Medicaid cuts would affect our families and neighbors

There IS a Gulf of America.

It’s the chasm between the 1% and the rest of us.

Still, Senate Republicans on April 5 approved, 51-48, their multitrillion-dollar tax breaks and spending cuts framework, which will now go to the House, where a vote to reconcile differences in what House Republicans passed on Feb. 25 is expected this month, so a final product could go to Trump by Memorial Day.

Democrats accused Republicans of laying the groundwork for cutting key safety net programs to help pay for more than $5 trillion tax cuts they say disproportionately benefit the rich. And a handful of Senators opposed the bill.

Voting against the Senate measure, Republican Susan Collins from Maine said the potential Medicaid cuts “would be very detrimental to a lot of families and disabled individuals and seniors.”

Another Republican opponent, libertarian Rand Paul of Kentucky, questioned the math being used by his colleagues (something called “current policy baseline,” which artificially claims there’s no increased cost in extending the tax cuts since it would merely renew current law). Paul said it really would pile on the debt – “Something’s fishy,” he remarked.

Trump and the GOP are looking for a way to extend 2017’s “Tax Cuts and Jobs Act” that mostly enriched the wealthy and big corporations – an extension that would add $4.6 trillion to the national debt over 10 years, according to the nonpartisan Congressional Budget Office (CBO). The highest-income households (the top 5%) would receive more than 45% of the benefits if the expiring provisions of the 2017 tax cuts are extended, according to an analysis by the Urban-Brookings Tax Policy Center.

The original bill Republicans pushed through (barely, 217-215), “House Continuing Resolution 14” requires about $880 billion in cuts over the next decade to help cover the cost of $4.5 trillion in tax cuts that mostly benefit people earning $450,000/year, and though it instructs the House Energy and Commerce Committee to propose where to cut, it doesn’t specify how, Medicaid (and SNAP food stamps) are the likely places.

The consequences could be far-reaching for families and states, taking health care and other assistance from the neediest Americans. The bottom line: cutting Medicaid takes health care away from those who need it to benefit those who literally don’t need more money.

“This budget resolution is an attack on the jobs, families and communities of everyday Americans,” said AFL-CIO President Liz Shuler. “It puts millions of Americans’ jobs at risk, including nursing home and home care workers, substance-abuse counselors, midwives, and hospital and community health-care center workers, along with jobs across food processing and production, [plus] librarians and public utility workers to EMTs and firefighters [in] rural communities and poorer red states, forcing those state and local governments to stretch what little budget they have even further.”

It would increase inequality, and “hurt most working families,” reported the Economic Policy Institute, and the Government Accounting Office says that includes tens of thousands of veterans would be affected.

 

RECENT HISTORY

For years, traditional Medicaid insurance was mainly available to children and their caregivers, people with disabilities and pregnant women. But the Affordable Care Act, which passed in 2010, four years later let more people qualify for Medicaid on the basis of income. Known as “Medicaid expansion,” it extended coverage to adults making up to 138% of the federal poverty level — about $21,000 a year for a single person. In 2012, the U.S. Supreme Court said the decision of whether to expand the program would be left up to the states, and 40 states and the District of Columbia (led by Democrats and Republicans alike) opted in.

Nationwide, 70 million Americans receive Medicaid (see at bottom), and because of expanded Medicaid eligibility, more than 21 million people with low incomes got health insurance. The federal government pays most of the cost of Medicaid by matching a portion of what states spend – at least 50% of state spending, and states administer the program.

In Illinois, Illinois had 2.9 million people using Medicaid before its expansion, after which it gained hundreds of thousands of recipients.

In the Labor Paper circulation area, thousands of residents represented by two Republicans who voted for the House bill could be hurt. According to ACASignups.net, 139,015 residents in Rep. Darin LaHood’s 16^th District receive Medicaid, and 174,085 Medicaid recipients in Mary Miller’s 15^th District.

After the February vote, LaHood didn’t refer to his constituents, instead parroting Trump’s endorsement of what the president called a “big. beautiful bill.”

Axios reported LaHood saying the budget bill “serves as the blueprint for extending President Trump's historic tax cuts, securing our southern border, bolstering our military, unleashing American energy, and setting us on a path toward responsible government spending for future generations.”

If Congress cuts Medicaid, its costs would shift to states, which may have to trim coverage in economically perilous times, and Illinois Gov. JB Pritzker joined Sen. Dick Durbin on Feb. 28 to encourage public opposition to the cuts.

“Red alert, everybody,” Pritzker said. “It is time to wake up. Get out. Do something.”

Illinois Congressman Raja Krishnamoorthi (D-Schaumburg) said he received a letter from a man who lives with autism and pleaded with the congressman to “save Medicaid,” saying he “cannot be healthy” without it.

Krishnamoorthi commented, “This man is about to see his Medicaid and his services cut, and for what? For tax breaks for billionaires, oligarchs and ‘broligarchs.’ That is wrong.”

SEIU National Media on Feb. 13 warned, “Make no mistake: Radical changes to Medicaid will hurt us all. Cutting Medicaid will shrink funding for other vital services and infrastructure families depend on, from child care to Meals on Wheels, while putting increased pressure on service providers by decreasing resources that are already insufficient.” 

Republicans’ House majority is the tightest in modern history (218-215), and there are cracks in the GOP’s “red wall.” In February, Nevada’s Republican Gov. Joe Lombardo called on Congress not to slash Medicaid funding, and Republican Rob Bresnahan of Pennsylvania, a member of the Energy and Commerce Committee who voted for the House bill, later said, “If a bill is put in front of me that guts benefits mu neighbors rely on, I will not vote for it.”

 

NEW WORK REQUIREMENT OPTION?

A back-door “compromise” floated by some Republicans, including Sen. Josh Hawley of Missouri, would be adding work requirement for Medicaid enrollees. A 2023 CBO analysis found that imposing new work rules on Medicaid recipients ages 19 to 55 who are not parents or caregivers could cut federal spending by an estimated $109 billion over the next 10 years. However, that could also mean between 4.6 million and 5.2 million adults ages 19 to 55 losing health-care coverage, according to an analysis from the Urban Institute, which reported, “Most adults who would lose eligibility for federal Medicaid funding ARE working, engaged in work-related activities, or could qualify for exemptions not readily identifiable through state databases but could still face disenrollment because of the reporting requirements.”

Their study cited several barriers to maintaining eligibility, from lack of broadband access to inadequate transportation.

On Feb. 18, Trump told Fox host Sean Hannity that Medicaid “is not going to be touched,” yet the next day he endorsed the House measure that makes it impossible to cut $880,000 without touching Medicaid..

Congresswoman Katherine Clark (D-MA), House Whip, said, “Do you know what it cost to keep a kid on Medicaid? $10 per day. What do Republicans want to give away to the already rich? $6 million – per billionaire.  Think about that.

“For a billionaire that $6 million is not even a rounding error,” she added. “There is no moral code under which that is acceptable. There is no public demand for it. There is no logical reason for it other than total fealty to billionaire donors."”

What happens next seems to depend on whether Congressional Republicans will stand for the people they’re supposed to represent or stand up against Trump.

 

 What is Medicaid?

Medicaid and Medicare were created by the same legislation — an addition to the Social Security Act — signed by President Lyndon Johnson in 1965.

Medicaid is a federal/state government health insurance program for people with low incomes and adults and children with disabilities. Medicare, by contrast, generally covers those 65 or older. For older Americans with low incomes, Medicaid also covers out-of-pocket costs for Medicare.

More than 70 million Americans (about 20% of the U.S. population) receive Medicaid benefits such as health care, home care, costs for nursing homes and other long-term care (which Medicare doesn’t cover). Federal law also requires all state Medicaid programs to cover services including emergency medical transportation, and X-rays and lab work.

Some Medicaid beneficiaries are low-income or disabled people; some are not. About 40% of all children in the country are covered by Medicaid or CHIP (the Children’s Health Insurance Program, created in 1997). Both pay for services such as routine checkups, vaccinations, and hospital stays. Medicaid also covers pregnant people before and after they give birth – more than 40% of all births.

Medicaid is larger than Medicare (which serves about 48 million Americans 65 and older). Medicaid costs less than Medicare (partly due to higher health-care costs for seniors) and less than private insurance. Per capita Medicaid costs are $6,052, according to Kaiser Family Foundation, compared to private insurance per capita costs of $7,752. Medicaid has lower administrative costs (because it doesn’t pay for marketing, or the expenses of denying coverage), and it has the authority to require using less expensive generic drugs and alternatives to questionable procedures with inflated prices.

Medicaid also generally pays health-care providers such as doctors and hospitals less money for services than Medicare or private insurance does. However, it can be more money than providers would get caring for people who are uninsured — which helps hospitals and doctors in small towns and rural areas, where fewer people are insured.

There may be an unfortunate sense that Medicaid is less vital (and less politically important, so conservatives can cut it without concern of blowback at the ballot box), because it mostly serves inner-city people of color.

“But that was never as true as people imagined,” economist Paul Krugman wrote, “and is definitely not true now.”

In fact, Medicaid serves a cross section of the country. About 40% of people under 65 who use Medicaid are white, 30% are Hispanic, 19% are Black, and 1% are Indigenous people. (Federal Medicaid dollars cannot be used to cover immigrants who are in the U.S. without legal permission.)

Most Americans support Medicaid. American adults, including two-thirds of Republicans, say they want Congress to either maintain current Medicaid spending or increase it, according to a February 2025 poll by Kaiser Family Foundation. Another February poll, from Hart Research, showed than 82% of U.S. adults oppose Medicaid cuts, as do 71% of respondents who said they voted for Trump.