The Rubber is About to Hit the Road on Medicaid Cuts

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The House and the Senate have now passed a budget resolution that implies big, but unspecified, cuts to Medicaid. The House Energy and Commerce Committee is expected to produce proposals to cut federal spending by at least $880 billion over a decade, and the math is inescapable that the vast majority of those cuts would come from Medicaid. Senate Majority Leader John Thune has suggested the Senate will seek at least $1.5 trillion in overall spending cuts, which again would have to include substantial cuts to Medicaid.

So far, the debate over Medicaid cuts has been about abstract numbers that don’t mean a lot to the public. Now the rubber hits the road. Congressional committees will put forward specific Medicaid cuts that will be targets for interest groups. Lobbying will intensify from patient groups, health care providers, and states. Medicaid covers 83 million people – more than Medicare or Social Security – so significant cuts could be felt quite broadly, even if that won’t be apparent to the public immediately.

Once Republicans in Congress get specific about Medicaid cuts, it will become more tangible and clearer who will be affected. Changes to the status quo in health care rarely get more popular when the details get filled in. We saw that with the Clinton health plan in the 1990s, with the Affordable Care Act (ACA) when it initially passed, and with the 2017 effort to repeal the ACA.