States Agency for International Development (USAID) for many programs. Other donor countries including Britain have also announced plans to cut aid budgets. 'One of the headline messages is that the funding cuts risk not only that progress, but we could have a shift backward,' said Dr. Bruce Aylward, Assistant Director-General, Universal Health Coverage at the WHO. The cuts have had 'pandemic-like effects' on health systems globally and could have a 'more structural, deep-seated effect,' Aylward added. The WHO said the cuts were already rolling back vital services for maternal, newborn and child health in many countries, reducing staff numbers, closing facilities and disrupting supply chains for supplies including treatments for hemorrhage and pre-eclampsia. Cuts to other areas, such as malaria and HIV treatment, would also impact maternal survival, the UN said. Even before the aid cuts led by the United States, things were backsliding in some countries, and progress has slowed globally since 2016, the report said. In 2023, despite recent progress, a woman still died roughly every two minutes — around 260,000 in total that year — from complications that were mainly preventable and treatable, it added. The situation was particularly bad in countries affected by conflict or natural disaster, although the US itself is one of only four countries to have seen its maternal mortality rate increase significantly since 2000, alongside Venezuela, the Dominican Republic and Jamaica. The COVID-19 pandemic also had an impact, the report said: 40,000 more women died due to pregnancy or childbirth in 2021, bringing the total number of deaths that year to 322,000. 'While this report shows glimmers of hope, the data also highlights how dangerous pregnancy still is in much of the world today – despite the fact that solutions exist,' WHO Director-General Tedros Adhanom Ghebreyesus said. The report itself was part-funded by USAID.
Yahoo
20-03-2025
- Health
- Yahoo
Maine bill would allow doctors to keep their names off prescription labels for abortion pill
Mar. 19—Maine is considering allowing doctors who prescribe medications used to perform abortions to keep their names off prescription labels in a change that advocates say would help protect them from legal risks and attacks. Lawmakers held a public hearing Wednesday on a bill that would permit doctors who prescribe mifepristone, misoprostol and their generic alternatives to use the name of the health care facility they work for on the prescription label rather than their own name, as is currently required by state law. Mifepristone and misoprostol are medications used to manage miscarriages and abortions within the first 10 weeks of pregnancy. Rep. Sally Cluchey, D-Bowdoinham, the bill's sponsor, told the Health Coverage, Insurance and Financial Services Committee that the change would offer additional protection for abortion providers amid increasing threats of violence and attacks after the 2022 overturning of Roe v. Wade. It follows legislation that Maine passed last year to provide legal protections for doctors who provide abortions and gender-affirming care that has been banned in a patient's home state. "This bill, LD 538, builds on those protections, ensuring that health care providers can continue to serve patients without fear of harassment or harm," Cluchey said. "Without this additional protection, medical professionals in Maine, who are already being targeted by states seeking to criminalize care, remain vulnerable to legal intimidation." Maine is not the only state to consider changes to its requirements around prescription labeling to protect abortion providers. New York Gov. Kathy Hochul signed legislation last month allowing prescribers of medical abortion to request that pharmacies print the name of their practice rather than their personal name on prescription labels. Washington state passed a similar law last year, and a proposal is also being considered in Illinois. The New York legislation came after a doctor there was criminally charged in Louisiana for prescribing an abortion pill that was taken by a Louisiana teenager. The same doctor is also facing a civil lawsuit in Texas for allegedly providing a Texas woman with abortion pills via telemedicine. In the aftermath of the fall of Roe v. Wade in 2022, some states, like Maine, have taken steps to ensure abortion remains legal while others have rolled back protections or enacted abortion bans. Twelve states currently ban abortion, according to the health policy organization KFF. "In this tumultuous national landscape, Maine has remained a safe harbor for those seeking access to vitally needed sexual and reproductive health care," said Lisa Margulies, vice president of public affairs Maine for Planned Parenthood of Northern New England. Margulies said the bill would protect the privacy and safety of Maine clinicians who might be targeted for their work. "This would deter abortion opponents from out of state from weaponizing a discarded or otherwise obtained pill bottle," she said. According to the National Abortion Federation's 2022 Violence & Disruption Statistics report, stalking incidents targeting abortion clinic staff and patients rose 229% from 2021 to 2022 while threats of harm and death threats to abortion providers rose 20%. Cluchey cited that report as well as examples of harassment and acts of intimidation at abortion clinics in Maine Wednesday. In one case last year, two men followed a patient into Maine Family Planning's Lewiston clinic and tried to gain access to the patient waiting room, she said. And in another case, protestors blockaded a clinic entrance in Waterville. "These are only a fraction of the harassment providers are experiencing," Cluchey said. Most of the testimony the committee heard Wednesday was in support, although the Retail Association of Maine testified against the proposal on behalf of pharmacies. President and CEO Curtis Picard told the committee that pharmacies are concerned the bill would conflict with labeling requirements in federal law. In response to a committee member's question about how New York and Washington have been able to enact similar laws, Picard said the retail association has received conflicting information and he is still looking into the issue. "(Our pharmacies) had an attorney say they think it can be done and Washington has done it, but then I've had my pharmacy corporate counsel say, 'No, we still think it violates federal rules,'" Picard said. Picard also told the committee it would be difficult for pharmacies to "delete" the prescriber's name in the technological systems they use. "Each system is different technology-wise, and the ability to modify that system would be costly and very difficult," he said. Picard said in an interview after the hearing that the association has no problems with the intent of the bill. "We're happy to keep talking with the committee and see if there's a way forward," he said. The Roman Catholic Diocese of Portland also submitted testimony against the bill. "This prescription should not be treated any differently than other prescribed drugs," the diocese said in written testimony. "The proponents of abortion consider it healthcare so it should be treated as such and held to the same standards." Copy the Story Link We believe it's important to offer commenting on certain stories as a benefit to our readers. At its best, our comments sections can be a productive platform for readers to engage with our journalism, offer thoughts on coverage and issues, and drive conversation in a respectful, solutions-based way. It's a form of open discourse that can be useful to our community, public officials, journalists and others. 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