Medicaid Is on the GOP Chopping Block. Could It Be Because of a Misunderstanding? | Leanne Berge, J.D., CEO of Community Health Plan of Washington

Part 2

Although there are many plot twists ahead before Congress passes a final budget bill, major cuts in federal funding for Medicaid are certainly on the table after the House narrowly passed a budget resolution last night that calls for between $1 trillion and $1.5 trillion in spending cuts over the next 10 years. Although some in the party have spoken out against the cuts, Medicaid has been a favorite target of Republicans.

“I think the big issue has always been people not understanding who is covered by Medicaid," Leanne Berge, J.D., CEO of the Community Health Plan of Washington, said in a recent interview with Managed Healthcare Executive. “[It covers] approximately 1 in 6 [people], even higher, depending on the state. It [covers] a significant portion of people who are over 65 who need nursing home care. One in 3 births are Medicaid-funded in this country. It covers so many different communities and so many different kinds of people."

Berge is also chair of the board of directors of the Association for Community Affiliated Plans and was in Washington, D.C., recently lobbying against the Medicaid cuts.

The budget resolution does not include Medicaid cuts per se — the details about how the cuts are to be accomplished are to be worked out later by House committees. And Senate and House Republicans must agree on a budget package for it to pass without the risk of Democrats using a Senate filibuster to block. But it has been widely reported that with cuts in Medicare off the table, Republicans are eyeing up to $880 billion in Medicaid cuts over 10 years. Last year, the Congressional Budget Office projected that federal Medicaid spending from 2025 to 2034 would be $7.46 trillion.

Although the number of people who are covered by Medicaid started to dip in the second half of 2023 and last year with the end of the continuous enrollment provisions of the COVID-19 public health emergency, increasing enrollment is the longer-term trend, partly because expanding Medicaid edibility was one of the principal strategies of the Affordable Care Act. In 2017, 74 million people were covered by Medicaid, according to CMS actuaries. By 2023, that number had grown to 91.7 million.

Public support for Medicaid

That fits with Berge's assessment that there is wide support for Medicaid despite the mischaracterizations about who is covered by it.

“Even with that bias, polls show that voters across all parties believe that Medicaid is an important program — that the government should be spending more money on healthcare, not less money,” Berge said.

Berge said some Medicaid cuts may be inevitable considering the magnitude of the cuts that the Republicans are considering.

“It does make me think that there will be some cuts, but presumably not to the extent that might be indicated by this initial direction, because I think that there is too much political pressure that will come to bear. But I do expect that there will be so-called reforms for Medicaid that will probably have the impact of people losing eligibility.”