With the House proposing the largest Medicaid cuts in the program’s history, the health care of 79.3 million enrollees is at stake.
The budget resolution to slash at least $880 billion through 2034 in health care and nutrition programs was proposed to the U.S. House of Representatives Energy and Commerce Committee in late February, and the House is poised to vote on the measure in late April.
Of the nearly one in four Americans enrolled in the Medicaid and Children’s Health Insurance Program (CHIP) — including low-income people, pregnant women, seniors and people with disabilities — the measure would feasibly eliminate coverage for 15.9 million.
“The magnitude of the cuts is extraordinary. Nothing in American history has been remotely this size,” said Stan Dorn, director of the Health Policy Project at UnidosUS, at a Friday, March 21 Ethnic Media Services briefing about the Medicaid measures.
The closest previous cuts, under the Reagan administration in 1981 and 1982, were a $3.9 billion dollar slash that dropped enrollment 13%; in today’s terms, this would translate to $12.4 billion and 9 million people.
In 2023, total Medicaid spending was about $860 million; were the cuts to be implemented, each congressional district nationwide would lose an average $2 billion in federal funds over nine years.
The April measure “passed by a single, party-line vote,” said Dorn. “Every Republican but one voted for it, every Democrat voted against it. Most bills now have to get 60 votes in the Senate to pass, which means you need Democratic and Republican support, but budget reconciliation has a ‘fast-track’ procedure where bills can pass entirely by Republican votes alone.”
“There’s no way you can cut huge amounts like this from Medicaid without hurting millions of people, he continued. “The reason Republicans are doing this is because the Trump 2017 tax cuts that primarily benefited large corporations in the wealthy will expire after this year, unless they can pay the nearly $5 trillion, according to the Congressional Budget Office, to continue it … This is the exact opposite of what was promised to the American people … Leaving people subject to medical bills without the protection of insurance means costs go up, not down.”
House Speaker Mike Johnson has said the plan is to vote on a budget bill on the House floor by Easter, April 20 and have it on the president’s desk by Memorial Day, May 26.
Cut implementation strategies discussed by House members include ending or limiting states’ ability to raise their share of Medicaid funds by taxing insurance companies and hospitals; capping the total amount of federal money that a state may get per enrollee; and terminating Medicaid for enrollees who don’t meet work requirements.
“Medicaid is the largest source of federal funds coming into states,” said Joan Alker, executive director of the Center for Children and Families and Research and professor at the Georgetown McCourt School of Public Policy Foundation. “Even a state that wanted to will not be able to raise taxes enough to make up for these large federal cuts … this will have ripple effects on all areas of state budgets, not just Medicaid.”
“States will be faced with pitting very, very vulnerable populations against one another — an aging population who needs long-term care, children, people with disabilities, low-income families,” she continued.
Approximately 72.1 million Americans are currently enrolled in Medicaid and 7.2 million in CHIP — including over 37 million children (roughly half of all children in the U.S.), 20 million Latinos, 13 million Black people, 4.8 million Asian Americans and 700,000 Native Americans.
“We are hearing a lot about cutting fraud. But if you want to address fraud, and you look at where fraud occurs, people who are enrolled in Medicaid are the victims, not the perpetrators,” Alker explained. “Proposals that limit people’s access are not addressing fraud. Proposals to address fraud would include hiring more prosecutors at the Department of Justice and beefing up Medicaid Fraud Control Units. These are not proposals to address fraud, they are proposals to cut Medicaid.”
The impact of these cuts will especially be felt by community health centers, which serve 32.5 million people — often, the Medicaid enrollees and uninsured patients who already struggle to access care the most.
“With cuts, you’ll probably see health centers forced to reduce operating hours, cut key programs, not hire new staff,” said Joanne Preece, director of government and external affairs at the Community Clinic Association of Los Angeles County, representing 66 health center organizations and two million patients countywide.
Medicaid is the largest source of funding for health centers nationwide, accounting for 43% of a total $46.7 billion in revenue.
Roughly half of health center patients are on Medicaid.
Meanwhile, Medicaid expansion “has a dramatic impact on our patients’ ability to access care,” Preece explained. “In a little over a decade since the Affordable Care Act and further expansions we’ve done in California, health center patients in Los Angeles County went from majority uninsured to majority insured.”
In 2011, 58% of LA County health center patients were uninsured; in 2023, 14% were.
Preece added that “our ‘three-legged stool’ Medicaid cuts will harm the health of patients through the entire system. When patients are uninsured, they’re more likely to minimize or delay care, they have fears related to costs, and this leads to worse health outcomes in the long run. It leads to folks relying on emergency rooms for care, which isn’t good for anyone.”
A recent KFF poll suggests that two-thirds of adult Americans “say that someone close to them has received help from Medicaid at some point, including over half (53%) who say either they themselves or a member of their family has been covered by the program.”
The same poll found that “very favorable” or “somewhat favorable” views of Medicaid were held by majorities of Democrat (88%), Republican (64%) and Independent (81%) respondents.
“Last November, people voted with their wallets, seeking greater affordability, including for health care, but the cuts proposed would shred our safety net, forcing families to lose coverage and access to health care and shifting costs onto people who are already struggling with costs for everything else,” said Anthony Wright, executive director of Families USA.
“All of this, to fund a tax cut geared toward the wealthiest corporations, is a cut to the health care system that serves all of us,” he continued, “whether it’s your local hospital forced to shut down its ER or add hours to its wait times or scale back services, or community clinics and long-term facilities that already may not be able to keep their doors open.”
“These Medicaid cuts will be felt by people in every state and every congressional district in the nation, regardless of our race, ethnicity, party, health provider or how we get covered,” he added.
