The prospect of deep Medicaid cuts has grow to be 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 funds 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 mentioned. “I can’t say it some other means. Republicans are mendacity. Show me unsuitable.”
Republicans mentioned Democrats have been distorting the Republican funds. Rep. Steve Scalise (R-La.) mentioned, “The phrase ‘Medicaid’ shouldn’t be even on this invoice.” Home Speaker Mike Johnson mentioned on CNN that Republicans don’t wish to lower Medicaid, “and the Democrats have been mendacity about it.”
Republicans are in search of huge funds financial savings to fulfill their aim of absolutely extending President Donald Trump’s 2017 tax cuts. This can be a separate course of from Congress’ must go 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 up to now about potential Medicaid cuts.
The Home GOP Funds Plan Seeks $880 Billion in Cuts
Medicaid serves about 1 in 5 People. The well being care program for low-income folks is paid for by the federal authorities and partly by states. Louisiana, dwelling to Johnson and Scalise, has one of many highest state proportions of Medicaid enrollees.
The Home Republican funds plan adopted Feb. 25 opens the door to slashing Medicaid, although it doesn’t title this system. The plan directs the Home Power and Commerce Committee to search out methods to chop the deficit by at the least $880 billion over the following decade.
The committee has jurisdiction over Medicaid, Medicare, and the Kids’s Well being Insurance coverage Program, along with a lot smaller applications. CHIP affords low-cost well being protection 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 funds, and Medicaid is about 8.6%.
When Medicare is put aside, Medicaid accounts for 93% of the funding beneath the committee’s jurisdiction, the nonpartisan Congressional Funds Workplace present in a March 5 evaluation. Meaning it’s unattainable for the committee to search out sufficient cuts that don’t have an effect on Medicaid.
“It’s a fantasy to indicate that federal Medicaid help received’t be lower very deeply,” mentioned Allison Orris, an professional on Medicaid coverage on the Heart on Funds and Coverage Priorities, a left-leaning assume tank.
After Medicaid, the next-largest program beneath the committee’s jurisdiction is CHIP. Lawmakers don’t seem like planning to wipe out CHIP, however even when they did, they’d be solely a “fraction of the way in which there,” mentioned Joan Alker, an professional on Medicaid and CHIP at Georgetown College.
If Medicare cuts are off the desk, the one technique to obtain $880 billion in financial savings is thru massive Medicaid cuts, mentioned Larry Levitt, govt 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 Providers, mentioned even when the committee eradicated all these “different” applications totally it might obtain solely $381 billion in financial savings — about 43% of the goal.
“Briefly, in the event that they don’t wish to lower Medicaid [or CHIP], they usually don’t wish to lower Medicare, the aim of chopping $880 billion is unattainable,” Schneider mentioned.
The $880 billion lower shouldn’t be a executed deal. Home Republicans have been capable of go their funds bundle, however Senate Republicans are taking a special strategy, with out proposing such important cuts.
Any finalized funds blueprint would wish Senate Republicans’ buy-in. Sen. Josh Hawley (R-Mo.) is amongst Republicans who’ve spoken towards potential cuts; he advised HuffPost, “I might not do extreme cuts to Medicaid.”
The numbers are beginning factors that will result in negotiation amongst at the least Republicans, mentioned Joseph Antos, a well being care professional on the conservative American Enterprise Institute. “We’re a good distance from last laws, so it’s not potential to foretell how a lot any program can 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 wish to approve a separate invoice and obtain Trump’s signature.
Why Eliminating Fraud Doesn’t Clear up the Downside
Republican leaders have deflected considerations about Medicaid cuts by speaking a few totally 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 advised Fox Information’ Maria Bartiromo on March 9, in line with his marketing campaign rhetoric that he would defend these applications.
On the similar time, Trump on his Reality Social platform praised the Home decision that will make cuts extremely probably: “The Home Decision implements my FULL America First Agenda, EVERYTHING, not simply components of it!”
Would eliminating fraud resolve the Medicaid downside? No.
On CNN, Johnson mentioned chopping 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 Authorities Accountability Workplace, the nonpartisan investigative arm that examines using public funds, discovered about $50 billion in improper funds in Medicaid and the identical quantity in Medicare in fiscal 2023.
These improper funds have 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 via willful misrepresentation.
The system used to establish improper funds shouldn’t be designed to measure fraud, so we don’t know what proportion of improper funds have been losses attributable to fraud, mentioned Schneider, the previous Obama administration well being adviser.
Plus, it’s a drop within the general bucket of the potential $880 billion in cuts.
