Republican Proposals To Slash Medicaid Could Be Blunted By Political Reality | Leanne Berge, J.D., CEO, Community Health Plan of Washington

Part 1

House Republicans are considering major cuts to Medicaid as one way to offset tax cuts and increased spending on their priorities. It is a moving target, but a figure of $880 billion in cuts over 10 years has been used in many media accounts of the budget negotiations that President Donald Trump says he wants to result in "one big, beautiful bill.”

But Leanne Berge, J.D., sees such large Medicaid cuts as running up against a political reality: Even in congressional districts represented by Republicans, a large proportion of people depend on the Medicaid program for health insurance and, therefore, for access to healthcare services

“Unlike a lot of things that are going on in Washington, D.C., right now, this [proposed Medicaid cuts] would have a very direct impact on people who voted for the Republican administration,” Berge said in a recent interview with Managed Healthcare Executive.

Berge is CEO of Community Health Plan of Washington, a not-for-profit health headquartered in Seattle that has approximately 300,000 members, 290,000 of which are covered by Medicaid, which in Washington state is called Apple Health. Berge, who is also chair of the board of directors of the Association for Community Affiliated Plans, was in Washington, D.C., recently, meeting with members of the House and Senate to lobby against the cuts.

The House passed a budget blueprint last night by a narrow margin that includes between $4.5 trillion and $4 trillion in tax cuts over 10 years that are linked to between $2 trillion and $1.5 trillion in spending cuts over the same period. The vote last night was just on overall amounts; the Republican-controlled Senate and House have come to an agreement on the details of both the tax and spending cuts. But major Medicaid cuts are widely seen as one of the main options as a way to achieve the reductions in spending.

Just over 72 million people in the U.S. are enrolled in Medicaid, and another 7.2 million are enrolled in the Children’s Health Insurance Programs, which are run alongside the Medicaid program for adults. Berge noted that 41 states and Washington, D.C., have expanded their Medicaid programs under the Affordable Care Act, and that not a few of them are Republican-leaning “red” states.

According to KFF, the federal government spent $606 billion to support Medicaid programs in 2023, or about 70% of the total cost of $808 billion. CMS actuaries have projected that

“These proposed dollar amounts would impact individuals in a very direct way, and states are absolutely dependent on this money from the federal government. It would be a major blow to their budgets. They couldn’t afford to make it up,” Berge said.

Many of the Republican states that expanded Medicaid eligibility under the ACA have provisions that automatically trigger the end of expanded eligibility if the federal government’s share of the cost of expansion is reduced. “That would have a really devastating impact on large numbers of people,” Berge said.

Possible Medicaid funding has emerged as a major bargaining chip as Republicans look for ways to offset the extension of tax cuts enacted during President Donald Trump’s first terms and other tax cuts he wants in this budget bill, including ending federal taxes on tips, Social Security benefits and overtime pay. Some of the proposals for cutting Medicaid include putting a per enrollee cap on federal funding and lowering the federal match rate, for ACA expansion in particular but also for the entire program.