MassHealth: Proposed Medicaid cuts could leave hundreds of thousands in Mass. uninsured
Photo I State House News Service
U.S. Rep. Lori Trahan of Massachusetts holds up a picture of "Philip from Haverhill" while arguing against a Republican proposal to overhaul Medicaid during a livestreamed hearing of the U.S. House Energy and Commerce Committee on Tuesday.
A key Congressional committee pressed ahead Tuesday on a bill that could slash hundreds of billions of dollars in federal spending, potentially leaving millions of Americans without health coverage and complicating state budgeting in Massachusetts and elsewhere.
The U.S. House Committee on Energy and Commerce set off on a perhaps overnight process of marking up a package of Medicaid, energy and communications policy reforms with the potential for seismic impacts.
A spokesperson for MassHealth, which combines Medicaid and the Children's Health Insurance Program under one umbrella in Massachusetts, on Tuesday warned that proposals House Republicans are advancing could lead to "hundreds of thousands" of Bay Staters losing health coverage.
"The Healey-Driscoll Administration is working on a detailed analysis of the House Republicans' proposals to cut Medicaid. After our initial review, we are gravely concerned that their proposals would take coverage away from hundreds of thousands of Massachusetts residents and significantly destabilize hospitals and other health care providers who provide life-saving treatment every day," MassHealth spokesperson Stacey Nee said in a statement.
Much of the proposal moving through the the Energy and Commerce Committee would reshape Medicaid operations, including new minimum work and service requirements for many adult recipients without dependents, and limits on the ability of states to tax providers as a way to help fund their local Medicaid programs.
"We make no apologies for prioritizing Americans in need over illegal immigrants and those who are capable but choose not to work. Our priority remains the same: strengthen and sustain Medicaid for those whom the program was intended to serve -- expectant mothers, children, people with disabilities and the elderly," said U.S. Rep. Brett Guthrie, a Kentucky Republican who chairs the committee.
Demonstrators who oppose the bill interrupted the committee at the start of Tuesday's hearing, chanting "no cuts to Medicaid" loudly enough from the audience to be heard on the livestream.
Like other Democrats on the committee, U.S. Rep. Lori Trahan of Massachusetts used her opening remarks to highlight a constituent. She held a photo of Philip from Haverhill under the title "Medicaid Matters," recounting the support he has received from a Medicaid-funded job skills program for individuals with disabilities.
"Philip and millions of Americans across our country like him are not fat to be trimmed or waste to be rooted out by disingenuous politicians in Washington. They're hard-working Americans trying to live their lives with dignity and make their communities better," Trahan said. "They're our constituents. They need you to vote no on this bill. They need you to protect Medicaid, protect the independence of Americans with disabilities, and if you can't do that, at least have the courage to look at the American people, people like Philip in the eyes while you take it away."
Budget-writers in Massachusetts have been watching the prospect of Medicaid cuts. MassHealth is the largest driver of state spending. The Massachusetts Taxpayers Foundation estimated MassHealth spending would total more than $21.5 billion in fiscal 2025, and that federal reimbursement would account for $13.3 billion of that total.
Gov. Maura Healey's budget for the fiscal year that begins July 1 expects federal MassHealth reimbursement to increase to $14.2 billion. Any cuts to that pot could trigger difficult local decisions about pulling dollars from elsewhere to fill the gap or scaling back services for the roughly 2 million Bay Staters currently in the program.
Healey joined 22 other Democratic governors on a joint statement Monday warning that the plan before Guthrie's committee would amount to "ripping away quality, affordable health care from families, forcing rural hospitals to close their doors, and causing fiscal chaos across the country."
"The notion that states will respond to massive cuts to federally appropriated dollars by backfilling with state resources is simply inaccurate and impossible," the Democratic governors said. "These proposals are not just a 'cost shift' to states, they are cuts to Medicaid, SNAP, and the social safety net that supports millions of Americans."
The Republican-led House Energy and Commerce Committee rolled out its plan Sunday night. The proposal combines new limits on state government provider taxes, eligibility requirements for many Medicaid recipients, a cost-sharing requirement for some patients, pharmacy benefit manager reforms and much more, according to POLITICO.
One key provision would require adults without dependents to perform at least 80 hours per month of work, education or service in order to qualify for Medicaid, according to ABC News. Guthrie said at Tuesday's hearing the work requirements "would only apply to able-bodied adults without dependents who don't have a disqualifying condition."
"When so many Americans who are truly in need rely on Medicaid for life-saving services, Washington can't afford to undermine the program further by subsidizing capable adults who choose not to work," Guthrie also wrote in a Wall Street Journal op-ed earlier this week. "That's why our bill would implement sensible work requirements. Every other capable adult works to afford healthcare. Half of all Americans get insurance through work, seniors on Medicare get coverage because they paid into the trust fund, and veterans earned their care through their service to our country."
Another focus of the package would limit state governments from expanding taxes on providers, which many states including Massachusetts use to cover a portion of Medicaid costs.
Bill authors opted not to pursue per capita limits on Medicaid benefits nor across-the-board changes to the Federal Medical Assistance Percentage (FMAP) rate, a pair of controversial ideas that had generated some pushback from moderate Republicans.
The proposal reaches beyond health care, too. Guthrie said it would rescind $6.5 billion in unspent climate funds under the Inflation Reduction Act. On the policy front, it would ban states from implementing most new regulations on artificial intelligence or "automated decision systems" for the next decade.
Most of the savings that would be generated would come from health care. An analysis from the nonpartisan Congressional Budget Office, requested by Democrats on the Energy and Commerce Committee, found the health care policies would reduce the national deficit by $715 billion over a decade, while the energy, environment and communications policies would save a combined $197 billion over the same span.
CBO projected the bill before the Energy and Commerce Committee would reduce the number of Americans with health insurance "by at least 8.6 million in 2034."
Other Republican-sought reforms to the American Care Act are advancing through the U.S. House Ways and Means Committee. Citing CBO estimates, health policy research group KFF said the combination of legislative vehicles together could result in 13.7 million more uninsured Americans by 2034.
"You can call it a trim, you can call it a cut, call it whatever you want -- the bottom line is these people are going to lose their Medicaid. That's why we have so many people, that's why there are so many people here today demonstrating," said U.S. Rep. Frank Pallone of New Jersey, the ranking Democrat on the Energy and Commerce Committee. "Let me be clear: this is not a moderate bill. I've heard [Guthrie] and others say this is a moderate bill. It is not focused on cutting waste, fraud and abuse. Instead, Republicans are intentionally taking health care away from millions of Americans so they can give giant tax breaks to the ultra rich, who, frankly, don't need them."
Republicans argue they are moving to rein in waste, fraud and abuse, and they are also pitching spending cuts as a way to help fund extensive tax cuts. Tax reforms Trump signed in 2017 are set to expire at the end of the year.
"Savings like these allow us to use this bill to renew the Trump tax cuts and keep Republicans' promise to hardworking middle-class families," Guthrie wrote in his op-ed. "The 2017 cuts gave Americans earning under $100,000 an average tax cut of 16%, while increasing the share of the tax burden carried by the top 1% of earners. Without this legislation, middle-class Americans will see that windfall reversed at the end of 2025."
The markup process, one of the final steps before a bill can reach the floor, is expected to continue through Tuesday night into Wednesday. House Speaker Mike Johnson has targeted Memorial Day as a deadline for legislative action.
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