During Joe Biden’s presidency, Medicaid enrollment reached a record high and the rate of uninsured individuals dropped to its lowest historical level.
However, the return of Donald Trump to the White House, along with a Republican-controlled Senate and House of Representatives, is expected to change this situation.
Republicans in Washington claim they plan to use funding cuts and regulatory changes to drastically reduce Medicaid, the federal health program managed by states that costs nearly $900 billion annually and provides coverage to about 79 million Americans, mostly low-income or disabled individuals.
Proposals include rolling back the Medicaid expansion driven by the Affordable Care Act (ACA), which over the past 11 years has added nearly 20 million low-income adults to the program.
Trump has expressed his desire to significantly cut government spending, which may be necessary for Republicans to extend the 2017 tax cuts set to expire later this year.
During his 2024 campaign, Trump did not focus much on Medicaid. His first administration approved work requirements in several states, although only Arkansas implemented them before a federal judge ruled they violated ACA principles. He also attempted to provide block grants to states.
Jodey Arrington, the chairman of the House Budget Committee, stated to KFF Health News that Medicaid and other federal welfare programs need significant changes to help reduce the federal debt. “Without these changes, we will sadly witness this country suffer a fiscal collapse.”
Representative Chip Roy, a member of the Budget Committee, suggested that Congress needs to explore federal spending cuts in Medicaid.
“A comprehensive reform in the healthcare sector is necessary, which could involve undoing much of the damage caused by ACA and Obamacare,” Roy said. “Frankly, we could end up providing better service if we do it the right way.”
Advocates for low-income individuals fear that the cuts sought by Republicans will leave more Americans uninsured, making it difficult for them to access healthcare.
“Medicaid is an obvious target for huge cuts,” said Joan Alker, executive director of the Georgetown University Center for Children and Families. “An existential battle over the future of Medicaid is likely on the horizon.”
As the program approaches its 60th anniversary in July, it faces a significant crisis after coverage protections implemented during the COVID-19 pandemic expired in 2023, requiring all enrollees to prove continued eligibility.
More than 25 million people lost their coverage during the 18 months following the “disenrollment” process, although there has not been a significant increase in the number of uninsured individuals, according to the latest census data.
However, this number could be insignificant compared to what may happen in the next four years, as stated by Matt Salo, former executive director and founder of the National Association of Medicaid Directors. “We are likely to see an even greater dramatic shift in who will be covered by Medicaid and how the program will operate.”
Nevertheless, Salo pointed out that any effort to reduce the program will face resistance.
“Many powerful entities – state governments, managed care organizations, long-term care providers, and all those interested in Medicaid running efficiently – will be highly motivated to resist cuts they consider draconian, as they could impact their business models,” he said.
Some of the Republican party’s strategies to reduce the size of Medicaid include:
1. Transition to block grant funding.
2. Cuts to ACA funding for Medicaid.
3. Reduction of federal funds.
4. Adding work requirements.
5. Imposing enrollment barriers.
If Republicans’ plans to reduce Medicaid materialize, experts say low-income individuals forced to purchase private insurance will struggle to afford premiums and common copays in these commercial plans, which are not typically present in Medicaid.
The Paragon Health Institute, a conservative think tank led by Brian Blasé, a former Trump advisor, has published reports suggesting that the billions of additional dollars states received to expand Medicaid under the ACA have primarily benefited private insurers managing the program and relatively wealthier individuals who, according to the organization, should not be enrolled.
Josh Archambault, a senior fellow at the conservative Cicero Institute, stated that he expects the Trump administration to hold states accountable for overpaying providers and enrolling ineligible individuals in Medicaid.
Archambault added that the Republican Party will aim to reduce Medicaid for its “traditional” populations: children, pregnant women, and individuals with disabilities.
“We need to rebalance the program that most people believe is underperforming,” he noted. The majority of Americans, including large majorities of both Republicans and Democrats, view the program favorably, according to surveys.
In conclusion, the future of Medicaid under a Republican-controlled government is uncertain, with potential significant changes on the horizon that could impact millions of Americans who rely on the program for essential healthcare coverage.
