With Social Security and Medicare off the budget-cutting table, Medicaid remains, but has much political support

While the House Republican platform for midterm elections was vague about cuts, “and even more vague on health policy, the conservative Republican Study Group’s budget blueprint for the current fiscal year would have restructured Medicaid entirely and cut $3.6 trillion over a decade compared to the current spending trajectory — but there’s no way that Democrats (or even some more establishment Republicans) would accept that,” Kenen writes.

Medicaid has “a much stronger constituency” these days because it covers many more people, 90 million, and is “the largest payer of nursing-home care in the U.S, and it’s a lifeline for disabled kids and their families, both very politically sympathetic populations,” Kenen reports, citing Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation. “More than half of U.S. kids are covered by Medicaid and its sister program the Children’s Health Insurance Program, or CHIP. In some states, more than half of births are covered, and it provides postpartum care, including to minority populations that have disproportionately high rates of maternal death. And it covers long-term care for the poor elderly — or people who became poor after spending most of their savings on long-term care. . . . It’s also a huge payer for mental health and for addiction treatment for opioids, including for kids.”

“Medicaid now is touching the majority of families in the country,” Joan Alker, executive director of the Center for Children and Families at Georgetown University in Washington, D.C., told Kenen.

“As if all that wasn’t enough, Medicaid keeps safety net hospitals afloat,” Kenen notes.” And those hospitals, which treat a large share of poor people in both rural and urban settings, are in an even more precarious financial position than usual after the pandemic. . . . Tom Miller, a health expert at the center-right American Enterprise Institute who has written extensively on what he sees as more realistic conservative approaches to improving Medicaid, including broader use of federally-approved waivers for states, expects conservative Republicans to try again this year — and again overreach and fail.”