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Texas leaders have demonstrated a decades-old antipathy toward Medicaid, the federal-state health insurance program that covers millions of low-income and vulnerable residents.
They rejected additional federal funding under the Affordable Care Act that would have enabled Medicaid to provide health insurance to more low-income families. The state was one of the last to offer coverage for a full year after a woman gives birth. And when the federal government last year ended a policy requiring states to keep people enrolled in Medicaid during the coronavirus pandemic, Texas officials warned that the expedited process could leave some people unfairly receiving benefits. Ignoring persistent warnings about their gender, they hastily removed those they deemed unqualified. Deleted.
Texas leaders may have another chance to scale back the program in January, when Donald Trump takes office for a second time — this time with fewer restrictions.
President Trump has not announced plans to cut Medicaid, which covers about 80 million Americans, and his campaign did not respond to requests for comment. But health care advocates and experts say the program is subject to significant cuts, given his past efforts to shrink the program and the positions of conservative groups and Republican lawmakers who support him. This indicates that there is a high possibility of this happening.
“I expect Republicans to move very quickly to make significant cuts to Medicaid and actually end the coverage that exists today,” said Joanne Alker, executive director of Georgetown University’s Center for Children and Families in Washington, D.C. “
Currently, the federal government pays an average of nearly 70% of Medicaid spending, with states covering the remaining costs. (A state’s share varies primarily depending on what percentage of its population is poor.) If a decision is made to reduce federal spending, each state will have to decide how many people are considered eligible and how many people enroll. Alker and other experts said this would likely lead to a reduction in the amount of care available. Said.
This would be especially devastating in Texas, which already has the lowest percentage of residents eligible for Medicaid in the nation and where officials have no political will to make up the funding gap with state funds. Experts say it’s missing. For example, a parent with two children must have a monthly income of less than $285 to qualify for Medicaid.
“Whether our elected officials will cut medical care for pregnant women, children, the disabled, and the elderly, because in Texas it is essentially the people who are eligible for Medicaid. ,” said Adriana Koehler, Texas Child Care Policy Director. A statewide nonprofit group advocating for families said in a statement.
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Republican Gov. Greg Abbott’s press secretary and the state Health and Human Services Commission did not respond to repeated requests for comment. While previously serving as state attorney general, Abbott led a lawsuit against the federal government that required states to completely remove Medicaid funding if they did not want to cover more residents as part of the Affordable Care Act. I made sure that there was no risk of losing it.
Even as Texas offers Medicaid coverage to its most vulnerable residents, state officials have enabled a system that creates often insurmountable barriers to accessing care. A 2018 Dallas Morning News investigation found that some of the insurance companies Texas hired to administer Medicaid benefits organized expensive and sometimes life-saving treatments to increase profits. It turned out that he had refused. Critics say that despite the legal reforms spurred by the series of stories, problems with the system remain.
Texas provides insurance to more than 4 million residents through Medicaid, a smaller percentage of its total population than almost any other state. But given its size, the state still covers the third-largest population in the nation, behind California and New York. According to KFF, a national health care policy research organization, the program provides medical care to 3 in 8 children, 3 in 5 nursing home residents, and 2 in 7 people with disabilities in Texas. I’m doing it. It is the largest funder of nursing homes and long-term care services for the disabled and elderly, and accounts for nearly half of the state’s births.
Michael Morgan, 75, a retired nurse from Fort Worth, worries that if President Trump caps or cuts federal Medicaid spending, it will become more difficult for states to cover Medicaid. I’m the one who does. his daughter Hannah; She has Down syndrome and schizophrenia, a brain malformation, and is deaf, partially blind, unable to speak, and requires assistance to walk and eat.
Morgan lost Medicaid coverage when Hannah turned 19 earlier this year, and is dipping into her limited savings to pay for Hannah’s medical bills. Hanna submitted a new application in May. Hannah needs to qualify for Medicaid because she has a disability. State officials denied her report in November, claiming Morgan had missed a deadline to return forms consenting to access her daughter’s medical and financial records. Morgan, who plans to appeal the denial, said in an interview that he received the application the day before the deadline.
“I don’t know how much more cuts we can make,” he said of Texas’ Medicaid.
During his first term, President Trump unsuccessfully attempted to repeal the Affordable Care Act, which provides health insurance to 45 million Americans. The administration also repeatedly supported spending caps on Medicaid, including block grants that would give each state a set amount of federal funding, regardless of the number of people who need coverage or the amount of health care costs. Currently, Medicaid covers everyone who qualifies, regardless of cost.
These efforts made no significant progress during President Trump’s first term, but in January, Republicans will take control of both houses of Congress, cap spending, and most program participants will have jobs. They are showing a positive attitude towards establishing requirements. They argue that Medicaid spending is unsustainable and that the program is susceptible to waste, fraud and abuse.
Republicans who supported the measure include Sen. John Cornyn and Rep. Jody Arrington, a Lubbock Republican who heads the House Budget Committee.
Republican policy primers, including Project 2025, published by the conservative think tank Heritage Foundation, and publications by the Republican Study Committee, a conservative group of Congressional leaders, also call for Medicaid cuts.
A spokesperson for Mr. Arrington did not respond to repeated requests for an interview, but told reporters last month that he supports “responsible and reasonable labor requirements.” Harvard health professors who studied the previous work requirement in Arkansas that President Trump granted during his first term found that most adults on Medicaid were already employed or eligible for a waiver. found that thousands of residents still lack health insurance, at least in part because of Medicaid. The tedious process of continually proving your eligibility.
This is not the first time Arrington has pushed for work requirements and sought to reduce the federal government’s share of health care spending to states. He previously proposed cutting federal Medicaid spending by more than a quarter, or $1.9 trillion.
A spokesperson for Mr. Cornyn also repeatedly declined comment, but said last month that he does not support cuts to Medicare or Social Security, the federal health insurance programs for the elderly and disabled. Still, he indicated that Medicaid cuts are on the table.
“We can’t keep doing things the same way we’ve always done things,” Cornyn told Politico Pro, adding that “block grants make a lot of sense.”
William T. Smith, 65, a retired construction worker who lives in Brownsville, along the U.S.-Mexico border, agreed that one reason he voted for Trump was “too much fat,” but some said he supports cuts to federal programs.
Smith has chronic obstructive pulmonary disease, which affects his lungs and makes it difficult for him to breathe. He said he also suffers from bipolar disorder, sleep apnea and chronic pain from decades of manual labor.
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Smith said Medicaid, which he has been trying to get since the summer, should not be used by the federal government to cut spending. Instead, he said, the federal government should use the money it saves from cuts to other programs to care for more people.
“I don’t think they’re going to take health care away from people,” he said. “I’d be really angry if that were the case.”
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Dan Keemahill contributed reporting.
