The final time a Republican-controlled Congress and President Donald Trump moved to slash Medicaid spending, in 2017, a key political pressure stood of their manner: GOP governors.
Now, as Congress steamrolls towards passing historic Medicaid cuts of about $1 trillion over 10 years by means of Trump’s tax and spending laws, red-state governors are saying little publicly about what it does to well being care — whilst 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 almost half of the nation’s kids. Republicans say the $900 billion-a-year program was allowed to develop too giant below Democrats Barack Obama and Joe Biden by including nondisabled adults they are saying don’t deserve authorities helpthey usually have lengthy sought to scale it again.
A number of the greatest well being cuts within the laws Trump calls the “One Large Lovely Invoice” are achieved by means of 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 below the Reasonably priced 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 thousands and thousands of people that gained it inside 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 needed reform in order that Medicaid is getting used for short-term 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 growth eligibility,” stated Josie Harms, a spokesperson for South Dakota Gov. Larry Rhoden, including that congressional lawmakers have the governor’s assist: “South Dakota has a superb federal delegation, and Governor Rhoden trusts them to battle 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 instrument that almost all of their states use to assist pay their share of Medicaid and achieve extra funds from the federal authorities. That change is anticipated to value states billions.
No Longer a Bipartisan Subject
In distinction to the radio silence from GOP governors, Democratic governors have campaigned towards the megabill for weeks.
Pennsylvania Gov. Josh Shapiro posted on the social platform X that Trump and congressional Republicans have been deceptive Individuals by saying they have been slicing solely waste, fraud, and abuse in Medicaid.
“They’re speeding to kick a whole bunch of hundreds of Pennsylvanians off their healthcare — and mendacity about it,” he posted. “The harm it will do right here in Pennsylvania and throughout America is staggering and will probably 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 influence of the GOP reconciliation invoice in Washington, D.C., may pressure hospitals to curtail critically wanted companies comparable to maternity care and psychiatric remedy, to not point out to downsize operations, and even shut fully,” she stated in an announcement.
In 2017, the refrain was bipartisan, as Republican governors in Ohio, Nevadaand Massachusetts spoke out towards slicing Medicaid. Trump’s invoice to repeal a lot of the Reasonably priced Care Act and roll again its Medicaid growth narrowly failed within the Senate.
“It’s been shocking that red-state governors, notably these in Medicaid growth states, haven’t spoken out towards 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 have been a potent political pressure within the failed 2017 effort to repeal and exchange the ACA, together with Medicaid growth.”
What’s modified since 2017, coverage specialists say, is that there are fewer reasonable Republican governors, and GOP state executives who advocated for Medicaid growth over a decade in the past are not in workplace.
Moreover, seven of the then-red states that expanded Medicaid did so through poll initiativelargely over opposition from their governors.
Actually, the Medicaid work requirement is backed by many Republican governors, even when it means much less federal Medicaid cash and results in fewer folks coated.
A number of states, together with Arkansas and Ohio, have already handed state legal guidelines to implement a requirement that adults enrolled below the ACA’s Medicaid growth work, volunteer, go to high school, or take part in job coaching. Most states have but to deliver 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 making an attempt to dam Medicaid cuts below the invoice, federal lawmakers are listening to from legislators of their states.
A political dilemma for Republican governors is that, not like in 2017, the invoice earlier than Congress just isn’t laws aimed expressly at repealing Obamacare. With a scope broader than well being care, it will lengthen a lot 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 enjoying multidimensional chess relatively than specializing in one problem,” Kahn stated.
Larry Jacobsdirector of the Heart for the Examine of Politics and Governance on the College of Minnesota, stated some Republican governors could have expressed issues privately to their states’ GOP senators however should not talking out publicly for concern of drawing Trump’s wrath.
“Why are they being cagey? Trump and never eager 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 specific. On June 29, Sen. Thom Tillis (R-N.C.) introduced he wouldn’t run for reelection after he voiced issues concerning the invoice and the president threatened to again a major challenger. Tillis was considered one of three GOP senators to vote towards 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 increased funds for his or her Medicaid sufferers.
The observe, which has been adopted in each state however Alaska, has been criticized by some Beltway Republicans as “cash laundering” — though the taxes are accredited by state lawmakers and the federal Facilities for Medicare & Medicaid Providers and have been allowed below federal legislation for many years.
The Senate invoice would restrict the cash states may increase — 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 issues about repealing the Obamacare Medicaid growth 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 a lot of our folks depend on Medicaid, any reduce to Medicaid would destroy households in West Virginia.” He added that “the results could 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 probably the most weak and people who 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 e-mail July 2.
KFF Well being Information correspondent Arielle Zionts contributed to this report.
