Medicaid Cuts: Millions More Uninsured, Thousands More Dead?
A study published last week by researchers from Harvard Medical School and Hunter College projects that the proposed House budget bill would increase the number of U.S. uninsured by 7.6 million due to Medicaid cuts included in it. The additional number of deaths annually was set at 16,642 by a middle estimate from the study. This would be caused by people forgoing medical care because of its particularly high cost to the uninsured.
According to the researchers, limiting or eliminating Medicaid provider taxes as well as Medicaid per capita caps and work requirements for Medicaid enrollment would have the worst effects on both factors. Rolling back Medicaid expansion, which 41 states opted into, comes a close fourth. Another analysis from the Congressional Budget Office meanwhile put the number of people who would become uninsured as a result of the bill at a very similar 7.7 million. The more highly publicized number of 13.7 million more uninsured is a combination of the effects of the One Big Beautiful Bill Act and other currently proposed and expiring legislation.
While the massive legislation out of the House passed last month as part of the budget reconciliation process proved controversial, the Senate recently published a revision that could lead to even deeper cuts, as it proposes very steep reductions of provider taxes that exceed those of the House bill.
Provider taxes refer to the taxes states levy on healthcare providers like nursing homes and hospitals, which are then used to fund Medicaid. As these tax incomes are matched with federal funds, limits or bans on these taxes are part of Medicare spending cuts. KFF notes that opponents of these taxes say that states shouldn't receive matches on taxes they took from health care providers, as this is seen as an inflation of Medicaid funds.
Medicaid per capita caps, on the other hand, are limits to how much of state funds spent on Medicaid can be matched by federal funds. As there currently is no limit, this could have a major effect on Medicaid funding depending on the level of the cap. As the growth of caps would also be determined over the upcoming 10 years, experts think the funding squeeze will get worse over time as limits are expected to rise only slowly.
Finally, work requirements have been one of the most contentious proposals from the One Big Beautiful Bill Act. While Republicans have said the rule would only target those who could work, but decide not to, research from states that have implemented work requirements in the past shows that major hurdles to continuing coverage are the inability to find work and issues providing the relevant paperwork showing one has worked or volunteered for 80 hours a month in a format that has often been very frequent, complicated and fraught with technical difficulties.
A Brooking Institution analysis found that the group of able-bodied, non-working Medicaid enrollees was actually quite small (around 300,000) and also not very cost-intensive. To actually achieve the desired saving through work requirements, the report concludes that Medicaid would actually need to disenroll a significant number of beneficiaries who are either working but would fail to file the necessary paperwork or are considered able-bodied as they are on the cups of eligability for sickness and disability benefits, which is the case for many enrollees with sustance abuse and mental health issues.