Medicaid Threats in the Upcoming Congress

Deeply damaging health coverage proposals recently advanced by Republican congressional leaders and conservative think tanks could gain traction in Congress next year.^[1] Cutting Medicaid would harm enrollees — including the millions of children, people with disabilities, and elderly people with low incomes who are covered by Medicaid — and increase health inequities.Medicaid helps children develop into healthy adults and helps adults stay healthy. And it’s an overwhelmingly popular program.

About 72 million people receive health coverage through Medicaid.^[2] It pays for 2 in 5 births in the U.S.^[3] and is the nation’s largest payer both of behavioral health services, which include mental health and substance use disorder treatment,^[4] and long-term care services, either at home or in nursing facilities.^[5] (See Figure 1, and more details in the Appendix.) Medicaid helps children develop into healthy adults and helps adults stay healthy. And it’s an overwhelmingly popular program.^[6]

Despite this, various Republican legislative proposals seek to cut Medicaid by eliminating or severely underfunding the Affordable Care Act (ACA) Medicaid expansion, by restructuring and cutting federal funding for the program as a whole, or by weakening long-standing program protections for enrollees.^[7] Republicans often use improving program efficiency and program integrity as a rationale for their proposed cuts, but the real common thread in the proposals is that they would lead to widespread cuts in eligibility, benefits, and provider payment rates, potentially leaving millions without health care coverage and access to care they need.

For example, the proposed Medicaid cuts would jeopardize people’s ability to access and afford life-saving medications, treatment to manage chronic conditions, and care for acute illnesses. People with cancer would be diagnosed at later stages and face higher risks of mortality. People with chronic conditions such as cardiovascular disease, obesity, and liver disease would go untreated and have worse health outcomes. People under serious psychological distress would delay or forgo the care they need. And families would have more medical debt and less financial security. A large body of evidence bears this out: Medicaid improves health, prevents premature deaths, and reduces medical debt and the likelihood of catastrophic out-of-pocket medical costs.^[8]

To be sure, there also is plenty of damage the incoming Trump Administration could inflict on Medicaid through administrative actions, as we saw during the first Trump Administration.^[9] This paper, however, focuses on harmful legislative Medicaid proposals that Republicans have floated in the past^[10] and that Congress should continue to resist.