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 approach: GOP governors.
Now, as Congress steamrolls towards passing historic Medicaid cuts of about $1 trillion over 10 years by way of 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 may 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 youngsters. Republicans say the $900 billion-a-year program was allowed to develop too massive underneath 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.
A number of the largest well being cuts within the laws Trump calls the “One Massive Stunning Invoice” are achieved by way 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 underneath 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 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 mentioned they backed imposing a piece requirement on grownup Medicaid enrollees.
“Implementing work necessities for able-bodied adults is an efficient and crucial reform in order that Medicaid is getting used for momentary help and never a everlasting entitlement,” mentioned Drew Galang, a spokesperson for Gov. Patrick Morrisey of West Virginia.
“Governor Rhoden helps workforce participation as a requirement of Medicaid enlargement eligibility,” mentioned 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 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 mentioned something about one other of the laws’s vital cuts, to supplier taxes — a software that every one of their states use to assist pay their share of Medicaid and achieve further funds from the federal authorities. That change is anticipated to price states billions.
No Longer a Bipartisan Problem
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 had been deceptive Individuals by saying they had been slicing solely waste, fraud, and abuse in Medicaid.
“They’re speeding to kick lots of of 1000’s of Pennsylvanians off their healthcare — and mendacity about it,” he posted. “The injury this can do right here in Pennsylvania and throughout America is staggering and will likely be felt for years to return.”
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., might pressure hospitals to curtail critically wanted companies comparable to maternity care and psychiatric remedy, to not point out to downsize operations, and even shut totally,” she mentioned in a press release.
In 2017, the refrain was bipartisan, as Republican governors in Ohio, Nevada, and Massachusetts spoke out towards slicing Medicaid. Trump’s invoice to repeal a lot of the Reasonably priced Care Act and roll again its Medicaid enlargement narrowly failed within the Senate.
“It’s been shocking that red-state governors, significantly these in Medicaid enlargement states, haven’t spoken out towards Medicaid cuts,” mentioned Larry Levitt, govt vp for well being coverage at KFF, a well being info nonprofit that features KFF Well being Information. “Republican governors had been a potent political pressure within the failed 2017 effort to repeal and change the ACA, together with Medicaid enlargement.”
What’s modified since 2017, coverage specialists 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 by way of poll initiative, largely over opposition from their governors.
The truth is, 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 underneath the ACA’s Medicaid enlargement work, volunteer, go to high school, or take part in job coaching. Most states have but to carry 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, mentioned that whereas fewer governors have engaged publicly in attempting to dam Medicaid cuts underneath 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 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 difficulty,” Kahn mentioned.
Larry Jacobs, director of the Middle for the Examine of Politics and Governance on the College of Minnesota, mentioned some Republican governors might have expressed considerations privately to their states’ GOP senators however are usually not talking out publicly for worry of drawing Trump’s wrath.
“Why are they being cagey? Trump and never desirous to be ‘Liz Cheney’d,’” Jacobs mentioned, 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 concerning the invoice and the president threatened to again a main challenger. Tillis was one in every 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 improve 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 follow, which has been adopted in each state however Alaska, has been criticized by some Beltway Republicans as “cash laundering” — regardless that the taxes are permitted by state lawmakers and the federal Facilities for Medicare & Medicaid Companies and have been allowed underneath federal regulation for many years.
The Senate invoice would restrict the cash states might increase — a transfer that may 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 depend on Medicaid, any lower to Medicaid would destroy households in West Virginia.” He added that “the results 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 susceptible 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, mentioned in an electronic mail July 2.
KFF Well being Information correspondent Arielle Zionts contributed to this report.
