Republicans Could Face Challenges in Attempting to Reduce Medicaid Funding
The unexpected strength of the program? It enjoys widespread popularity.
TroibNews 
Republicans might have just witnessed a troubling glimpse of what lies ahead.
During the turmoil surrounding the now-lifted domestic funding freeze by President Donald Trump, Medicaid portals across the nation were taken offline, preventing states from accessing their Medicaid funds. This situation created significant public outrage and bipartisan concern, contradicting assurances from the administration that such an occurrence would never happen.
Presently, Republicans are deliberating how to address Medicaid within their strategy to offset the financial impact of substantial tax cuts, which form the core of Trump’s legislative initiatives. At the beginning of the year, with the GOP firmly in control in Washington, the question appeared to be not if Medicaid cuts would occur, but how steep they would be. Just last month, various proposals were circulated among Republicans seeking to cut hundreds of billions from Medicaid and fundamentally reshape the program. However, this week, Speaker Mike Johnson indicated that the most severe cuts may not be imminent, as GOP lawmakers remain entrenched in discussions about their budget plans amidst a vigorous divide between hard-liners and moderates on spending.
The backlash concerning the portal issues highlighted that targeting Medicaid may be more complicated than anticipated. The program has grown and been refined significantly over the years, leading to a diverse constituency. Approximately 80 million people currently utilize Medicaid for health care, including a substantial number of working-class voters within Trump’s support base.
Throughout the 2024 campaign, Trump consistently assured concerned Americans that he would not touch their Social Security or Medicare benefits. Medicaid, however, did not receive similar guarantees, even though Trump expressed last month that he would “love and cherish” the program. Recently, sources reported that Trump and his aides privately voiced concerns that significant cuts to Medicaid could be politically detrimental.
Patrick T. Brown, a fellow at the conservative Ethics and Public Policy Center advocating for more pro-family Republican policies, pointed out the internal conflicts facing the party. According to him, traditional budget-conscious Republicans view this moment as an opportunity to pursue their long-standing goal of reducing social spending, ideally reverting to pre-Affordable Care Act policies. However, he also noted a political transformation is in progress, with the GOP increasingly catering to voters reliant on government assistance. “You can say President Trump was elected on a mandate. But the mandate was not ‘Let’s slash health care from working-class Americans,’” he observed.
Data from various polls reinforces this perspective. Growing support for Medicaid is apparent among voters across partisan lines, with seven states that have held ballot initiatives on Medicaid expansion seeing it passed by significant margins, even in staunchly conservative areas like Idaho and Utah.
A 2024 poll by the nonprofit health research organization KFF revealed that 71 percent of voters preferred Medicaid to remain largely unchanged, with over half of Republicans included in that figure. Additionally, 77 percent of respondents viewed the program positively, including 63 percent of GOP members.
This broad backing for Medicaid could be expected given its widespread reach. About two-thirds of U.S. adults indicate they or someone close to them has depended on Medicaid at some point. The program has evolved into the largest source of funding for treatment of opioid and substance abuse disorders and covers care for serious mental illnesses. Medicaid is responsible for about 40 percent of births in the U.S. and plays a critical role in providing prenatal and postnatal care in states facing high maternal mortality rates. Furthermore, it is the premier payer for nursing homes and long-term care, helping middle-class families cope with the staggering costs associated with aging.
Chiquita Brooks-LaSure, who led the Centers for Medicare and Medicaid Services during the Biden administration, emphasized the increased importance of Medicaid: “With more people covered, Medicaid is way more important to both states and for the health care ecosystem,” she noted. “Dismantling parts of Medicaid would be truly, truly catastrophic to our health care system.”
The implications of Medicaid extend beyond individual welfare; they significantly impact the financial viability of hospitals, clinics, nursing homes, and other healthcare providers. These groups possess considerable political influence at both state and federal levels. Larry Levitt, executive vice president for health policy at KFF, highlighted, “Medicaid is not as politically sacrosanct as Medicare and Social Security, but it’s a program that touches an enormous number of people.” He warned that severe cuts would likely incite “a firestorm of political opposition from all segments of the industry and patient advocates.”
Despite the growing support and reliance on Medicaid, significant changes remain a possibility.
With a majority in Congress, albeit slim and divided, Republicans face pressure from traditional budget hawks. The Elon Musk-led DOGE initiative aims to reduce federal spending by over $1 trillion. Johnson has also floated the prospect of revisiting the Affordable Care Act, which expanded Medicaid access and was previously targeted for repeal under Trump. The $600 billion annual Medicaid spending pot presents an enticing opportunity for Republicans seeking to counterbalance enhanced tax cuts.
On Thursday, members of the House Budget Committee reviewed a plan that could lead to cuts to Medicaid totaling as much as $880 billion over the next decade. Although this proposal faces various challenges, it plays a crucial role in the reconciliation process, enabling legislation to pass with a simple Senate majority, bypassing Democratic filibusters.
So, what could Republicans attempt regarding Medicaid?
Some conservatives advocate for implementing per capita caps, which would change Medicaid from an open-ended entitlement program to one with a fixed annual allocation per state, offering increased flexibility in spending, although growth may not meet demand. Such measures have been floated since the Reagan administration but have consistently faced considerable pushback.
Another probable approach involves imposing work requirements for Medicaid enrollees in select states, whether through new legislation or federal waivers. While millions of Medicaid beneficiaries are already employed, the implications for disabled individuals under such requirements remain unclear. Additionally, documenting compliance presents logistical challenges that have previously led to loss of coverage for thousands in Arkansas due to cumbersome processes. Courts have historically been wary of work requirements, as Medicaid statutes primarily focus on health rather than employment, but transformed judicial dynamics during Trump’s presidency could influence outcomes.
Federal or state-level adjustments to rules and procedures could also complicate enrollment processes or make it more difficult for individuals to maintain Medicaid coverage. A frequent Republican assertion revolves around eliminating “waste and abuse,” yet how this would be defined is ambiguous. The Trump administration might also limit or prevent states from using Medicaid funding to address social determinants of health, like housing and food security issues.
Republican legislators have also considered reducing the ACA Medicaid expansion currently implemented nationwide. Since Medicaid operates as a federal-state partnership with varying funding ratios, with the federal government covering 90 percent for expansion, some states have introduced “triggers” to halt the expansion population's coverage if federal contributions decrease. The Georgetown University Center for Children and Families noted that such budget cuts would effectively repeal Medicaid expansion.
Neither Robert F. Kennedy Jr., Trump’s newly confirmed HHS secretary, nor Mehmet Oz, his appointee for the Centers for Medicare and Medicaid Services, has articulated specific views on these potential scenarios. Kennedy's responses during his confirmation hearings were often vague and inaccurate concerning Medicare and Medicaid, while Oz’s hearings have yet to occur.
One challenge for Republican cost-cutters is that Medicaid spending projections may yield lower savings in the upcoming years due to a slowdown in cost growth. Sherry Glied, a health economist and dean of NYU’s School of Public Policy, mentioned that “back in the days when Medicaid was growing really like gangbusters,” less growth is now anticipated.
Critics like Tom Miller from the American Enterprise Institute point to Medicaid’s “bloat” as a longstanding concern but advocate for a more careful, policy-focused approach rather than a broad-based cost-cutting initiative.
Historically, Medicaid began in 1965 with minimal recognition, overshadowed by Medicare’s headlines despite being established under the same legislation signed by President Lyndon Johnson. Originally a modest program for the impoverished, it has grown significantly in scope and political resilience.
The ACA Medicaid eligibility expansion has further solidified the program’s significance for individuals and states alike. Under Obamacare, individuals who lose their health insurance due to job loss can access Medicaid until they regain coverage through new employment or ACA markets.
“Medicaid is in a position to dial up rapidly if there’s an economic downturn, and we did see that during that Covid public health emergency,” stated Kate McEvoy, executive director of the nonpartisan National Association of Medicaid Directors, although enrollment has since declined from pandemic highs.
Moreover, the health industry, which wields considerable political influence at multiple levels, is resistant to relinquish funding, particularly in anticipation of future economic challenges.
A crucial transformation for Medicaid is its perception; it is no longer merely a welfare program. Instead, a significant majority of Americans, including about 45 percent of Republicans, see it as a legitimate health care program.
This distinction is critical. While welfare may carry political stigma, health care does not. Depending on Republicans’ actions and approach, the perception of Medicaid as a health care program could present challenges.
Republicans’ initial foray during Trump’s presidency into modifying health care, particularly with their unsuccessful efforts to repeal Obamacare, demonstrated the potential political consequences of jeopardizing health benefits. The dynamics surrounding removing benefits are considerably more complex than those associated with establishing them.
Currently, GOP lawmakers tend to be more conservative and pro-Trump than they were eight years ago, and they have largely aligned with the party’s ethos. However, it remains early in the political cycle. The prospect of cost savings might sound appealing to Trump supporters, but the potential loss of health benefits for themselves or their families might not be the deal they are seeking.
Mathilde Moreau contributed to this report for TROIB News
During the turmoil surrounding the now-lifted domestic funding freeze by President Donald Trump, Medicaid portals across the nation were taken offline, preventing states from accessing their Medicaid funds. This situation created significant public outrage and bipartisan concern, contradicting assurances from the administration that such an occurrence would never happen.
Presently, Republicans are deliberating how to address Medicaid within their strategy to offset the financial impact of substantial tax cuts, which form the core of Trump’s legislative initiatives. At the beginning of the year, with the GOP firmly in control in Washington, the question appeared to be not if Medicaid cuts would occur, but how steep they would be. Just last month, various proposals were circulated among Republicans seeking to cut hundreds of billions from Medicaid and fundamentally reshape the program. However, this week, Speaker Mike Johnson indicated that the most severe cuts may not be imminent, as GOP lawmakers remain entrenched in discussions about their budget plans amidst a vigorous divide between hard-liners and moderates on spending.
The backlash concerning the portal issues highlighted that targeting Medicaid may be more complicated than anticipated. The program has grown and been refined significantly over the years, leading to a diverse constituency. Approximately 80 million people currently utilize Medicaid for health care, including a substantial number of working-class voters within Trump’s support base.
Throughout the 2024 campaign, Trump consistently assured concerned Americans that he would not touch their Social Security or Medicare benefits. Medicaid, however, did not receive similar guarantees, even though Trump expressed last month that he would “love and cherish” the program. Recently, sources reported that Trump and his aides privately voiced concerns that significant cuts to Medicaid could be politically detrimental.
Patrick T. Brown, a fellow at the conservative Ethics and Public Policy Center advocating for more pro-family Republican policies, pointed out the internal conflicts facing the party. According to him, traditional budget-conscious Republicans view this moment as an opportunity to pursue their long-standing goal of reducing social spending, ideally reverting to pre-Affordable Care Act policies. However, he also noted a political transformation is in progress, with the GOP increasingly catering to voters reliant on government assistance. “You can say President Trump was elected on a mandate. But the mandate was not ‘Let’s slash health care from working-class Americans,’” he observed.
Data from various polls reinforces this perspective. Growing support for Medicaid is apparent among voters across partisan lines, with seven states that have held ballot initiatives on Medicaid expansion seeing it passed by significant margins, even in staunchly conservative areas like Idaho and Utah.
A 2024 poll by the nonprofit health research organization KFF revealed that 71 percent of voters preferred Medicaid to remain largely unchanged, with over half of Republicans included in that figure. Additionally, 77 percent of respondents viewed the program positively, including 63 percent of GOP members.
This broad backing for Medicaid could be expected given its widespread reach. About two-thirds of U.S. adults indicate they or someone close to them has depended on Medicaid at some point. The program has evolved into the largest source of funding for treatment of opioid and substance abuse disorders and covers care for serious mental illnesses. Medicaid is responsible for about 40 percent of births in the U.S. and plays a critical role in providing prenatal and postnatal care in states facing high maternal mortality rates. Furthermore, it is the premier payer for nursing homes and long-term care, helping middle-class families cope with the staggering costs associated with aging.
Chiquita Brooks-LaSure, who led the Centers for Medicare and Medicaid Services during the Biden administration, emphasized the increased importance of Medicaid: “With more people covered, Medicaid is way more important to both states and for the health care ecosystem,” she noted. “Dismantling parts of Medicaid would be truly, truly catastrophic to our health care system.”
The implications of Medicaid extend beyond individual welfare; they significantly impact the financial viability of hospitals, clinics, nursing homes, and other healthcare providers. These groups possess considerable political influence at both state and federal levels. Larry Levitt, executive vice president for health policy at KFF, highlighted, “Medicaid is not as politically sacrosanct as Medicare and Social Security, but it’s a program that touches an enormous number of people.” He warned that severe cuts would likely incite “a firestorm of political opposition from all segments of the industry and patient advocates.”
Despite the growing support and reliance on Medicaid, significant changes remain a possibility.
With a majority in Congress, albeit slim and divided, Republicans face pressure from traditional budget hawks. The Elon Musk-led DOGE initiative aims to reduce federal spending by over $1 trillion. Johnson has also floated the prospect of revisiting the Affordable Care Act, which expanded Medicaid access and was previously targeted for repeal under Trump. The $600 billion annual Medicaid spending pot presents an enticing opportunity for Republicans seeking to counterbalance enhanced tax cuts.
On Thursday, members of the House Budget Committee reviewed a plan that could lead to cuts to Medicaid totaling as much as $880 billion over the next decade. Although this proposal faces various challenges, it plays a crucial role in the reconciliation process, enabling legislation to pass with a simple Senate majority, bypassing Democratic filibusters.
So, what could Republicans attempt regarding Medicaid?
Some conservatives advocate for implementing per capita caps, which would change Medicaid from an open-ended entitlement program to one with a fixed annual allocation per state, offering increased flexibility in spending, although growth may not meet demand. Such measures have been floated since the Reagan administration but have consistently faced considerable pushback.
Another probable approach involves imposing work requirements for Medicaid enrollees in select states, whether through new legislation or federal waivers. While millions of Medicaid beneficiaries are already employed, the implications for disabled individuals under such requirements remain unclear. Additionally, documenting compliance presents logistical challenges that have previously led to loss of coverage for thousands in Arkansas due to cumbersome processes. Courts have historically been wary of work requirements, as Medicaid statutes primarily focus on health rather than employment, but transformed judicial dynamics during Trump’s presidency could influence outcomes.
Federal or state-level adjustments to rules and procedures could also complicate enrollment processes or make it more difficult for individuals to maintain Medicaid coverage. A frequent Republican assertion revolves around eliminating “waste and abuse,” yet how this would be defined is ambiguous. The Trump administration might also limit or prevent states from using Medicaid funding to address social determinants of health, like housing and food security issues.
Republican legislators have also considered reducing the ACA Medicaid expansion currently implemented nationwide. Since Medicaid operates as a federal-state partnership with varying funding ratios, with the federal government covering 90 percent for expansion, some states have introduced “triggers” to halt the expansion population's coverage if federal contributions decrease. The Georgetown University Center for Children and Families noted that such budget cuts would effectively repeal Medicaid expansion.
Neither Robert F. Kennedy Jr., Trump’s newly confirmed HHS secretary, nor Mehmet Oz, his appointee for the Centers for Medicare and Medicaid Services, has articulated specific views on these potential scenarios. Kennedy's responses during his confirmation hearings were often vague and inaccurate concerning Medicare and Medicaid, while Oz’s hearings have yet to occur.
One challenge for Republican cost-cutters is that Medicaid spending projections may yield lower savings in the upcoming years due to a slowdown in cost growth. Sherry Glied, a health economist and dean of NYU’s School of Public Policy, mentioned that “back in the days when Medicaid was growing really like gangbusters,” less growth is now anticipated.
Critics like Tom Miller from the American Enterprise Institute point to Medicaid’s “bloat” as a longstanding concern but advocate for a more careful, policy-focused approach rather than a broad-based cost-cutting initiative.
Historically, Medicaid began in 1965 with minimal recognition, overshadowed by Medicare’s headlines despite being established under the same legislation signed by President Lyndon Johnson. Originally a modest program for the impoverished, it has grown significantly in scope and political resilience.
The ACA Medicaid eligibility expansion has further solidified the program’s significance for individuals and states alike. Under Obamacare, individuals who lose their health insurance due to job loss can access Medicaid until they regain coverage through new employment or ACA markets.
“Medicaid is in a position to dial up rapidly if there’s an economic downturn, and we did see that during that Covid public health emergency,” stated Kate McEvoy, executive director of the nonpartisan National Association of Medicaid Directors, although enrollment has since declined from pandemic highs.
Moreover, the health industry, which wields considerable political influence at multiple levels, is resistant to relinquish funding, particularly in anticipation of future economic challenges.
A crucial transformation for Medicaid is its perception; it is no longer merely a welfare program. Instead, a significant majority of Americans, including about 45 percent of Republicans, see it as a legitimate health care program.
This distinction is critical. While welfare may carry political stigma, health care does not. Depending on Republicans’ actions and approach, the perception of Medicaid as a health care program could present challenges.
Republicans’ initial foray during Trump’s presidency into modifying health care, particularly with their unsuccessful efforts to repeal Obamacare, demonstrated the potential political consequences of jeopardizing health benefits. The dynamics surrounding removing benefits are considerably more complex than those associated with establishing them.
Currently, GOP lawmakers tend to be more conservative and pro-Trump than they were eight years ago, and they have largely aligned with the party’s ethos. However, it remains early in the political cycle. The prospect of cost savings might sound appealing to Trump supporters, but the potential loss of health benefits for themselves or their families might not be the deal they are seeking.
Mathilde Moreau contributed to this report for TROIB News
