Republican efforts Congress for steep spending cuts I was impressed Extensive concern Donald, but the federal government can reduce spending on Medicade. Trump pointed out that he did not want To do that. This public health insurance program is included around 72 million people About one out of five Americans.
We asked Paul Schaefer and Nicole HuberfeldBoston University Health Policy and Legal Professor explain why it is difficult to reduce medicaid spending and what is the result.
What is the role of Medicaid in the health care system?
It was created in 1965 with Medicare, a public health insurance program for the elderly. Medicaid pays Health care for low -income adults and children, including more than one out of three people with disabilities. In addition, both Medicare and Medicaid deal with more than 12 million people who are poor and qualified for 65 years of age.
In addition, this safety net program pays medical expenses. 5 to 2 or more Born in the United States. Medicaid is a joint federal/main program according to the Federal Fund and rules. Manage it.
Affordable Care Act had to make almost all adults under 65 years old without the maximum children. 138% of the federal poverty level Medicaid qualifications. Previously before the Landmark Health Care Reform Act in 2010, adults without children in most states I couldn’t get Medicade Insurance. But the Supreme Court I made this change as an option for the state..
Until now, 40 stock prices as well as Washington DC Medicaid expansion. The growth of this program has narrowed the number of Americans and the scope of insurance coverage without health insurance. Color And in general, people with low -wage jobs that are not guaranteed by employers.
Hundreds of research Medicaid expansion has been found to improve access to the treatment and health of those who have benefited from insurance benefits, reducing mortality and strengthening the main economy. Among other positive results.
In 10 states, we have not yet expanded Medicaid. Two of them, Georgia Mississippi considered seriously I am doing so.
AP Photo/Rogelio V. SOLIS
Why are you worried about Medicaid’s funds?
no way The memo circulated between the Republican Republican Party January 2025 Including menu Medicaid cuts up to $ 2.3 trillion in Medicaid. no way House budget blueprint,,, Approved in 217-215 On February 25, the vote said that many Republicans are targeting the goal instead of 25 people on behalf. Medicaid expenditure reduces $ 880 million More than 10 years.
Obviously, GOP lawmakers did not say they plan to do so.
Instead, they told the committee that they overseed Medicaid and Medicare to identify the cuts of the scale. Experts agree that it will be more difficult to slash medicare spending. Trump said he was out of limitations.But sometimes he proposed He will be able to trim Medicaid. Trump says We support the budget plan approved by the House of Representatives.
Medicaid itself as an interesting coincidence It takes about $ 880 billion a year. Between the federal government and state spending. This suggests that Republicans are aiming to cut about 10%.
How does the program work?
If you are qualiced for Medicaid, you can register in the program and receive health insurance at any time.
If breast cancer is required, regardless of the flu No or in a low state -The cost of the self. Registering in Medicaid means that your medical treatment is compensated and cannot be rejected for budget reasons. The federal government donates the amount paid by the state for the health care of the residents who are registered, but cannot determine the amount to spend to Medicaid.
that Federal rate It is related to each person’s income. This means that stocks with low income per capita will increase federal economies and earn more than 50%of all stocks. If you participate in the expansion of Medicaid, the federal race is 90%of the population.
12 states were so -called Trigger the law In a book that can automatically cancel Medicaid expansion when this strengthened economic speed decreases.
How can the federal government reduce Medicide spending?
The federal government can simply adjust the economic speed and move more mainly for Medicide. but Preliminary proposal We suggested greater change Cap per person or Block subsidy.
While CAPS per capita has an upper limit per capita fund, block subsidies have a total restriction on how much contributors will contribute to the state’s expenses every year. As a result, the state will cover less people, reduce benefits, reduce treatment costs, and reduce the combination of cost savings.
The cap or block subsidy per person requires a large -scale deformation of the Medicaid operating method.
The program has always provided open funds in the state, and relies on the stability of the federal fund to perform the program. If you impose a cap or block subsidy, the state should donate much more money to the program or cut the registration rapidly. Assuming a significant cut of federal funds for Medicaid Millions of people can lose health insurance The range that they can’t afford elsewhere.
Speaker MIKE Johnson has a change in the upper limit of per capita and a federal match rate Not at the tableBut they were included in Early House Republican memo Explain the potential cut in detail.
Saul Rob/AFP through Getty Images
Can other things happen?
Another idea that many Republicans support themWork requirements. ” The first Trump administration has approved the state proposal to complete the minimum “community participation” in order to register and maintain Medicaid qualifications in activities such as work, vocational education, education, or community services. This is despite the facts The majority of Medicaid registrants already workI am a caregiver or a school for the disabled, a loved one.
Some politicians Understand that people will work for Medicade. It helps to switch to employer -based guarantee, so the limit can sound like common sense. However, this required document can be made by many people who work. The cost of implementation is very high. also, Vocational training program,,, resources Education is generally defective in this reasoning because there is no scope of health insurance unless it is a degree program.
Even though most registrants are already working when Arkan implements Medicide’s work requirements in 2018 About 18,000 people have lost their coverage.. This policy was not well understood, and registrants had a hard time reporting work. In addition, the employment of low -income people has not grown.
Are Medicaid vulnerable to waste or fraud?
Medicaid already spends It is less than Medicare or personal health insurance per benefit. This includes expenditure Doctors, hospitals, drugs and tests.
Government responsibility office, an independent party government agency, $ 50 billion in federal savings Annual. GAO warns, “All inappropriate payments are not the result of fraud.” This considerable amount is still close to the size of the republican circles that they want to make.
Is Medicaid Reductions popular?
It is unlikely.
vote and Focus Group It shows that Medicaid is very popular.
More than half The Americans say the government spends too much money on Medicaid, and only 15%of spending is too high.
We believe that if Medicaid cuts are openly controversial, the council members will be flooded with the demands of parliamentary members to oppose them. That happened in 2017. When the first Trump administration tried and Affordable Care Act could not be abolished.
If Medicaid is cut to nearly $ 880 billion over the next decade, we expect to see millions of the poorest and most vulnerable people in the United States. Started in the program Do not buy insurance. But it is just the beginning of their problems. People who do not have insurance are likely to wait too long before they meet a doctor when they get sick or injured. Health results are worse And wider Gap Between have and nots.
