gotchanewsdaily.com 
CNN
—
President Donald Trump and congressional Republicans may no longer be pushing to wholly repeal Obamacare, but big cuts to the nation’s health system are still on the table.
As GOP leaders in the House and Senate scramble to pull together a massive legislative package with Trump’s pricey priorities, they are looking for ways to offset the costs. One of their prime targets is Medicaid, which provides health coverage to more than 72 million low-income Americans.
The Senate Budget Committee kicked off the process on Friday, releasing its budget blueprint that calls for the Senate Finance Committee and House Energy and Commerce Committee, both of which have jurisdiction over Medicaid, to find at least $1 billion in savings, among other provisions.
“The way this is written means only one thing: Republicans have their knives out for Americans’ health care,” Oregon Sen. Ron Wyden, the ranking Democrat on the Senate Finance Committee, said in a statement. “It’s been clear from the start that congressional Republicans plan to gut health care for working families to fund their ideological priorities.”
The House is working on its own version of what could be an even larger reconciliation package, which can be passed with a simple majority of votes in the Senate.
Republicans have long sought to rein in Medicaid, which they view as rife with fraud and abuse. Their reform efforts in the first Trump administration largely failed, but they have renewed energy now that they again control the White House and both sides of Capitol Hill, albeit with a super-slim margin in the House.
Even so, it could be difficult for GOP lawmakers to pass many of their Medicaid wish-list items, which House Republicans have laid out as possible savings to offset extending the 2017 Trump tax cuts, beefing up border security and enacting other measures. Some of their constituents – both individuals and powerful hospitals – rely on the program, and the GOP already knows the fallout that comes from threatening to take away millions of people’s health coverage. Their efforts to repeal Obamacare, as well as overhaul Medicaid, at the start of the first Trump administration cost them their House majority in the 2018 midterm election.
“Cutting Medicaid hurts people whom Republicans purportedly want to protect,” said Allison Orris, director of Medicaid Policy at the left-leaning Center on Budget and Policy Priorities. “It’s hard to see how any population would remain unscathed.”
More than half of Americans (55%) feel that the US government spends too little on Medicaid, while 29% feel it spends the right amount, according to a January AP-NORC poll. Only 15% said the government spends too much.
Another potentially complicating factor: In recent weeks, Trump has added Medicaid to the list of programs, including Social Security and Medicare, that he says he wants to protect. However, while he promised to “love and cherish” Medicaid, the president also said that he would do something to the program if abuse or waste is found.
“Don’t touch Social Security, don’t touch Medicare, Medicaid. Just leave them alone,’” Trump told Senate Republicans on Friday, reflecting on his discussions with their House counterparts the day before.
Ways to cut trillions from Medicaid
Still, that’s not stopping House Republicans from floating proposals to cut several trillion dollars from Medicaid over the next decade.
One of the changes that could be easier to get through both chambers is instituting work requirements, particularly among the able-bodied adults without dependent children who gained Medicaid coverage through the Affordable Care Act’s expansion of the program.
In the first Trump administration, multiple states received approval to add work mandates, but the attempts were swatted down by federal judges, who found that employment was not one of the program’s core objectives. That determination would be wiped away if Congress added work requirements to the law.
“Conservatives view it as welfare reform,” said Brian Blase, president of Paragon Health Institute and former Trump administration health policy adviser. “If you are able-bodied, you should be working to get government benefits. You shouldn’t just get handouts.”
Such a measure could save $100 billion over a decade, according to a menu of potential spending cuts circulated by House Budget Committee Republicans last month.
But it could also put at risk the health care coverage of 36 million Americans, who could have trouble fulfilling the employment verification requirements, according to the Center on Budget and Policy Priorities, noting that nearly two-thirds of non-elderly adult Medicaid enrollees work full- or part-time.
Another major option on the GOP menu would change the formula that determines how much federal matching funds flow to the states to cover their traditional Medicaid enrollees, who include children, the elderly, the disabled and parents. It would reduce the formula’s floor, which would primarily affect high-income states, such as New York and California, and save up to $387 billion over a decade.
Republicans are also looking at slashing the federal match for the Medicaid expansion population, which is currently 90%, to the same match a state receives for its traditional enrollees. That would lead at least nine states to drop out of the expansion program since their participation is tied to the 90% match rate, which was specified in the Affordable Care Act, but other states could also stop coverage because of the big hits their budgets would take. This measure would save $561 billion over a decade.
The most consequential idea being floated would establish a per capita cap in Medicaid, which could save up to $900 billion over 10 years. Instead of receiving an open-ended amount of federal funding based on enrollees’ health care costs, states would get a set amount of money based on enrollment and that funding would grow at the rate of medical inflation. The cap would vary based on the type of enrollee, such as children or the elderly.
Although Republicans failed to enact these measures during the first Trump administration, today’s Congress is different, said Leslie Dach, founder and chair of Protect Our Care, a health policy advocacy group that supports the Affordable Care Act. GOP lawmakers are more ideological, less likely to buck Trump and desperate to find savings for their massive tax cuts, he said.
The organization launched two television and digital ads last week as part of its $10 million “Hands Off Medicaid” campaign, which will run almost exclusively on Fox News and on digital platforms in 10 House Republican districts in Arizona, California, New York, Pennsylvania and Washington state.
“The threats are very real,” Dach said.
