In Washington, there is a debate among Republicans about potentially cutting billions of dollars from Medicaid, which could affect the health care coverage of the approximately 80 million adults and children currently enrolled in the program. Democrats had previously praised the increase in Americans signing up for taxpayer-funded health care coverage under Medicaid and the Affordable Care Act during the Biden administration. However, Republicans, aiming to reduce federal spending and provide tax cuts for corporations and wealthier individuals, now view these programs as targets for budget reductions. Medicaid, a program totaling $880 billion mostly financed by federal taxpayers, with some states receiving up to 80% funding, is facing financial challenges due to years of growth and an increase in patients with more complex health needs.
To address budget concerns, the GOP-controlled Congress is considering implementing work requirements for Medicaid beneficiaries and potentially adjusting the fixed rate paid to states. Over the next decade, significant cuts may be made to the funding for health care coverage for low-income Americans. Prior to these discussions in Congress, Republican governors in states such as Arkansas, Ohio, and South Dakota had already taken steps to introduce work requirements for Medicaid recipients, actions likely to be endorsed by the Trump administration.
Additionally, the Republican administration announced a drastic 90% reduction in the budget for the Affordable Care Act’s navigator program, which assists individuals in enrolling in health care programs. Some Republicans, including Speaker Mike Johnson, have suggested that tying work to Medicaid eligibility is a sensible approach, emphasizing the value of work and the potential morale boost it could provide. However, research shows that approximately 92% of Medicaid enrollees are already engaged in employment, education, or caregiving responsibilities.
Republican proposals also include implementing work requirements similar to those for the Supplemental Nutrition Assistance Program (SNAP) and changing the federal government’s reimbursement system to a per-person cap. Lawmakers argue that these changes could encourage individuals to seek employment opportunities that offer health insurance. Critics, however, are concerned that such cuts could disproportionately impact vulnerable populations and stress the importance of targeting inappropriate beneficiaries rather than reducing benefits for those in need.
“States may be faced with difficult decisions regarding who and what they provide coverage for,” explained Joan Alker, the executive director of the Georgetown Center for Children and Families. “Even if coverage is reduced, people still have ongoing healthcare needs that cannot be ignored.”
Potential cuts to the program could lead to dissatisfaction, as over half of U.S. adults believe the government is not allocating enough funds to Medicaid, according to a January poll conducted by the Associated Press-NORC Center for Public Affairs Research. Only 15% of respondents felt that the government was spending “too much.”
In response to President Joe Biden’s administration restricting states from implementing their own work requirements and mandating that 10 states eliminate such requirements for Medicaid coverage, some Republican-led states are now taking steps independently. Governors in Arkansas, Iowa, and Ohio have expressed plans to seek approval from the federal Centers for Medicare and Medicaid Services to reintroduce work requirements. Additionally, South Dakota voters approved a proposal to implement a work rule last fall.
During the previous administration under Trump, Arkansas implemented a work requirement resulting in approximately 18,000 individuals losing their coverage. This rule was later blocked by a federal judge during Biden’s administration. Trevor Hawkins, an attorney with Legal Aid of Arkansas, noted that individuals faced challenges with the state’s online system for reporting hours, leading to coverage loss for many.
In Georgia, Paul Mikell, 47, part of Georgia’s Pathways to Coverage plan, encounters obstacles in meeting work requirements for Medicaid. Mikell commutes monthly to a government office to report work hours, navigating an online system that often fails to log his hours accurately.
In Idaho, where legislators are discussing a state work rule and a three-year limit on Medicaid benefits, family physician Peter Crane estimates that about two-thirds of his patients are Medicaid recipients. Many work in agriculture or mining, and before the state expanded Medicaid, uninsured patients delayed seeking medical care.
Democrats are cautioning against the repercussions on healthcare facilities, particularly rural hospitals and nursing homes. These institutions have benefited from increased enrollment in Medicaid, providing guaranteed payment for patient treatments.
“From rural America to urban America and the heartland of America, House Democratic leader Hakeem Jeffries of New York issued a stark warning during a recent speech on the House floor. He cautioned that if action is not taken, nursing homes across the country will face closure, resulting in harm to everyday Americans, including children, seniors, and individuals with disabilities. Reporting from Little Rock, Arkansas, DeMillo was joined by Associated Press polling editor Amelia Thomson-DeVeaux in Washington, along with writers Charlotte Kramon in Atlanta, Rebecca Boone in Boise, Idaho, and Jack Dura in Bismarck, North Dakota, who all contributed to this important coverage.”
