Medicaid Once Again Under Attack

By Jessica Gehr

With just two weeks left before the end of the federal fiscal year, Senate Republicans are once again trying to “repeal and replace” the Affordable Care Act (ACA), leaving millions without coverage.

This time, Senators Bill Cassidy (R-LA) and Lindsey Graham (R-SC) have proposed a bill that fundamentally alters the Medicaid program. It turns the ACA’s enhanced match for the Medicaid expansion population into a fixed block grant and converts the existing Medicaid entitlement into a per capita cap, a mechanism under which states would receive a set amount of money per enrollee from the federal government to administer the program. It also block grants the financial assistance that helps workers and families buy private insurance through the ACA and undermines protections for people with pre-existing health conditions.

As hard as it is to imagine, this bill goes further and cuts Medicaid deeper than previous proposals, posing serious risks to low-income children, parentsyoung adults, seniors, and individuals with disabilities.

The proposed financing changes to Medicaid are a significant cost shift to states. States would receive between 35 and nearly 60 percent less funding for Medicaid in 2026 than under current law. This would cause states to reduce benefits (such as prescription coverage), create waiting lists for care, and raid other parts of their budgets such as postsecondary education funding to help fill the void of federal Medicaid dollars. To make matters worse, the bill’s block grant funding for the Medicaid expansion population would entirely disappear after 2026. Beginning in 2027, the Cassidy-Graham bill would be nearly identical to the repeal-without-replace bill estimated by the nonpartisan Congressional Budget Office (CBO) to leave 32 million more people uninsured.

The Cassidy-Graham bill also includes a provision found in previous House and Senate repeal-and-replace bills that would allow states to require Medicaid recipients to work to receive health coverage unless they are pregnant, seniors, determined disabled by the state, or single parents of young children or children with disabilities. Work requirement policies are inconsistent with the realities of today’s low-wage jobs, which are characterized by changing, unpredictable schedules, lack of paid leave for personal or family health needs, and no health insurance. A work requirement provision would cause workers to lose the health care coverage they depend on through Medicaid to stay healthy so they can find and keep work.

This last-ditch partisan effort to repeal and replace the Affordable Care Act is being driven by the legislative mechanism expiring at the end of this month that allows Republicans to pass the bill with a simple majority. That is why the Senate is rushing this legislation through without hearings, a CBO score, or public debate. Rather than rushing to push a partisan bill that has not yet been reviewed by the CBO, Republicans and Democrats should come together to reauthorize the Children’s Health Insurance Program, stabilize the ACA’s Marketplace and work to help people afford the coverage they need.