Twenty-one Million Americans to Lose Healthcare
Republicans taking away healthcare from “poor” Americans to fund tax breaks for the 1% which would include billionaires (as if Musk and others are struggling). I believe it is time to put some of them back in the Labor Force.
Republicans have decided which 21 million Americans should lose their healthcare,
– Charles Gaba
As regular readers know, I’ve been a bit obsessed over the past month or so with generating pie charts which break out the total healthcare program enrollment for the entire population of all 435 U.S. Congressional Districts as well as all 50 states +DC.
As you can imagine, this has been a monumental task; not only did I have to crunch a lot of data to break out the statewide numbers into House district-level estimates, I also had to convert that data into nearly 480 easy-to-read graphics . . . and then I doubled my workload by going one step further and adding high-res PDF versions for folks to print out in large format for town halls, rallies and #HandsOff protests nationally. (Click on the image to enlarge.)
Now that I’ve finally completed this project, it’s time to turn back to the main reason for it in the first place: The imminent threat to healthcare coverage for literally tens of millions of Americans being posed by the budget resolution recently passed by House Republicans, which (fortunately) still has a number of points where it can potentially be stopped.
The budget resolution calls for a draconian $880 BILLION to be slashed from the House Energy & Commerce Committee’s jurisdiction over the next decade. While Congressional Republicans are quick to point out that technically the word “Medicaid” isn’t included in the resolution itself, simple math makes it clear that there’s absolutely no way to achieve that type of federal spending reduction without absolutely gutting Medicaid one way or another.
The CBO letter confirms early expectations, finding that over the next 10 years, 93% of non-Medicare spending in the E&C jurisdiction is from the federal share of Medicaid spending: $8.2 trillion out of a total $8.9 trillion. An additional $200 billion of federal spending comes from the Children’s Health Insurance Program (CHIP). Some of the committee’s remaining spending is budget-neutral, and therefore, won’t count towards deficit reduction. Even if E&C eliminated all non-Medicaid and CHIP spending, the committee would need to cut federal spending on Medicaid and CHIP by well over $700 billion, nearly 10% of projected spending; and most agree that E&C is unlikely to eliminate all other sources of non-mandatory spending.
OK, so they are indeed going after Medicaid…but how much of it and how many would lose coverage?
Well, back in January, Politico got ahold of a “wish list” of potential strategies House Republicans were tossing around to gut Medicaid and kick millions of people off of their healthcare coverage. I wrote up a breakout of these (while also relying heavily on an explainer by Edwin Park of Georgetown University):
- “REPEAL MAJOR BIDEN HEALTH RULES” ($420B): The Biden Administration put rules into place to reduce paperwork and streamline the process for eligible seniors & disabled folks to enroll in Medicaid/CHIP. House Republicans are proposing to make it more difficult for people to do so.
- “Per Capita Caps” ($918B): Under the current federal-state financial partnership, the federal government pays a fixed percentage of states’ Medicaid costs, whatever those costs are. [Under a per capita cap] …states would receive only a fixed amount of federal Medicaid funding on a per-beneficiary basis, irrespective of states’ actual costs.
- “Equalize Medicaid Payments for Able Bodied Adults” – up to $690B: For non-ACA Medicaid, the federal government pays between 50 – 83% of the cost depending on the state/territory (this is known as the Federal Medical Assistance Percentage, or FMAP). For the ~21 million people enrolled in Medicaid via the ACA, the federal gov’t picks up 90% of the cost. House Republicans are proposing to drop that 90% to the same 50 – 83% rates as for non-ACA Medicaid, which averages just 57% nationally.
- Limit Provider Taxes – $175B: By making it more difficult for states to fund their share of Medicaid, it would force them to cut those programs entirely, which in turn would mean less federal spending on the programs. It’s like telling your kid you’ll pay for half their college tuition but then forbidding them to get a part-time job to cover their half.
- Lower FMAP Floor – $387B: Again, right now the federal government pays anywhere between 50 – 90% of Medicaid expenses depending on the state and program. House Republicans are proposing to reduce the lower threshold from 50% to…something less than 50%. This would be devastating to the ten states which currently have a 50% FMAP rate…nine of which are blue, I should note (CA, CO, CT, MD, MA, NH, NJ, NY & WA).
- Special FMAP Treatment for DC – $8B: Under the standard FMAP formula, the District of Columbia would be set at a 50% federal matching rate, down from its current 70% (I’m a little unclear as to why it’s 20 points higher than it “should” be under the standard formula, and Park’s explanation doesn’t lend much insight).
- Repeal American Rescue Plan FMAP Incentive – $18B: As I wrote about at the time, the ARPA law included one provision specifically intended to encourage the holdout states into finally expanding Medicaid by simply bribing them to do so with a generous 2-year FMAP boost for doing so. This was a critical factor in North Carolina’s decision to expand Medicaid to over 600,000 low-income residents.
- Work (Reporting) Requirements – $120B: (Sigh) Work reporting requirements have been an obsession of Republicans for decades. I’ve written about how absurdly (and deliberately) inefficient and pointless they are countless times.
There were several other healthcare-related bullets as well which mostly focus on the ACA’s individual market exchange plan subsidies. I’ll be writing about those separately soon, but for the moment I’m sticking with Medicaid.
As you can imagine, there’s been a loud and growing backlash against Congressional Republicans in response to their proposed gutting of Medicaid & other critical programs…a backlash which my own pie chart project has been a part of, I’m proud to say.
Isn’t the idea behind this to save Social Security by cutting US life expectancy to 62?
@Kaleberg,
Yipes!
You may be right.
Joel:
Unless he has a citation somewhere. I am going to say “no.” This group of people were always shy healthcare until covid, Biden extended healthcare to cover them along with other parts of the program then.
If you raise the age of acquiring Social Security to 70, you will have a large fallout. That is explained here:
Some policymakers, such as those on the Republican Study Committee, have proposed to raise Social Security’s full retirement age to 70 and beyond.[1] Raising the retirement age cuts benefits for all new retirees — that is, those claiming Social Security benefits for the first time. These cuts could be deep, and they would fall hardest on lower- and middle-income beneficiaries because they rely most heavily on Social Security benefits. Moreover, they have not seen the life expectancy gains that higher-income people have experienced and that are often used as the rationale for raising the retirement age.
Raising Social Security’s Retirement Age Would Cut Benefits for All New Retirees
I do not particularly care for comments being made without a foundation to support them. I have known Charles for a long time. He would say it if such was the objective. Bruce and Dale had a plan which was found to be realistic in supporting SS one-tenth of 1% increase for people and companies would make SS solvent for 70 years. If you wish to kill or murder people easily, increase the age as to when you can collect it.
Kaleberg:
Not that I am aware. I would believe this involves Medicaid and cutting taxes for the one-percenters. Charles Gaba is a big backer of the ACA even though it was not meant to be commercialized in the beginning. I have known him for a decade at least while in Michigan which probably means I have known him longer.
You can always enlighten us Kaleberg.
There’s a reason Nordic countries with single payer healthcare are happier than we are. Adding financial disaster to the stress of serious illness really isn’t good for anyone.
I’m trying to remember now back a decade, but I thought that one of the rationales offered by the states not expanding Medicaid was that the 90% share was, at some point, going to be reduced to the same rate as the rest of the program. Was that part of the ACA law, or simply an expectation coming from prior experiences with cost sharing? I was surprised to read that it remains at 90%. I think it wise to have one sharing ratio, since that pretty much kills any ideas of squeezing more beneficiaries into the 90% category, but they could blend the 90% into a new unitary level based on income distribution or similar data. I do scratch my head on the lower FMPA floor item though. I’m no expert, but it seems to imply that there is a formula that state data is input to determine that sharing level. If that process is thought of as defensible, not sure why a state that comes out at 44% should get 50%. I get why they like the floor at 50%, but not sure that dropping the floor below that is unfair. Maybe it was unfair that they got a better deal for years and years.
Hmmmmm,
The Affordable Care Act’s (ACA) Medicaid expansion expanded Medicaid coverage to nearly all adults with incomes up to 138% of the Federal Poverty Level ($21,597 for an individual in 2025) and provided states with an enhanced federal matching rate (FMAP) for their expansion populations. Status of State Medicaid Expansion Decisions April 2025.
You think they should pay more?
It appears the boneheads in Wisconsin opted out. And you want other states to do so? Would it cost more if commercial healthcare handled it? Or should we just let then die?