Congressional lawmakers are facing tricky arithmetic as they hammer out a budget plan to finance President Donald Trump’s agenda.
Republicans need to free up roughly $4 trillion to pay for renewing Trump’s 2017 tax cuts, which expire at the end of the year. Trump has vowed not to touch the costliest government programs, including Medicare and Social Security.
He’s been less clear about his plan for Medicaid.
On Wednesday, he endorsed a House GOP plan that cuts at least $880 billion from, very likely, Medicaid — the federal-state health insurance program for Americans with low incomes or disabilities.
As my colleague Phil Galewitz reports, changes to expand Medicaid have become entrenched in most states — and their budgets — over the past decade. Hospitals, which not only treat but also employ a lot of Americans, are reaching out to Congress with concerns.
Medicaid is also popular. A January KFF poll found that about 3 in 4 Americans view the program favorably. So Republicans would have to be strategic about cuts.
But first, let’s back up. What is Medicaid? My colleague Sam Whitehead and I published a useful explainer this week.
Medicaid, which turns 60 this summer, was created as part of President Lyndon B. Johnson’s “Great Society” strategy to attack poverty along with Medicare, the federal health insurance program for those 65 and older.
More than 79 million people receive services from Medicaid or its closely related Children’s Health Insurance Program. That’s about 20% of the country’s population.
About 40% of all children are covered by Medicaid or CHIP. Medicaid also pays for 4 in 10 births and covers costs of caring for more than 60% of nursing home residents.
State and federal spending on the program reached $880 billion last year.
Back in Washington, Phil writes that the GOP is considering a few strategies to shrink Medicaid.
They could reduce how much money the federal government sends to states, leaving state leaders to decide whether and how to plug budget holes.
One idea Republicans are openly talking about is imposing work requirements. Most adults enrolled in Medicaid are already working or probably would be exempt because they’re in school, are caregivers, or are disabled.
But, as Sam and I report, state experiences with work requirements show they make it harder for even eligible people to get coverage.
At the heart of it all are key questions about the role of government in people’s health: How big should the U.S. medical insurance safety net be? Who deserves government assistance?
And, perhaps most urgently, where will those who could lose Medicaid go for coverage?
