The future of Medicaid, the nation’s largest public health insurance program, hangs in the balance as House Republicans push for deep budget cuts that could drastically reshape it.
In Pennsylvania, where 3 million residents rely on Medicaid, advocates like Shana Jalbert, communications director of the Pennsylvania Health Access Network, a Philadelphia-based nonprofit that promotes affordable health care access, worry about the vulnerable populations that stand to lose coverage.
Statewide, about 40% of people covered by Medicaid are children, according to PHAN. Another 33% are seniors, pregnant women and people with disabilities, and 25% are low-wage workers without employer-provided insurance.
“That's kind of the population we're talking about when we’re talking about cuts,” she said. “It’s not a done deal yet. But what do we know is that any cut to the program, regardless of where it falls, will hit those populations hard.”
Embroiled in a contentious budget reconciliation process, Congress is weighing how to cut federal spending by $1.5 trillion over the next decade, in part to finance President Donald Trump’s extended tax cuts and increased border enforcement.
Experts warn that cuts to Medicaid are likely. Medicaid is the main program providing comprehensive health and long-term care to one in five Americans.
Of significant concern are proposals to restructure Medicaid funding by imposing a per-capita cap or converting it into a block grant, either of which could reduce federal Medicaid funding from between $500 billion and $800 million over nine years, according to the Congressional Budget Office.
Laura Harker, a senior policy analyst with the Center for Budget and Policy Priorities, explained that a per-capita cap would force states to absorb “unpredictable” costs.
“Medicaid’s current structure ensures the federal government shares financial risk with states, which is especially crucial during economic downturns or public health crises,” Ms. Harker said.
As a result, states would likely cut eligibility and benefits. Optional services that states offer, such as community-based care for people with disabilities or even prescription drug coverage, could be among the first to be cut.
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