Speaker McCarthy and MAGA Congressional Republicans have committed to balance the budget while adding $3 trillion or more to the deficit through tax cuts skewed toward the wealthy and large corporations. As a matter of simple math, that requires trillions in program cuts. Congressional Republicans have yet to disclose to the American people where these cuts will come from. But past Republican legislation, budgets, and litigation, along with recent statements, proposals, and budget plans, provide clear evidence that health care will be on the chopping block for severe cuts.
Virtually every Republican budget or fiscal plan over the last decade has included repeal of the Affordable Care Act (ACA) and deep cuts to Medicaid. That would mean: higher health care costs for American families; ending critical protections for people with pre-existing conditions; and threats to health care for seniors and people with disabilities, including growing home care waiting lists and worse nursing home care.
Americans deserve to see congressional Republicans’ full and detailed budget plan, including what it cuts from the ACA and Medicaid, Social Security and Medicare, and other critical programs, and should have the chance to compare it with the President’s budget plan, which he will release March 9.
ACA repeal would reverse The United States’ progress in getting more Americans health insurance. Since the passage of the Affordable Care Act, monthly enrollment rates for Medicaid have increased by over 59 percentage points—coverage gains that would surely be lost if the ACA and Medicaid expansion is eliminated.
More than 106 million Americans—about 32 percent of the country—rely on Medicaid and the Affordable Care Act for health coverage.
In total, over 37 million Americans’ health insurance coverage will be at risk from ACA repeal. This includes over 16,306,448 who have signed up for ACA marketplace coverage for 2023, and over 21,339,037 enrolled in Medicaid expansion coverage available due to the ACA.
Nearly 54 million Americans with pre-existing health conditions could lose critical protections. Before the ACA, at least 53,883,000 Americans with pre-existing health conditions could be denied coverage or charged more if they tried to buy individual market health insurance. Republican repeal proposals either eliminate these protections outright or find other ways to gut them.
Over 25 million Americans could lose protection against catastrophic medical bills. Before the ACA, insurance plans were not required to limit enrollees’ total costs, and almost one in five people with employer coverage had no limit on out-of-pocket costs, meaning they were exposed to tens of thousands of dollars in medical bills if they became seriously ill.
About 68 million Americans with Medicaid could lose critical services, or could even lose coverage altogether, including over 44,223,975 children. Slashing federal funding for Medicaid will force states to make Medicaid eligibility changes that would make it harder to qualify for, and enroll in, Medicaid coverage. States would also likely consider capping or limiting enrollment.
Medicaid funding could be slashed. Republican budget plans would eliminate the minimum federal Medicaid matching rate (FMAP) for states. Under current law, states with lower relative average per-capita income receive higher matching rates than states with the highest average per-capita income, and no state receives a FMAP that is lower than 50 percent. If the 50 percent floor were eliminated, according to some older estimates, states could see their FMAP fall to as low as 15 percent, forcing Americans to pick up a far greater share of the cost of their Medicaid programs or make substantial cuts to their Medicaid programs.
Almost 10 million seniors and people with disabilities could receive worse home care, with ballooning wait lists for those still in need. Under a block grant or per-capita cap, there would be fewer dollars available for home care services, an optional benefit in Medicaid. Faced with large federal funding cuts, states would almost certainly ration care. The United States already has over 655,596 people on its home care wait lists so any additional cuts in federal funding will likely cause the state’s existing waitlist to skyrocket.
Hundreds of thousands of nursing home residents would be at risk of lower-quality care. Over 60 percent of nursing home residents are covered by Medicaid. With large cuts in federal funding, states would be forced to cut nursing home rates to manage their costs, as many states have done during recessions. Research shows that when nursing homes are paid less, residents get worse care.
NOTE: All numbers are updated as of March 2023.