Biden vows to fight the Republican Party over eviscerating Medicaid. The budget talks seem like just another story.

Most lawmakers, Republicans and Democrats alike, have declared major Medicare and Social Security programs off-limits to cuts as a divided Washington braces for a showdown over public debt and public spending. However, health care programs for low-income Americans have not received such bilateral guarantees.

More than 20 million people have received Medicaid coverage in the past three years after Congress expanded access to the benefits program during the covid-19 pandemic, causing the Medicaid population to increase by about 30%. But starting in April, enrollment will drop as the pandemic-era changes end and states begin cutting coverage for Americans who are no longer eligible.

On Tuesday, President Joe Biden pressured Republicans to unveil the party’s plans to cut government spending, which are expected to require deeper Medicaid cuts — and could offer Americans a preview of the Republican wish list if the party gains full power in the 2024 election. . .

If far-right Republicans “try to deprive people of healthcare by gutting Medicaid and the Affordable Care Act, I will stop them,” Biden said.

Biden and other Democratic leaders have said they want to expand Medicaid, a goal likely to be reflected in the president’s budget proposal due next week. But while leading Democrats say they won’t negotiate public spending with Republicans when the GOP refuses to raise the debt ceiling, they left open the possibility of negotiating Medicaid spending at a later stage.

New York Rep. Hakim Jeffreys, the new Democratic leader in the House of Representatives, said in January that Democrats are open to “talking” with Republicans apart from the debt ceiling debate.

“There is a budget process and an appropriation process,” Jeffries said in response to a KHN question why Medicaid has not received the same strong protections as Medicare and Social Security during Biden’s State of the Union address. “We are ready to talk to the other side of the aisle about how to invest in improving the lives of ordinary Americans, how to invest in the middle class, how to invest in all those Americans who aspire to become part of the middle class. sort.”

Some Republicans are hoping to win concessions from Democrats to cut the program by limiting benefits, such as allowing more states to impose work requirements on Medicaid beneficiaries, a plan promoted by the Trump administration but largely defeated by the courts. Republicans could also impose taxes on Medicaid providers, which are taxes levied on things like inpatient services in hospitals or beds in nursing facilities.

Progressive Democrats are taking a hard line and hoping that expanding the program will make eliminating Medicaid a riskier political idea than it used to be. Currently, more than 1 in 4 Americans are insured with Medicaid or children’s health insurance, including children, pregnant women, people with disabilities, and people with low incomes.

“In my opinion, Medicaid should be taken out of the discussion,” Sen. Bernie Sanders (I-Vt.), chairman of the Committee on Health, Education, Labor and Pensions, told KHN. “The idea of ​​going down on low-income people would be outrageous, and I really feel like Republicans have that in mind.”

On March 9, the Biden administration is expected to send Congress its annual budget outline, outlining the president’s spending priorities for federal programs, including Medicaid.

In his Feb. 28 speech, Biden pointed to recent Republican proposals to cut Medicaid and repeal the Affordable Care Act. And he listed the possible consequences of those proposals — such as the loss of mental health care for millions of children under the Medicaid Comprehensive Health Insurance Guarantee — and urged Americans to compare the as-yet-unknown cuts Republicans want with his budget proposal.

Biden is likely to start any talks advocating spending increases. He urged conservative states that had resisted expanding Medicaid coverage, traveling to Florida after his address to Congress to chastise nearly a dozen states that had not yet expanded the program under the ACA. He has pushed for expanding ACA subsidies during the pandemic and, more recently, making them permanent.

Republicans in the House of Representatives say they want to balance the federal budget in 10 years without raising taxes and cutting spending on Medicare, Social Security or military spending – a feat some analysts have called “impossible.” Medicaid, Medicare, and Social Security, along with funding for the Affordable Care Act and the Children’s Health Insurance Program, alone account for almost half of the federal budget.

The Washington Post recently reported that a former Trump administration official briefed lawmakers on a balanced budget proposal that includes $2 trillion in Medicaid cuts. A separate proposal from House Republicans last year would cut total federal spending on Medicaid, CHIP and ACA subsidies by almost half over the next decade.

Edwin Park, research professor at the Center for Children and Families at Georgetown University’s McCourt School of Public Policy, wrote that the House proposal “is likely to result in tens of millions of people becoming uninsured and severely curtailing access to health care and long-term care.” services and supports needed by underprivileged children, families, the elderly, people with disabilities and other adults.”

Because Medicaid is the largest source of federal funding for states, dollars could also run dry for priorities like education, Park added.

A longstanding push by the Conservatives has been to cut Medicaid by adding eligibility restrictions such as job requirements or stricter screenings. Republicans have tried to do so since the unsuccessful repeal of the ACA in 2017. The same plan included a proposal to convert state Medicaid funding to a per capita allocation instead of the federal government matching a percentage of what the state spends.

Republicans can also push for a reduction in the percentage of federal care that states receive for Medicaid. This percentage has now been increased due to the public health emergency. And at least one senior Republican has expressed interest in making changes to how people with disabilities receive home and community care services that allow them to stay in their homes, said Yvette Fontenot, senior political and legislative adviser. in a liberal organization. Protect our care.

Fonteno said Republicans could focus on fraud as a pretext for their proposals, raising oversight questions about how many people received benefits improperly and how many remained in Medicaid under pandemic rules that required states to keep enrollment when otherwise. they would be excluded. “I think it just becomes the basis for all the different possible policies here,” she said.

Brian Blaze, a former economic adviser to the Trump administration and now president of the Paragon Health Institute, told KHN he doubts Republicans will make much headway against Medicaid, especially ahead of next year’s presidential election when Democrats are less likely to concede any ground. . rights.

But he noted potentially promising discussions on Capitol Hill of some of the GOP goals, notably cutting taxes on healthcare providers or introducing new job requirements, an idea that some conservative Democrats like Sen. Joe Manchin of West Virginia signaled they are open to.

Conservatives view the taxes that states levy on Medicaid providers as a loophole to increase what the federal government sends to states, as states use those taxes to fund their share of Medicaid funding under FMAP.

Blaise pointed to reports of major budget showdowns in 2011 and 2013 as evidence that Biden, then vice president, might be open to cuts.

“The fact that Biden officially called them a ‘scam’ that needs to be rooted out I think makes it a little easier for Republicans in Congress to argue that they should be on the negotiating table,” he said.

The fight for public spending is approaching a tipping point. The unbiased Congressional Budget Office recently estimated that the United States will reach its debt ceiling between July and September, meaning that the Treasury Department’s ability to pay the country’s bills and prevent debt default could be exhausted as early as this summer without action by Congress.

A recent NPR-PBS NewsHour-Marist poll found that while most voters support raising the debt ceiling, they disagree on how lawmakers should tackle the national debt problem. Nearly three-quarters of Republicans and a majority of independent voters said Congress should cut programs and services rather than raise taxes and other revenues.

While Republicans have yet to propose specific cuts, Democrats are betting that Medicaid and other benefits will prove to be as difficult to target as Social Security and Medicare if voters understand their impact on the lives of many Americans.

“I think it’s going to be tough for Republicans right now,” Rep. Alexandria Ocasio-Cortez (DN.Y.) told KHN. If the GOP wants to cut benefits for low-income families “at a time when eggs are expensive and groceries and food have become quite expensive for ordinary people, then they need to speak to the public, to the people.” of the American people, and explain why they want to deprive people of the opportunity to feed themselves and their children.”