Republicans say Medicaid is safe. But budget math says otherwise
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Congress is acting on one of President Trump's top domestic priorities. And the next phase of our plan to deliver the greatest economy in history is for this Congress to pass tax cuts for everybody. But achieving that goal will require trillions of dollars in spending cuts, which will dramatically reshape the federal budget. And one big potential target for those spending cuts is Medicaid. We need it!

That was Democratic Representative Al Green disrupting President Trump's address to Congress last week. After he was removed from the chamber, he spoke with reporters.

And I was making it clear to the president that he has no mandate to cut Medicaid. Now, House Republicans have said that cuts to Medicaid are totally off the table. Here's Republican Representative Tim Burchett of Tennessee with NPR's Layla Fadl. So what I think I hear you saying is that this $880 billion of proposed cuts, that's

that people believe will hit Medicaid. You're saying it won't hurt people's coverage because that's really important to constituents. No, ma'am. Yeah, I believe that is exactly what I'm saying, ma'am. That is exactly what I'm saying. But that's a lot of money for it not to hit the actual health care coverage. Ma'am, it's a whole heck of a lot of money, but we're finding that over and over and over again that there is

There is waste, fraud and abuse. And that's just the bottom line. And House Speaker Mike Johnson said this last week on NBC's Meet the Press with Kristen Welker. Our cuts to Medicaid, Medicare and Social Security off the table.

Yes. And don't take my word for it, Kristen. Go do a word search of the budget resolution that we passed on Tuesday. There is not one mention of Medicare, Medicaid or Social Security. Which is true. Those words are not in the legislation. But the reality is Republicans likely will not be able to meet their budget target without major cuts to Medicaid.

That's just math. It was all laid out in a letter last week sent to lawmakers by the nonpartisan Congressional Budget Office. And with major cuts to Medicaid, the end result is: I think millions of people would lose coverage and millions of additional people would lose access to needed care as a result. That's Edwin Park, a health policy expert at Georgetown University's McCourt School of Public Policy.

He says finding $880 billion in cuts over a decade simply cannot be done without touching Medicaid. Unless you're cutting Medicare, and both Speaker Johnson, other House Republican leaders, and President Trump have said that they do not want to cut Medicare. So if you take Medicare off the table, Medicaid constitutes 93% of all mandatory spending that remains. ♪♪

Consider this. House Republicans have claimed that spending cuts will not impact Medicaid coverage. But experts say that's just impossible. We'll explain the math coming up. From NPR, I'm Elsa Chang.

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It's Consider This from NPR. Edwin Park is a health policy expert at Georgetown University's McCourt School of Public Policy, and he joined me to explain all of the math on this. Now, the budget bill does not specifically mention Medicaid, but that's because the budget just gives instructions to lawmakers on the committee that oversees Medicaid to find $880 billion in cuts over the next decade.

The legislation doesn't explain exactly where lawmakers should make those cuts. So I started by asking Park very simply, can Congress find $880 billion in federal savings without cutting spending for Medicaid?

It cannot unless you're cutting Medicare, and both Speaker Johnson, other House Republican leaders, and President Trump have said that they do not want to cut Medicare. So if you take Medicare off the table...

Medicaid constitutes 93% of all mandatory spending that remains under the jurisdiction of the Energy and Commerce Committee. Okay, well, that argument has been floated, but Republicans say that they can cut spending without cutting any benefits in either Medicare or Medicaid because they're going to do this by eliminating waste and fraud. Here's another question. Is there $880 billion worth of waste and fraud in the system?

Simply no. If you look at the major Medicaid cut proposals that are under consideration, they're the same proposals that were included in the failed 2017 repeal and replace plans. And they all involve major cost shifts for the cost of Medicaid onto states because of the federal government and states sharing the cost of the program, making it harder for states to finance their share of the cost of Medicaid.

or imposing more red tape on those who are already working or who aren't able to work because they're disabled, have chronic conditions, they may be caregivers or in school. Speaker Johnson has talked about how there is about $50 billion worth of fraud in Medicaid each year. Is that an accurate estimate? I'm just curious. It is not. What he's trying to do is equate a

a measure that's used in the federal government to assess improper payments. But he's trying to equate these improper payments as fraud, and the vast majority of improper payments are not because the payment shouldn't have been made, but there were some errors in terms of the documentation related to that payment.

or errors in terms of some of the procedural steps that were taken in making those payments. But there's no finding that that was actually fraud or even payments that should not have been made. Okay. Well, one proposal that Republicans have talked about is instituting what's called a work requirement for adults who receive Medicaid. Okay.

but who do not have disabilities or young children. This is actually a broadly popular idea, like it's an idea that former Democratic Senator Joe Manchin of West Virginia had talked about in his exit interview with NPR. But realistically, how much would that work requirement save the federal government?

According to the Congressional Budget Office, it would save about $120 billion or so in federal Medicaid spending. Far cry from $880 billion.

Certainly. And the reason that it produces savings is not because it encourages employment or increases hours worked, as the Congressional Budget Office has confirmed, but it's actually about the owner's red tape in terms of reporting your employment, reporting your hours, trying to navigate a very complicated process to get an exemption because you're a person with disability or you're in school, you're a caregiver, whatever the exemption may be.

This is something that applies to all states, to most non-elderly adults, and as a result, people get disenrolled. According to the Congressional Budget Office, one and a half million people would lose coverage under such a work requirement. Okay, there's another proposal to cut Medicaid spending, and that is to reduce or eliminate health care provider taxes, which states use to finance their portion of Medicaid.

And to be fair, there is some buy-in on this idea, like the Committee for a Responsible Federal Budget, which is a nonpartisan group focused on cutting the national debt. They call those taxes a state financing gimmick. And they say getting rid of health care provider taxes could actually save more than $600 billion. So tantalizing, is that actually a way to cut spending without cutting benefits?

Actually, no. All states but Alaska rely on these provider taxes to finance their share of the cost of Medicaid. And the reason such a proposal would cut federal spending, even though this is about a restriction on what states are able to do, is because states would be unable to replace the lost revenues from these provider taxes. These are assessments on hospitals, nursing homes, other health care providers. They've been used...

under rules that have been in place since the early 1990s. And because they can't replace those revenues, they're not going to be able to maintain their current Medicaid programs. They're going to have to make cuts. So, you know, are there ways to ensure that states are in full compliance with these federal rules related to provider taxes? Certainly. But we're

requiring blunt changes that restrict the ability of states to continue to raise the funds they need to finance Medicaid would result in big cuts that would ultimately harm beneficiaries, whether it's losing their eligibility, they're having to pay more in premiums and cost sharing, they have fewer benefits covered, or they can't find a provider that they need. Okay. Well, I want to step back just for some perspective here. $880 billion would be something like what?

An 11% cut to federal funding for Medicaid, right? So like, however, that cut of $880 billion happens, what would it mean for Medicaid if we see more than a 10th of the federal spending on the program eliminated?

I think millions of people would lose coverage and millions of additional people would lose access to needed care as a result. It's simply the case that these cuts are large, they're significant,

And many of the proposals that are being considered to achieve this $880 billion target involve shifting costs to states or making it harder for states to finance their share of the costs of Medicaid. So states are essentially left holding the bag. They're going to have to make the painful choices in terms of cutting eligibility, cutting benefits.

cutting payments to providers like hospitals and nursing homes that serve Medicaid beneficiaries. And in fact, that's one of the reasons it's politically attractive to some federal policymakers is because they're not explicitly cutting Medicaid benefits. They're making states, legislatures, governors have to make the politically difficult choices, the politically painful choices that they'll have no choice but to make.

in light of these massive cost shifts that they could face. Edwin Park with Georgetown University's McCourt School of Public Policy. Thank you so much for making this so clear. Thank you for having me. This episode was produced by Mallory Yu, Connor Donovan, and Mark Rivers. It was edited by Sarah Handel and Nadia Lansi. Our executive producer is Sammy Yenigan.

It's Consider This from NPR. I'm Elsa Chang. This message comes from Warby Parker. If you wear glasses, you know how hard it is to find the perfect pair. But step into a Warby Parker store and you'll see it doesn't have to be. Find a Warby Parker store near you at warbyparker.com slash retail.

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