The final time a Republican-controlled Congress and President Donald Trump moved to slash Medicaid spending, in 2017, a key political drive stood of their method: GOP governors.
Now, as Congress steamrolls towards passing historic Medicaid cuts of about $1 trillion over 10 years via Trump’s tax and spending laws, red-state governors are saying little publicly about what it does to well being care — at the same time as they face reductions that can punch multibillion-dollar holes of their states’ budgets.
Medicaid, a program collectively run by states and the federal authorities, covers greater than 70 million low-income or disabled folks, together with practically half of the nation’s kids. Republicans say the $900 billion-a-year program was allowed to develop too massive beneath Democrats Barack Obama and Joe Biden by including nondisabled adults they are saying don’t deserve authorities help, and so they have lengthy sought to scale it again.
Among the largest well being cuts within the laws Trump calls the “One Large Lovely Invoice” are achieved via new insurance policies that would cut back enrollment by imposing extra paperwork calls for on enrollees, together with a requirement that many show they’re working. These insurance policies would have an effect on solely states that expanded Medicaid to extra low-income folks beneath the Inexpensive Care Act.
Nineteen of these states are led by Republican governors. Their silence on the invoice’s well being measures is giving political cowl to GOP lawmakers from their states as they search to chop Medicaid protection for hundreds of thousands of people that gained it throughout the final decade.
KFF Well being Information contacted all 19 governors for touch upon the laws’s Medicaid cuts. Solely six responded. Most stated they backed imposing a piece requirement on grownup Medicaid enrollees.
“Implementing work necessities for able-bodied adults is an effective and mandatory reform in order that Medicaid is getting used for non permanent help and never a everlasting entitlement,” stated Drew Galang, a spokesperson for Gov. Patrick Morrisey of West Virginia.
“Governor Rhoden helps workforce participation as a requirement of Medicaid enlargement eligibility,” stated Josie Harms, a spokesperson for South Dakota Gov. Larry Rhoden, including that congressional lawmakers have the governor’s help: “South Dakota has a wonderful federal delegation, and Governor Rhoden trusts them to combat for South Dakota’s priorities whereas delivering on President Trump’s guarantees.”
In an indication of how the political winds have modified, not one of the governors stated something about one other of the laws’s vital cuts, to supplier taxes — a software that just about all of their states use to assist pay their share of Medicaid and acquire extra funds from the federal authorities. That change is predicted to value states billions.
No Longer a Bipartisan Subject
In distinction to the radio silence from GOP governors, Democratic governors have campaigned in opposition to the megabill for weeks.
Pennsylvania Gov. Josh Shapiro posted on the social platform X that Trump and congressional Republicans had been deceptive Individuals by saying they had been slicing solely waste, fraud, and abuse in Medicaid.
“They’re dashing to kick lots of of hundreds of Pennsylvanians off their healthcare — and mendacity about it,” he posted. “The injury this may do right here in Pennsylvania and throughout America is staggering and can be felt for years to come back.”
In New York, Gov. Kathy Hochul on July 1 charged that Trump’s laws would devastate hospitals and will result in greater than 34,000 job cuts in her state.
“The collective affect of the GOP reconciliation invoice in Washington, D.C., may drive hospitals to curtail critically wanted companies equivalent to maternity care and psychiatric remedy, to not point out to downsize operations, and even shut completely,” she stated in a press release.
In 2017, the refrain was bipartisan, as Republican governors in Ohio, Nevada, and Massachusetts spoke out in opposition to slicing Medicaid. Trump’s invoice to repeal a lot of the Inexpensive Care Act and roll again its Medicaid enlargement narrowly failed within the Senate.
“It’s been stunning that red-state governors, significantly these in Medicaid enlargement states, haven’t spoken out in opposition to Medicaid cuts,” stated Larry Levitt, government vice chairman for well being coverage at KFF, a well being data nonprofit that features KFF Well being Information. “Republican governors had been a potent political drive within the failed 2017 effort to repeal and exchange the ACA, together with Medicaid enlargement.”
What’s modified since 2017, coverage consultants say, is that there are fewer average Republican governors, and GOP state executives who advocated for Medicaid enlargement over a decade in the past are not in workplace.
Moreover, seven of the then-red states that expanded Medicaid did so through poll initiative, largely over opposition from their governors.
In truth, the Medicaid work requirement is backed by many Republican governors, even when it means much less federal Medicaid cash and results in fewer folks lined.
A number of states, together with Arkansas and Ohio, have already handed state legal guidelines to implement a requirement that adults enrolled beneath the ACA’s Medicaid enlargement work, volunteer, go to high school, or take part in job coaching. Most states have but to convey work requirement packages to fruition as a result of they’re ready for federal authorities approval.
Charles “Chip” Kahn, president of the Federation of American Hospitals, a commerce group of investor-owned hospitals, stated that whereas fewer governors have engaged publicly in attempting to dam Medicaid cuts beneath the invoice, federal lawmakers are listening to from legislators of their states.
A political dilemma for Republican governors is that, in contrast to in 2017, the invoice earlier than Congress is just not laws aimed expressly at repealing Obamacare. With a scope broader than well being care, it will prolong lots of Trump’s tax cuts and direct billions in new spending towards border safety, immigration enforcement, and the army, whereas additionally slicing well being care spending.
“It’s like taking part in multidimensional chess fairly than specializing in one problem,” Kahn stated.
Larry Jacobs, director of the Middle for the Research of Politics and Governance on the College of Minnesota, stated some Republican governors might have expressed considerations privately to their states’ GOP senators however aren’t talking out publicly for concern of drawing Trump’s wrath.
“Why are they being cagey? Trump and never desirous to be ‘Liz Cheney’d,’” Jacobs stated, referring to the Republican former Wyoming lawmaker whom Trump helped oust after she served as vice chair of an inquiry into his makes an attempt to overturn the outcomes of the 2020 election.
Strolling Political Tightropes
The political peril Republican lawmakers face in publicly difficult Trump stays express. On June 29, Sen. Thom Tillis (R-N.C.) introduced he wouldn’t run for reelection after he voiced considerations in regards to the invoice and the president threatened to again a major challenger. Tillis was one in all three GOP senators to vote in opposition to it on July 1, although it nonetheless narrowly handed.
Along with the work requirement, the most important Medicaid cuts within the invoice stem from its restrictions on supplier taxes — levies that states impose on hospitals, nursing houses, and different well being care establishments to assist enhance their federal reimbursement. A lot of the extra cash is then returned to the well being care suppliers within the type of greater funds for his or her Medicaid sufferers.
The follow, which has been adopted in each state however Alaska, has been criticized by some Beltway Republicans as “cash laundering” — despite the fact that the taxes are authorised by state lawmakers and the federal Facilities for Medicare & Medicaid Companies and have been allowed beneath federal regulation for many years.
The Senate invoice would restrict the cash states may elevate — a transfer that might imply billions in funding cuts to states and their hospitals.
The states with Republican governors that expanded Medicaid are Alaska, Arkansas, Idaho, Indiana, Iowa, Louisiana, Missouri, Montana, Nebraska, New Hampshire, Nevada, North Dakota, Ohio, Oklahoma, South Dakota, Vermont, Virginia, West Virginia, and Utah.
One of many governors who expressed considerations about repealing the Obamacare Medicaid enlargement in 2017 was Jim Justice of West Virginia, a Democrat on the time.
In a June 2017 letter to West Virginia Sen. Shelley Moore Capito, a Republican, Justice wrote: “Since so lots of our folks rely on Medicaid, any reduce to Medicaid would destroy households in West Virginia.” He added that “the implications can be past catastrophic.”
On July 1, Justice — elected to the Senate as a Republican final 12 months — voted for Trump’s megabill, together with its Medicaid cuts.
“The Senator believes this invoice strikes a superb steadiness between defending essentially the most weak and those that depend on this system whereas rooting out waste, fraud, and abuse to make sure this system is run effectively for these deserving,” William O’Grady, a Justice spokesperson, stated in an electronic mail July 2.
KFF Well being Information correspondent Arielle Zionts contributed to this report.
KFF Well being Information is a nationwide newsroom that produces in-depth journalism about well being points and is likely one of the core working packages at KFF—an unbiased supply of well being coverage analysis, polling, and journalism. Study extra about KFF.
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