The House Republican health care bill’s massive cuts to Medicaid, often skimmed over in the last-minute drama over pre-existing conditions, are fast emerging as a critical source of opposition in the Senate.
President Donald Trump said in his speech announcing his 2016 campaign that he would not cut Medicaid and bragged on Twitter that he was the first candidate to do so. He didn’t keep that promise: The bill’s Medicaid cuts, which the Congressional Budget Office estimates at $839 billion over 10 years, are arguably its most sweeping change. They’re also critical to financing the bill’s tax cuts for high-income Americans and medical industries, which require the savings to offset the loss in revenue.
Leading patient advocacy groups are warning the combination of less spending and a restructuring of the program will threaten coverage for millions of vulnerable Americans, including seniors, people with disabilities, and children. The top medical industry groups representing doctors, hospitals, and insurers are raising similar concerns, along with key Republican senators whose support will be needed to pass a bill.
Cuts could force tough choices
About 73 million people receive coverage through Medicaid. The program covers low-income Americans and was expanded under the Affordable Care Act. All but 19 states have accepted the additional federal funding, which covers people with incomes up to 138% of the federal poverty line.
The House bill would gradually do away with the expansion, but would go much further than simply rolling back Obamacare’s changes. It would also transform Medicaid from a program that provides guaranteed matching funds to states to one that provides a fixed per-capita amount for every recipient or a block grant to cover total spending. The Congressional Budget Office has estimated these changes will leave 14 million fewer people covered by the program after a decade.