The prospect of deep Medicaid cuts has change into a flashpoint in Congress, with leaders of each events accusing their counterparts of mendacity.
Home Democratic chief Hakeem Jeffries mentioned Feb. 27 {that a} Republican price range measure would “set in movement the biggest lower to Medicaid in American historical past,” and that Republicans are hiding the implications.
“The Republicans are mendacity to the American folks about Medicaid,” Jeffries said. “I can’t say it some other method. Republicans are mendacity. Show me improper.”
Republicans mentioned Democrats had been distorting the Republican price range. Rep. Steve Scalise (R-La.) said, “The phrase ‘Medicaid’ isn’t even on this invoice.” Home Speaker Mike Johnson said on CNN that Republicans don’t need to lower Medicaid, “and the Democrats have been mendacity about it.”
Republicans are searching for large price range financial savings to fulfill their objective of absolutely extending President Donald Trump’s 2017 tax cuts. It is a separate course of from Congress’ have to cross a seamless decision to maintain the federal government operating by March 14 or face a federal authorities shutdown.
Right here’s what we all know to this point about potential Medicaid cuts.
The Home GOP Finances Plan Seeks $880 Billion in Cuts
Medicaid serves about 1 in 5 Americans. The well being care program for low-income folks is paid for by the federal authorities and partly by states. Louisiana, residence to Johnson and Scalise, has one of many highest state proportions of Medicaid enrollees.
The House Republican budget plan adopted Feb. 25 opens the door to slashing Medicaid, though it doesn’t title this system. The plan directs the Home Vitality and Commerce Committee to seek out methods to chop the deficit by at the least $880 billion over the subsequent decade.
The committee has jurisdiction over Medicaid, Medicare, and the Kids’s Well being Insurance coverage Program, along with a lot smaller applications. CHIP offers low-cost health coverage to kids in households that earn an excessive amount of cash to qualify for Medicaid.
Republicans dominated out cuts to Medicare, the medical insurance program for seniors that leaders lower at their political peril. Medicare is about 15% of the federal budget, and Medicaid is about 8.6%.
When Medicare is put aside, Medicaid accounts for 93% of the funding underneath the committee’s jurisdiction, the nonpartisan Congressional Finances Workplace present in a March 5 analysis. Which means it’s inconceivable for the committee to seek out sufficient cuts that don’t have an effect on Medicaid.
“It’s a fantasy to indicate that federal Medicaid help gained’t be lower very deeply,” mentioned Allison Orris, an skilled on Medicaid coverage on the Heart on Finances and Coverage Priorities, a left-leaning assume tank.
After Medicaid, the next-largest program underneath the committee’s jurisdiction is CHIP. Lawmakers don’t seem like planning to wipe out CHIP, however even when they did, they might be solely a “fraction of the way in which there,” mentioned Joan Alker, an skilled on Medicaid and CHIP at Georgetown College.
If Medicare cuts are off the desk, the one solution to obtain $880 billion in financial savings is thru massive Medicaid cuts, mentioned Larry Levitt, government vice chairman for well being coverage at KFF, the well being coverage analysis, polling, and information group that features KFF Well being Information.
Andy Schneider, a professor at Georgetown College who served within the Obama administration as a senior adviser on the Facilities for Medicare & Medicaid Companies, mentioned even when the committee eradicated all these “different” applications solely it may obtain solely $381 billion in financial savings — about 43% of the goal.
“Briefly, in the event that they don’t need to lower Medicaid [or CHIP], they usually don’t need to lower Medicare, the objective of slicing $880 billion is inconceivable,” Schneider mentioned.
The $880 billion lower isn’t a carried out deal. Home Republicans had been in a position to cross their price range bundle, however Senate Republicans are taking a special method, without proposing such significant cuts.
Any finalized price range blueprint would want Senate Republicans’ buy-in. Sen. Josh Hawley (R-Mo.) is amongst Republicans who’ve spoken against potential cuts; he told HuffPost, “I might not do extreme cuts to Medicaid.”
The numbers are beginning factors which will result in negotiation amongst at the least Republicans, mentioned Joseph Antos, a well being care skilled on the conservative American Enterprise Institute. “We’re a good distance from closing laws, so it’s not doable to foretell how a lot any program will probably be lower,” he mentioned.
“If the invoice additionally contains extending the [Trump 2017] tax cuts, we’re most likely months away from seeing actual language,” Antos mentioned.
As soon as the Home and Senate have reached an settlement on language and the decision passes each chambers, the committees will work on detailed cuts. To enact such cuts, each chambers would want to approve a separate invoice and obtain Trump’s signature.
Why Eliminating Fraud Doesn’t Remedy the Downside
Republican leaders have deflected considerations about Medicaid cuts by speaking a couple of completely different goal: Medicaid fraud.
“I’m not going to the touch Social Safety, Medicare, Medicaid. Now, we’re going to get fraud out of there,” Trump instructed Fox Information’ Maria Bartiromo on March 9, consistent with his marketing campaign rhetoric that he would defend these applications.
On the identical time, Trump on his Reality Social platform praised the House resolution that would make cuts highly likely: “The Home Decision implements my FULL America First Agenda, EVERYTHING, not simply elements of it!”
Would eliminating fraud clear up the Medicaid drawback? No.
On CNN, Johnson said slicing fraud, waste, and abuse would lead to “a part of the financial savings to perform this mission.” He mentioned the federal government loses $50 billion a yr in Medicaid funds “simply in fraud alone.”
Johnson conflated “fraud” with “improper funds.” The Government Accountability Office, the nonpartisan investigative arm that examines using public funds, found about $50 billion in improper funds in Medicaid and the identical quantity in Medicare in fiscal 2023.
These improper funds had been made in an incorrect quantity (overpayment or underpayment), shouldn’t have been made in any respect, or had lacking or inadequate documentation. However that doesn’t imply that there was $50 billion in Medicaid fraud, which might contain acquiring one thing by means of willful misrepresentation.
The system used to establish improper funds isn’t designed to measure fraud, so we don’t know what share of improper funds had been losses attributable to fraud, mentioned Schneider, the previous Obama administration well being adviser.
Plus, it’s a drop within the total bucket of the potential $880 billion in cuts.
