In 2017, Republicans who controlled Congress made an enormous try to cut federal spending on Medicaid, the government-funded health program for low-income families and individuals.
But the Republican effort failed – embodied iconically by Republican Sen. John McCain of Arizona, affected by terminal brain cancer, who gave his decisive thumbs down earlier that morning.
More than seven years later, it's that point again.
As Donald Trump prepares to maneuver back into the White House, supported by Republican majorities in each houses of Congress, expectations are high that Republicans will quickly revive their long-sought goal of cutting Medicaid.
Republicans need to fund big tax cuts, and that GOP platform under Trump guarantees not to the touch Social Security or Medicare. Of course, this isn't set in stone. But for now, like mine KFF colleagues have noticedMedicaid looks quite a bit like low-hanging fruit. (KFF is a nonprofit health information organization that features KFF Health News.)
Health officials in California and across the country are concerned about the opportunity of major Medicaid cuts as early as next 12 months. Such cuts would have an outsized impact on Golden State, whose 14.7 million Medi-Cal enrollees exceeds the overall population from all but three other US states. Medi-Cal provides medical insurance for over 40% of the state's children and pays for nearly 40% of births. It is a critical source of funding for safety net hospitals and community clinics.
And over 60% The bulk of this 12 months's $161 billion budget comes through Washington.
The possibility of great federal cuts to Medicaid could have been a think about Democratic Gov. Gavin Newsom's decision to make the decision a special session of the state parliament this week.
California could attempt to offset a pointy decline in federal dollars through higher taxes or cuts to other state programs. But each options might be politically untenable. That's why many health experts imagine leaders in Sacramento would almost definitely have to contemplate reducing Medi-Cal.
That could mean cutting any variety of them optional services corresponding to dental services, optometry and physical therapy. It could also mean you could have to roll back a few of the ambitious Medi-Cal expansion you've undertaken in recent times. That could include some elements of California Advancing and Innovating Medi-Cal, a $12 billion program with services that address patients' social and economic needs along with their medical needs.
Some observers worry that federal cuts could have an effect on the economy about 1.5 million Immigrants living within the U.S. without authorization and enrolling in Medi-Cal incur annual costs of greater than $6 billion, almost entirely funded by the federal government. But others say a more likely path could be to chop payments to managed care plans across the board cover 94% of Medi-Cal participants reasonably than targeting specific groups of individuals.
“Medicaid is at stake, and I don’t think that’s speculation,” said Gerald Kominski, a senior fellow on the UCLA Center for Health Policy Research. “It is widely viewed by potential members of the Trump administration as a program that is too broad and needs to be brought under control.”
Whether they’ll succeed this time stays to be seen. But more on that later.
People who’ve followed previous GOP efforts to shrink Medicaid say quite a few previously tried methods might be back on the table this time. They could include total caps on federal Medicaid dollars; Eliminate the Affordable Care Act's core policy under which the federal government would pay 90% of the price of expanding coverage to a bigger group of low-income adults; a piece requirement that would affect enrollment; and rule changes designed to make it harder for states to acquire federal Medicaid dollars through using taxes on medical insurance, generally known as MCOs.
The first Trump administration proposed changes to the foundations for such taxes but later dropped them. If similar changes were made this time, it could cause financial problems in California, which frequently uses MCO taxes to offset medical expenses from state coffers.
Proposition 35, recently approved by California voters, may be in danger. The initiative calls for the MCO tax to turn out to be a everlasting fixture in 2027, pending federal approval, with the goal of funding billions of dollars in latest medical spending, primarily to extend funding for doctors and other providers. A change in federal rules could undermine these intentions.
Ending the federal government's 90 percent coverage of the ACA-Medicaid expansion would create a gaping hole within the Medi-Cal budget. Medi-Cal spent greater than $34 billion in fiscal 12 months 2023 to serve the roughly 5 million people enrolled because of this of the expansion, and nearly $31 billion of that quantity was paid for by the federal government.
If the federal government's share were to revert to the regular Medi-Cal rate of fifty%, California would must fork out nearly $14 billion more to cover expansion enrollees – and that's only for one 12 months.
A more ambitious Republican push that features each spending caps and a rollback of federal support for Medicaid expansion could put California officials in real trouble.
In 2017, the state Department of Health issued one Analysis shows that a bill introduced by a bunch of Republican U.S. senators to limit Medicaid spending and end increased funding for the ACA expansion, together with another cuts, would end in California losing nearly $139 billion in federal funding from 2020 to 2027 US dollars lost.
“There are almost unlimited changes state leaders could make to Medi-Cal if forced to,” said David Kane, a senior attorney on the Western Center on Law & Poverty. “And we fear that this burden will almost certainly harm poor people and immigrants the most.”
But major cuts to Medicaid should not a given. After all, when Trump was within the White House in 2017, the Republicans also had majorities within the House of Representatives and the Senate and still didn’t achieve their goal. This time the political stars might be different, but Republicans only have a razor-thin majority within the House of Representatives.
A decade after the ACA's Medicaid expansion, some 21 million people across the country are covered, making this system more embedded within the country's healthcare landscape. According to a Study 2023 From Georgetown University, Medicaid and its associated children's medical insurance program cover a bigger share of the population in rural counties than in urban ones. And as we all know, rural America leans heavily Republican.
Faced with a vote to chop Medicaid, will Republican members of Congress defy their very own constituents?
Edwin Park, one among the authors of this Georgetown study, believes there may be a possibility that giant cuts might be detected. “A large number of Americans are either on Medicaid, have family members who are on Medicaid, or know someone who is on Medicaid,” said Park, a research professor on the McCourt School of Public Policy at Georgetown. “Hopefully its popularity and importance will prevail.”
Originally published:
image credit : www.mercurynews.com