Alliance Alert There’s a lot of Opposition to Medicaid Cuts…..from Republican Legislators
Just as advocacy groups and organizations continue to ramp up their opposition to House Republicans’ proposals to cut Medicaid, many Republican legislators are voicing mounting concerns. The Alliance will be helping launch a state and national campaign of opposition to such cuts from our broader mental health community this week: stay tuned!
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Some Republicans fear Medicaid cuts could cost them their jobs
by Hannah Knowles, Marianna Sotomayor
Washington Post February 28, 2025
Republican Rep. Jeff Van Drew (New Jersey) called President Donald Trump this week with a warning: The House GOP’s framework for enacting Trump’s agenda would almost certainly require cuts to Medicaid and open the party up to devastating attacks.
“They’re going to go after you for this,” Van Drew recalled telling the president. “You know, we could very easily lose the majority for it. I think it’s a mistake.”
Democrats are already using the threat of Medicaid cuts against Republicans.
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GOP Split on Medicaid Imperils Trump’s Tax-Cut Plans
Story by Olivia Beavers, Liz Essley Whyte • Wall Street Journal
…House Republicans are deeply divided on Medicaid, split between spending hard-liners who want big savings and pragmatists who warn against angering voters…
When President Trump locked a group of House Republicans into the Cabinet Room at the White House earlier this month with the directive to emerge with a GOP plan that would help fund his top priorities, he also cautioned the roughly dozen lawmakers about making cuts to Medicaid.
The federal government spends about $600 billion annually on Medicaid. States help fund and manage the program, which provides health insurance for roughly 72 million people, or about one in five Americans, including children and people with low incomes or disabilities.
Republicans have a long list of options on how they could cut Medicaid. Work requirements would save, by some estimates, $120 billion over 10 years. But the GOP will likely need more trims than that. Some potential changes, such as altering the funding formula to allow the federal government to contribute less to wealthier states, could hurt states such as California and New York, which lean Democratic but also have vulnerable Republican lawmakers.
Republicans are also considering whether to slash the fatter federal subsidies that enabled the expansion of the Affordable Care Act program in 41 states and Washington, D.C. The federal government currently contributes 90% of the costs of care for people who join Medicaid under those wider eligibility rules.
Republicans aren’t allowed to touch Social Security in the fast-track legislative process they are using, and Trump has said he opposes reducing Medicare benefits, leaving Medicaid as one of the remaining ways to significantly shrink spending. Within a 24-hour period, Trump stated that Medicaid shouldn’t be touched but also posted on X that he backs the House-led package that is likely to rely on cuts to Medicaid to meet its targets.
…. Steve Bannon, a onetime adviser to Trump who now hosts the influential show “War Room,” recently warned about the dangers of cutting Medicaid. “A lot of MAGAs on Medicaid,” he said. “Just can’t take a meat ax to it, although I would love to.”
…Some House Republicans say keeping Medicaid intact is essential if they want to hold the House majority in 2026. Some are privately warning party leadership that there are scores of members—including some in safe GOP districts—who oppose deep cuts. Healthcare groups are aggressively lobbying members’ offices to defend Medicaid spending.
Trump “does not want this to be an issue in two years,” said Bacon, a centrist Republican who won re-election in one of the few districts that swung toward Kamala Harris in 2024.
Pennsylvania Rep. Rob Bresnahan, a first-term Republican who unseated a House Democrat, said on X that if a “bill is put in front of me that guts the benefits my neighbors rely on, I will not vote for it.”
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Senate Republicans Plot Changes To House-Passed Blueprint For Trump’s Agenda
By Savannah Kuchar and Sudiksha Kochi USA TODAY February 25, 2025
WASHINGTON – House Republicans’ budget plan to enact President Donald Trump’s agenda has already hit a snag: Senate Republicans.
The upper chamber is already demanding changes to the budget blueprint passed late Tuesday night before they’ll vote on it, which would kick off the process of filling the shell bill with policy.
“Will there be changes in the Senate?” said Sen. John Kennedy, R-La. “The short answer is yes. The long answer is hell yes.”
…“I don’t love that,” said Sen. Josh Hawley, R-Mo., who represents a state with 1.2 million residents enrolled in Medicaid. “I will predict to you that that resolution in that form will not be voted on on the Senate floor.”
Sen. Jim Justice, R-W.Va., also said Medicaid is “monstrously important” in his state, where almost 500,000 people are enrolled, but that something needs to be done about the federal deficit.
….Sen. Mike Rounds, R-S.D., said Senate Republicans want to “make (Medicaid) more efficient, but not to hurt people.”
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How 7 states could thwart GOP plans to overhaul Medicaid
Republicans have a bigger tent than they did in 2017. So does the health care program.
By Alice Miranda Ollstein, Liz Crampton and Kelly Hooper
Politico February 27, 2025
Republicans are facing a nationwide backlash over the fate of Medicaid — but the potential program cuts are most threatening in seven conservative-leaning states where voters have cast ballots to expand the entitlement in recent years.
It’s a growing problem as Republicans hunt for enough savings to pay for the White House’s proposed tax cuts.
Republican Sen. Mike Rounds of South Dakota, which has enrolled more than 24,000 people in Medicaid since voters expanded the insurance program for low-income people in 2022, told POLITICO he’s been arguing against some of his own party’s proposals. One would reduce significantly how much funding for the program comes from the federal government.
“That’s not a cost cutting measure — that’s a cost transfer,” he said. “And when you’ve got partnerships with the states, you shouldn’t be doing that without having them involved in the discussion.”
…Republican Sens. Josh Hawley of Missouri and Susan Collins of Maine — both of whom hail from states that expanded Medicaid by ballot measure — crossed the aisle earlier this week to support a Democratic amendment to the Senate budget resolution that would have blocked tax cuts for the wealthy if any Medicaid funding is cut.
Hawley, who represents about 326,000 people who became eligible for Medicaid under the state’s 2021 expansion, has said he wouldn’t support “severe” cuts to Medicaid — specifically cuts that would lead to reduced benefits — calling it a “red line” for securing his vote.
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Republicans Want to Gut Medicaid. They Might Regret It.
By Michael Kinnucan New York Times Opinion February 27, 2025
…Republicans are fooling themselves if they think it will be easy. Gutting Medicaid means attacking a program backed by a wide range of organizations — from the AARP to the American Hospital Association — that also enjoys broad public support. Even longtime Trump ally Steve Bannon recently warned: “A lot of MAGA’s on Medicaid,” adding, “just can’t take a meat ax to it, although I would love to.”
…Significant cuts to this funding would send fiscal shock waves through state governments across the country as billions of dollars in federal funding stopped flowing, forcing states to decide where and how to cut their Medicaid programs — whether to eliminate coverage for some beneficiaries, reduce payments to physicians, deny home care to some seniors or raise state taxes to make up the difference.
….Once considered a poor people’s program, Medicaid has proved itself a political juggernaut. Why? Start with the money. The Medicaid program spends about $900 billion a year in state and federal funds, paying for close to one-fifth of health care expenditures in the United States. The program is the primary payer for almost two-thirds of nursing home residents and funds just over 60 percent of long-term care.
….Hospitals have an obligation in many instances to provide care even when patients can’t pay. Significant Medicaid cuts would almost certainly leave hospitals to provide more uncompensated care. Many medical facilities, particularly in low-income and rural communities, could be at greater risk of closing. That’s among the reasons the hospital industry has supported Medicaid expansion and opposed cuts at the state and federal levels.
Hospitals are politically influential. According to OpenSecrets, in 2023 and 2024, the hospital and nursing home industries accounted for $62 million in political contributions. And hospitals are major employers: Indiana University Health has about 36,000 employees and Prisma Health in South Carolina has 29,000 employees.
If they vote to cut Medicaid, Republicans probably won’t just face opposition from patient advocates and liberal do-gooders. They’ll very likely hear from the board members and executives of major employers in their districts.
They’re also very likely to face opposition from another constituency: older voters and voters who have family members with disabilities. Medicare generally doesn’t pay for nursing homes and home care for elderly and disabled Americans; Medicaid does. Medicaid also helps pay Medicare premiums and co-pays for low-income seniors through Medicare Savings Programs. And it funds a substantial portion of supportive services for the intellectually and developmentally disabled.
Low-income seniors may not sound like a powerful constituency, but many people who benefit from Medicaid long-term care coverage don’t start out as low-income. Nursing home care can easily cost $100,000 a year; many middle-class families who start out paying out of pocket will find that their loved ones become eligible for Medicaid in short order. That means there is a broad middle-class constituency, including Republican voters, that relies on Medicaid-funded long-term care.
Medicaid is crucial to state budgets — including in red states. On average, when federal funds are included, Medicaid represented 28.8 percent of states’ budgets in 2022. Even a relatively limited federal cutback could present many states with fiscal crises. Some red-state governors would very likely push back against cuts that might force them to make an unpopular choice between cutting their Medicaid programs or raising taxes.
Blue-state Republicans might balk as well: A Medicaid cut might be a tough sell for the seven Republicans from New York and nine from California helping to prop up Republicans’ three-vote House majority.
Republicans might find all these sources of opposition — provider lobbies, Medicaid beneficiaries, Republican governors, blue-state Republicans — more manageable if the public supported their larger goal of shrinking Medicaid. But far from supporting Medicaid cuts, voters — even those in deep-red states like Idaho, Missouri and Oklahoma — have voted for Medicaid expansion by ballot initiative. A 2024 KFF poll found that 71 percent of adults think that Medicaid should largely continue as it is today, and 66 percent of adults in (overwhelmingly Republican) non-expansion states support expansion. A Pew Research Center poll recently found that 65 percent of Americans think that “it is the federal government’s responsibility to make sure all Americans have health care coverage.”
That’s among the reasons Republicans’ last major push to cut Medicaid spending, in 2017, fell apart. In 2016, Mr. Trump and Republicans ran on rolling back the A.C.A., but the bottom fell out of their effort when the Congressional Budget Office estimated that the Republican plan would increase the number of people without health insurance by more than 20 million in a decade. The effort to repeal the A.C.A. stumbled on for several more weeks before Senator John McCain famously put it out of its misery.
There’s little evidence the public’s views on this issue have changed since. Republicans hoping to slash Medicaid for the sake of tax cuts do so at their peril.
Michael Kinnucan is the health policy director at the Fiscal Policy Institute.