The final time a Republican-controlled Congress and President Donald Trump moved to slash Medicaid spending, in 2017, a key political drive stood of their method: GOP governors.
Now, as Congress steamrolls towards passing historic Medicaid cuts of about $1 trillion over 10 years via 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 beneath Democrats Barack Obama and Joe Biden by including nondisabled adults they are saying don’t deserve government assistance, they usually have lengthy sought to scale it again.
Among the greatest well being cuts within the laws Trump calls the “One Huge Lovely Invoice” are achieved via new insurance policies that would scale 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 beneath the Inexpensive 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 thousands and 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 essential reform in order that Medicaid is getting used for non permanent 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 wonderful federal delegation, and Governor Rhoden trusts them to struggle 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 important cuts, to provider taxes — a device that every one of their states use to assist pay their share of Medicaid and acquire extra funds from the federal authorities. That change is predicted to price states billions.
No Longer a Bipartisan Problem
In distinction to the radio silence from GOP governors, Democratic governors have campaigned in opposition to 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 chopping solely waste, fraud, and abuse in Medicaid.
“They’re speeding to kick tons of of hundreds of Pennsylvanians off their healthcare — and mendacity about it,” he posted. “The injury this may do right here in Pennsylvania and throughout America is staggering and shall be felt for years to come back.”
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 impression of the GOP reconciliation invoice in Washington, D.C., may drive hospitals to curtail critically wanted companies similar to maternity care and psychiatric therapy, to not point out to downsize operations, and even shut totally,” she mentioned in a statement.
In 2017, the refrain was bipartisan, as Republican governors in Ohio, Nevada, and Massachusetts spoke out in opposition to chopping Medicaid. Trump’s invoice to repeal a lot of the Inexpensive Care Act and roll again its Medicaid enlargement narrowly failed within the Senate.
“It’s been stunning that red-state governors, significantly these in Medicaid enlargement states, haven’t spoken out in opposition to 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 drive within the failed 2017 effort to repeal and substitute 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 now not in workplace.
Moreover, seven of the then-red states that expanded Medicaid did so via ballot initiative, largely over opposition from their governors.
In actual fact, 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 beneath the ACA’s Medicaid enlargement work, volunteer, go to highschool, or take part in job coaching. Most states have but to deliver work requirement applications 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 making an attempt to dam Medicaid cuts beneath 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 will not be laws aimed expressly at repealing Obamacare. With a scope broader than well being care, it might lengthen lots of Trump’s tax cuts and direct billions in new spending towards border safety, immigration enforcement, and the army, whereas additionally chopping well being care spending.
“It’s like enjoying multidimensional chess quite than specializing in one difficulty,” Kahn mentioned.
Larry Jacobs, director of the Middle for the Research of Politics and Governance on the College of Minnesota, mentioned some Republican governors might have expressed issues privately to their states’ GOP senators however usually are not talking out publicly for worry of drawing Trump’s wrath.
“Why are they being cagey? Trump and never eager 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 specific. On June 29, Sen. Thom Tillis (R-N.C.) introduced he wouldn’t run for reelection after he voiced issues in regards to the invoice and the president threatened to again a major challenger. Tillis was one among three GOP senators to vote in opposition to it on July 1, although it nonetheless narrowly handed.
Along with the work requirement, the largest 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 enhance their federal reimbursement. A lot of the extra cash is then returned to the well being care suppliers within the type of larger 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 “money laundering” — though the taxes are authorised by state lawmakers and the federal Facilities for Medicare & Medicaid Companies and have been allowed beneath federal legislation for many years.
The Senate invoice would restrict the cash states may elevate — 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 issues 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 rely on Medicaid, any minimize to Medicaid would destroy households in West Virginia.” He added that “the results could 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 great steadiness between defending probably the most weak and those that 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.