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FACT SHEET: Republicans’ Threats to Medicaid Are A Clear and Present Danger

By April 4, 2023No Comments

April marks the 5th annual Medicaid Awareness Month. With Medicaid currently serving over 92 million Americans, the largest enrollment in history, this program has never been more important to the lives of everyday Americans. Medicaid enrollment has increased by 61 percent nationally since 2013 and the program has been proven time and time again to save lives, increase coverage and – in turn – broaden access to needed care, and help reduce racial, rural, and other health disparities. Republican attacks on Medicaid are especially harmful for communities of color, rural Americans, people with disabilities, and low-income families. 

Even with Medicaid serving more Americans than ever before, Republicans across the country have made it their mission to slash its budget by billions. One budget plan offered by an influential former member of the Trump administration would cut over $2 trillion from Medicaid, ending Medicaid expansion entirely and kicking over 21 million Americans off of their health care plans. Whether it’s at the state level where Republican lawmakers in 10 states continue to refuse to expand Medicaid or in Congress where Speaker Kevin McCarthy recently released a plan that would impose work reporting requirements and other burdensome policies for new moms and families, this war on Medicaid will not stop.

By The Numbers

  • Tens of Millions of Americans are at Risk of Losing Vital Parts of Their Health Care if Cuts to Medicaid Are Pushed Through. Over 92 million Americans are currently enrolled in Medicaid. Cuts to Medicaid would surely see considerable reductions in coverage leaving millions potentially uninsured with no pathway to get health coverage.
  • More Than 50 Percent Of Children Could See Significant Reductions in Their Health Coverage. Nationally, 54 percent of American children are covered by Medicaid/CHIP. Slashing Medicaid funding would see many of these children become ineligible for low-cost health insurance with no pathway to finding affordable health care.
  • Funding For Nearly Two-Thirds of Long-Term Residents in Nursing Homes Would Dry Up. Medicaid covers nursing home bills for over 60 percent of residents in nursing homes. In 2019, this totaled over $50 billion. The median private nursing home room can cost over $100,000 annually. Medicaid caps or cuts would see more seniors without the financial resources to afford long-term care.
  • Marginalized Groups Are Disproportionately Harmed by Republican Attacks. Increasing Medicaid access is the single most important action available to expand coverage and reduce racial inequities in the American health care system. The ACA led to historic reductions in racial disparities in access to health care, but racial gaps in insurance coverage narrowed the most in states that adopted Medicaid expansion. States that expanded their Medicaid programs saw a 51 percent reduction in the gap between uninsured white and Black adults after expansion, and a 45 percent reduction between white and Hispanic adults. Cutting Medicaid and repealing the ACA’s Medicaid Expansion would result in coverage loss, and therefore inflame these disparities.
  • Rural Americans Relying on Medicaid Would be Left Behind by Republicans. Nearly 14 million Medicaid enrollees reside in rural areas. Medicaid helps fund rural hospitals, which employ six percent of all employees in rural counties that report having any hospital employment. Rural hospitals in Medicaid expansion states are 62 percent less likely to close. In 2023, over 600 rural hospitals are at risk of closing in the near future.
  • Nearly 45 Percent Of Adults With Disabilities Could See Reduced Health Coverage or Lose Coverage Entirely. Medicaid covers 45 percent of non-elderly adults with disabilities, including adults with physical disabilities, developmental disabilities, and brain injuries. Republican plans could leave many of these people and their families with little support and sometimes even no health coverage at all.
  • Births Currently Covered by Medicaid Could be at Risk. Medicaid covers over 40 percent of births in the United States and Congress recently offered permanent federal funding to states that opt to expand Medicaid coverage to mothers for one year postpartum. All of these gains would be rolled back under Republican plans and maternal mortality, already a dire crisis in this country especially for Black and Indigenous mothers, would only be worsened.
  • Medicaid’s Assistance for Those With Substance Use Disorders Would Substantially Diminish. Nationally, around 12 percent of Medicaid enrollees over 18 have some kind of substance use disorder (SUD) and Medicaid is crucial to building a system of comprehensive substance use care. These interventions have been vital and life saving, with one study finding that around 10,000 lives were saved from fatal opioid overdoses as a direct result of Medicaid expansion alone. Cutting Medicaid, put simply, would increase overdoses and decrease treatment options for thousands of Americans.
  • Over a Quarter of Americans Living With a Serious Mental Health Condition Could See Their Coverage Cut Back. Medicaid is the single-largest payer for mental health services in America, serving 26 percent of all adults living with a serious mental health condition. Expanding Medicaid services, such as behavioral health benefits, also has led to improved access and better outcomes for low-income individuals. Simply having access to Medicaid has shown in some studies to reduce depression rates by over 3 percent among those with chronic health conditions. Capping or cutting Medicaid spending could see these achievements in mental health care rolled back.

Some Republicans Have Proposed Sunsetting Medicaid Programs. Republicans have a long history of targeting Medicaid for spending cuts and these threats have only grown more serious in recent weeks. Senator Rick Scott has famously proposed a budget that sunsets all federal programs, putting Medicaid in particular on the chopping block. Representative Barry Loudermilk called out Medicaid by name when pronouncing that “everything was on the table” when it came to spending cuts. At the same time, Representative Brett Guthrie called for an explicit cap on Medicaid spending, harkening back to the failed ACA replacement bill which led to Republicans losing the House of Representatives when Americans voted in the midterms. Speaker Kevin McCarthy recently released a plan that would impose work reporting requirements and other burdensome policies for new moms and families.

Speaker Kevin McCarthy Has Proposed Strict Work Requirements to Medicaid While Holding Debt Ceiling Deal as Leverage Over the Country. Kevin McCarthy gave up a significant amount of his power in order to take the title of Speaker. As such, it should be no surprise that his Medicaid proposals mirror that of the radical MAGA Freedom Caucus, proposing the addition of strict work requirements to Medicaid in order for eligible Americans to even have access to the program. Studies of states which have implemented work requirements have repeatedly found these barriers increase disenrollment rates, particularly among those with chronic illnesses (which has itself been increasing steadily since 2020). Other studies have found that even Medicaid beneficiaries who do work often struggle with the complex reporting requirements and risk losing coverage even if they fully comply with the work requirements.

The Proposed Vought Budget Plan Will Slash Medicaid and Rip Away Health Care from Millions of Americans. Former Trump budget director Russell Vought has been quietly tasked by House Republicans to craft a budget that will focus on cutting essential programs for millions of Americans. Although the party line is that Republicans want to reduce spending, choosing Vought is an interesting choice considering his direct role under Donald Trump in ballooning the national debt to a state which will weigh down the American economy for decades. Nevertheless, Vought has proposed a wide swath of austerity measures aimed at punishing the poorest and most vulnerable Americans. Vought’s plan would cut over $2 trillion from Medicaid alone and would also repeal the Affordable Care Act, which would end Medicaid Expansion entirely and kick over 21 million Americans off of their health care plans.

The House Freedom Caucus Budget Proposes Radical Medicaid Cuts. The House Freedom Caucus, to whom Speaker Kevin McCarthy ceded much of his official power as Speaker, has proposed a budget plan which will cut over $3 trillion in non-defense spending taking aim specifically at health care programs like Medicaid. One of the major plans for restructuring the program would be the institution of strict work requirements in order to even access Medicaid. All research on the subject shows that work requirements reduce dramatically the number of people who can access Medicaid. Almost two-thirds, or 62 percent, of those who would lose their Medicaid coverage as a result of work requirements are women, and disproportionately women of color. As well, even though the Freedom Caucus is claiming this is an attempt to cut spending on needless bureaucracy, time and time again Medicaid work requirements end up costing more money to implement and maintain than traditional Medicaid or Medicaid Expansion. Georgia’s new Medicaid work requirements require the state to develop “expensive administrative processes,” estimated to cost upwards of $270 million annually to implement, nearly 3 times more than Medicaid Expansion would cost.

Republicans in 10 States Continue to Fight Against Medicaid Expansion. While Republicans are fighting a war of ideology, the facts are clear, Medicaid expansion saves lives. According to the Center on Budget and Policy Priorities, Medicaid expansion saved the lives of 19,200 older adults aged 55 to 64 between 2014 and 2017. At the same time, 15,600 older adults died prematurely as a result of their state’s decision not to expand the program. A study published in the Journal of Health Economics found that Medicaid expansion reduced mortality in non-elderly adults by nearly four percent. Cancer deaths have dropped more in states that accepted Medicaid coverage under the ACA than in states that have held out, and expansion has also been tied to fewer heart-related deaths. Often Republicans know that Medicaid Expansion would be the best program for their state, but continue to refuse to expand it or, in some states, will try to implement a milquetoast replacement program.

  • Republicans are Leaving Hundreds of Thousands of Georgians Behind With Their Sham Medicaid Waiver. Governor Brian Kemp’s Medicaid waiver program will likely increase coverage for 50,000 Georgians, costing taxpayers around the same amount of money it would cost to adopt Medicaid expansion and cover over 500,000 Georgians. Included in Kemp’s plan are strict work requirements aimed at punishing those who cannot afford health care which will cost taxpayers three times more simply to maintain than expanding Medicaid. Under the Republican waiver plan, almost 300,000 Georgians would have no pathway to any type of health insurance at all. Brian Kemp and Georgia Republicans are willing to leave these Georgians behind in the name of pure ideology.

Texas and Florida Are Cutting Staff While Millions Are At Risk of Losing Medicaid Coverage. Due to the Public Health Emergency (PHE), nearly 3 million Texans and 1 million Floridians were able to access and maintain Medicaid coverage for around three years. As the federal unwinding process begins , these 4 million people will likely see themselves kicked off of Medicaid, through no fault of their own. In 2022 Texas chose to purposefully cut staffing to their Medicaid program, making it even more difficult to enroll or renew coverage. Until April 1, this was not as large of an issue as Americans were protected from being booted off of Medicaid rolls, but now that Medicaid continuous coverage protections have been decoupled from the PHE eligibility for millions of Americans on Medicaid are being put into question. Even for people who are still eligible for Medicaid, the renewal process may be so difficult and burdensome that they cannot receive the coverage, with studies suggesting anywhere between 45 percent and 83 percent of those estimated to lose coverage will lose it purely for administrative reasons. In Florida, Republican lawmakers have made draconian cuts to hospitals specifically treating poor and marginalized Floridians amidst widespread protests from hospitals and staff throughout the state. These cuts have led to worse outcomes and patient care and the already fragile state of many hospitals in the state becoming dire. Since 2005, Florida has seen the 9th most rural hospital closures of any state in the country. Expanding Medicaid would increase funding to these hospitals, increase coverage of Floridians and Texans, and reduce the impacts of the PHE unwinding but both Republicans in Florida and Texas have no plans to move forward with expanding Medicaid programs.