House Republicans’ Plan for Medicaid Emphasizes Work Requirements

On Sunday evening, May 11, the leaders of the House Republican Caucus in the U.S. Congress released the details of their plan to make considerable cuts to the Medicaid program, one that critics say will cause millions to lose health insurance coverage, but which avoided earlier, more drastic plans.

The New York Times’s Margot Sanger-Katz and Catie Edmonson wrote on Monday morning, May 12, that “The proposal, which is one piece of a sweeping bill to enact President Trump’s domestic agenda, including large tax cuts and increased military spending, omits the structural changes to Medicaid that ultraconservative Republicans have demanded. Instead, it bows to the wishes of a group of more moderate and politically vulnerable G.O.P. lawmakers whose seats could be at risk if they embraced deep Medicaid cuts. It was published late Sunday night by the House Energy and Commerce Committee, which under the G.O.P. budget blueprint had to find $880 billion in savings over a decade. The panel is scheduled to meet on Tuesday afternoon to debate and refine the package.”

Sanger-Katz and Edmondson noted that, “Overall, the legislation would reduce federal spending by an estimated $912 billion over the decade and cause 8.6 million people to become uninsured, according to a partial analysis from the Congressional Budget Office that was circulated by Democrats on the committee. Most of those cuts —$715 billion — would come from changes to Medicaid and the Affordable Care Act. The legislation’s remaining savings would come largely from changes in energy policy, including the repeal of two Biden-era regulations that affect car pollution and auto efficiency,” they wrote.

What many are noting is that, while the proposed bill “tries to split the difference between Republicans agitating for deep cuts to Medicaid and those eager to protect their states from changes that could force them to shoulder much higher costs,” it adds work requirements for single, childless adults “mandating that they prove they are working 80 hours every month to stay enrolled. That is a less flexible version of a work requirement briefly imposed in Arkansas in 2018 that caused 18,000 people to rapidly lose coverage.”

Late Sunday night, POLITICO’s Ben Leonard and Robert King wrote that the legislation “does not include the most controversial ideas, including per-capita caps on federal Medicaid payments to states, but it incorporates new mandates that will likely force states to revamp how they finance their programs or cut benefits. The health provisions also include new work requirements that are expected to lead many people to lose coverage, as well as a new cost-sharing requirement for some beneficiaries in the program, not to exceed five percent of a patient’s income.” And, they added, “The Energy and Commerce plan also hits on hot-button social issues — proposing, for instance, to cut federal funding for groups like Planned Parenthood and ban the use of Medicaid dollars for gender-affirming care for youth. It also scales back funding from states that use their own funds to offer coverage for undocumented people.”

In an op-ed published in the Wall Street Journal online on Sunday, whose text incorporates parts of his official statement as chair of the House Energy and Commerce Committee, Brett Guthrie (R-Ky.) wrote that “Democratic extremism is threatening Americans’ access to affordable healthcare. States are struggling to manage rising Medicaid costs, which ballooned under Mr. Biden. This is particularly true in Democrat-run states such as California that use federal Medicaid funding to subsidize health insurance for illegal aliens through state insurance programs. This policy puts undue budgetary pressure on Medicaid, thereby endangering the healthcare access of the vulnerable Americans the program was designed to help. Just as Mr. Trump is working to end sanctuary cities, congressional Republicans will reduce federal aid to states that give welfare to illegal immigrants. The Biden administration is responsible for this problem, too, having imposed burdensome regulations on Medicaid that jeopardize the program’s long-term health. The last president stripped away guardrails against fraud by making it more difficult for states to remove ineligible people from Medicaid enrollment and expanded coverage such that capable but unemployed adults could take resources meant for people in need.”

Meanwhile, ABC News’s Lisa Mascaro wrote late on Sunday night that, “While Republicans insist they are simply rooting out “waste, fraud and abuse” to generate savings with new work and eligibility requirements, Democrats warn that millions of Americans will lose coverage. A preliminary estimate from the nonpartisan Congressional Budget Office said the proposals would reduce the number of people with health care by 8.6 million over the decade.” And she quoted a statement by Rep. Frank Pallone (D.-N.J.), the ranking member on the House Energy and Commerce Committee, who said that, “In no uncertain terms, millions of Americans will lose their health care coverage; hospitals will close, seniors will not be able to access the care they need, and premiums will rise for millions of people if this bill passes."

Mascaro wrote that, “As Republicans race toward House Speaker Mike Johnson's Memorial Day deadline to pass Trump's big bill of tax breaks and spending cuts, they are preparing to flood the zone with round-the-clock public hearings this week on various sections before they are stitched together in what will become a massive package.”

Writing late Sunday night, CNN’s Sarah Ferris and Lauren Fox wrote that, “Since Medicaid is a joint federal-state program, many conservatives wanted to cut federal costs by requiring states to pay more. But that idea — which would have involved what’s called the Federal Medical Assistance Percentage, or FMAP — was too contentious among GOP centrists. The GOP panel’s plan does make one proposed change to FMAP, however: The bill would penalize states that provide a state health care program, such as Medicaid, to “illegal immigrants” by cutting their federal contribution to Medicaid by 10 percent — an apparent targeting of some blue states like California. Guthrie, in his op-ed, also signaled that Republicans would repeal at least some parts of former President Joe Biden’s signature climate policy bill — though it’s not yet clear whether GOP moderates will support this move, as some had lobbied publicly and privately to keep certain tax credits.”

House Minority Leader Hakeem Jeffries was already on record opposing any major Medicaid cuts; on May 7, he released a statement that began thus: “Donald Trump and Rubber Stamp Republicans in Congress are lying to the American people about their plans to enact the largest cut to Medicaid in our nation’s history. Today, the nonpartisan Congressional Budget Office has confirmed what House Democrats, under the leadership of Energy and Commerce Committee Ranking Member Frank Pallone, have been saying: the Republican budget scheme rips away healthcare and slashes Medicaid benefits from millions of people. The CBO analysis makes clear that the Republican plans to gut healthcare will leave states to make up massive budget shortfalls by raising taxes, cutting school funding and kicking people off of their health insurance.”

Further, Jeffries added, “The reckless Republican budget will strip coverage and benefits from millions of everyday Americans in a scheme designed to justify massive tax breaks for their billionaire donors under the phony excuse of cutting waste, fraud and abuse. House Democrats will continue to strongly oppose the extreme Republican budget on behalf of hardworking American taxpayers.”

This is a developing story. Healthcare Innovation will update readers as new developments emerge.