Medicaid’s Future at Stake: A Look at Proposed Cuts

House Legislation Threatens Decades of Progress in Healthcare Access

The fate of Medicaid hangs in the balance as lawmakers debate significant funding cuts. This legislative push aims to reshape Medicaid, potentially reversing advancements and limiting healthcare access for millions. The core issue at hand concerns the very essence of Medicaid and the direction of our society.

The Proposed Cuts: A Deep Dive

The recently passed House Reconciliation bill could trigger the most substantial Medicaid reduction in history. According to estimates, this could remove healthcare coverage from approximately 16 million individuals, creating considerable hardship for families, healthcare providers, and states across the country. It’s essential to look at Medicaid’s evolution to understand the impact of these changes.

Phase One began in 1965 with Medicaid’s inception. Eligibility was initially tied to cash assistance programs like AFDC (Aid to Families with Dependent Children), limiting access based on the belief that only a select few of the poor were worthy of aid.

During the 1970s to the mid-1990s, Phase Two saw significant expansions. As society recognized the need for broader coverage, eligibility grew through various expansions. The program evolved slowly but steadily.

Phase Three arrived in 1996, a pivotal moment. Recognizing that Medicaid was not solely a “welfare” program, Congress redesigned AFDC into TANF, and severed Medicaid eligibility from AFDC/TANF. It was now considered a healthcare program in its own right.

Phase Four, from 1996 to 2010, witnessed a continuation of expansions, with more groups gaining eligibility. Congress introduced categories like workers with disabilities, and also created the Children’s Health Insurance Program (CHIP) in 1997.

Phase Five began in 2010 with the Affordable Care Act (ACA) and its Medicaid expansion, a turning point in U.S. healthcare. Congress recognized the need for universal access, adding a new category: “everyone else who has been left out of Medicaid and is poor.” This marked the end of classifications of worthy and unworthy poor.

This leads to Phase Six: the political backlash. A minority has attacked the progress made in Medicaid. The Supreme Court ruled that expansion could not be mandatory for states. However, 41 states and DC have voluntarily expanded it.

Legislative Proposals: Taking Steps Backwards

The House-passed Reconciliation bill, now under Senate consideration, proposes substantial cuts to Medicaid, primarily targeting Medicaid expansion. These include work reporting requirements, doubled renewal demands, the end of incentives for expansion, increased cost-sharing, and a doubling of costs for states with programs covering immigrants. Even more concerning, hospital reimbursement limits may be set lower for expansion states compared to non-expansion states. This approach seeks to diminish expansion.

A poll indicates that two-thirds of Americans want their states to expand Medicaid. Many states have voted in favor of expansion, yet the House is acting in opposition to public opinion.

House leaders, when describing the American population that uses Medicaid, have mentioned “young men who need to be out working instead of playing video games all day.” They discuss Medicaid as “welfare” and “handouts.” They want to bring back the exclusion of poor people they deem “unworthy.” They are attempting to curtail Medicaid expansion by making it difficult to enroll, erecting barriers, and punishing expansion states. The intent is to reverse the progress and return to 1965.

A 2024 study by the Kaiser Family Foundation revealed that Medicaid expansion has led to a significant reduction in the uninsured rate, from 16.1% in 2013 to 11.4% in 2022, showing the positive impact of the ACA’s Medicaid expansion initiative (KFF 2024).

The Future of Medicaid

The ongoing debate will determine whether Congress moves backward or acknowledges Medicaid’s evolution and the American public’s wishes. The choice before policymakers is whether to hinder or support the expansion of healthcare access.