In an America where health care is already a broken and warped industry, there may be more pain ahead for those just trying to get by. The Republican-controlled House of Representatives squeaked through a major budget resolution 217-215 on Feb. 25, aiming to pay for the second Trump administration’s proposed tax cuts. The problem is that in order to make up the difference on those cuts, Republicans will have to shred Medicaid benefits for people across America, putting a core tenet of the United States’ health care system in jeopardy.
The Medicaid program can be traced back to the Lyndon B. Johnson administration. In 1965, both Medicaid and Medicare were created to help Americans with health care services. Over the years, Medicaid was slowly built up, culminating in the Affordable Care Act under Obama. The ACA significantly expanded Medicaid coverage to more Americans, resulting in the current program we have today. Now, Medicaid provides health insurance to 72 million people in the U.S. who are often low-income and rely on these benefits for their coverage, all the way from birth until death. In Connecticut, for instance, 38% of births are paid for with Medicaid coverage, and care for seniors and people with disabilities is also largely funded by Medicaid.
All 50 states have Medicaid to some extent, as they are reimbursed for at least 50% for the cost of giving their residents coverage. Since the ACA expansion was optional for each state, some rely on Medicaid more than others. California, New Mexico, Arkansas, Louisiana, New York and West Virginia are the states with the highest number of people on Medicaid, forming a group that cuts through typical red and blue lines. Out of the states that have opted in – 41 if you include D.C. – the overall reimbursement also varies relative to wealth. Poorer states often get 70% or more of their coverage costs paid back from the federal government.
Medicaid’s importance in health care is also recognized by a large majority of the population, making it very politically popular, especially in the bitterly polarized environment we’re in today. Nearly three-fourths of Americans have a favorable view of Medicaid, because a large percentage of U.S. residents have benefited or know someone who has benefited from the program.
At the same time, opposition to government-funded health care has always existed. In the 1980s and 1990s, Republicans tried to cap spending for Medicaid by having the program pay out a flat fee to states, not a percentage of costs. Decades later, they nearly succeeded in getting rid of the ACA expansion in 2017.
The new budget resolution Republicans pushed through will have to cut Medicaid, even though the right has argued that it won’t. House Majority Leader Steve Scalise claimed in a press conference on Feb. 25 that “this bill doesn’t even mention the word Medicaid a single time.” It is true that the resolution technically does not refer to Medicaid, but this does not mean that benefits won’t be cut. The plan calls for $880 billion over 10 years in cuts to the House Energy and Commerce Committee, which oversees both Medicaid and Medicare. This huge amount will have to come from somewhere. Since even President Donald Trump has declared Medicare off the table when it comes to cuts, Medicaid, with an approximately $600 billion federal cost each year, presents a ripe and guaranteed target for the budget tightening. A recent New York Times report outlined how there is essentially no way around making major cuts to Medicaid if the budget resolution persists as it currently stands.
If these cuts are put in place, states will have to shoulder far more of the burden on providing healthcare. As a result, the poorer and mostly Republican states I mentioned earlier that need the federal government to reimburse more of their costs will suffer at a disproportionate rate, but all states would see their programs negatively affected. Hospitals, which are required to provide care regardless of whether someone is covered, would have to administer more uninsured treatment, likely leading to closures for those struggling financially.
It’s worth mentioning that none of the lawmakers trying to shrink Medicaid are the ones who actually need the program. The average salary for members of the House of Representative is $174,000, and a large share of representatives already arrived to Congress with a significant amount of wealth. The author of the budget resolution, Rep. Jodey Arrington, has a estimated net worth of over $1 million, which is far from unique to him.
In sacrificing Medicaid for tax cuts that will benefit the wealthy members of society, Republicans are showing they don’t care about the Americans who rely on it, just the rich. Even though Medicaid is popular with Democrats and Republicans alike and has helped offset costs for tens of millions of Americans, Republicans are showing that they don’t care about their constituents. And although this new resolution passed the House, Republicans should be aware that their plan will alienate the American people who simply want to have the healthcare they deserve.