WASHINGTON — Republicans in Congress have gotten a crash course in Medicaid during the last few weeks, as they eye the health care program for lower-income Americans as a source for hundreds of billions of dollars in savings to pay for tax cuts.
The 72 million Americans who rely on Medicaid, especially those represented by GOP lawmakers, as well as state leaders nervous about the effect on their budgets, are closely watching what Congress does.
Democrats already have seized on potential cuts in the state-federal program to portray Republicans as trying to harm poor and vulnerable Americans to preserve tax cuts for the wealthy.
Some GOP lawmakers have begun signaling to leadership they won’t vote for anything that reduces benefits to Medicaid recipients, a position that once would have left that handful of centrists out of negotiations.
But the extremely narrow majority in the House means that Speaker Mike Johnson, R-La., will have to keep pretty much everyone on the same page as the package takes shape in the weeks ahead.
Johnson himself might hear from constituents about Medicaid, given his deeply red state holds the nation’s second-highest percentage of residents enrolled in the program. Other GOP-led states like Arkansas and West Virginia have more than a quarter of their residents signed up for Medicaid.
Johnson is suggesting as much as $50 billion a year in Medicaid waste, fraud and abuse could be recouped, though that won’t come near the level of savings the GOP has tasked its committee that oversees health care with finding.
“Medicaid is hugely problematic because it has a lot of fraud, waste and abuse. Everybody knows that. We all know it intuitively,” Johnson said in late February. “It doesn’t matter what party you’re in, you should be for that because it saves your money and it preserves the program so that it is available for the people who desperately need it.”
Beyond that, it’s unclear at the moment how exactly Republicans may alter Medicaid in the yet-to-be written package they hope to use to bolster defense and border security spending, rewrite energy policy and extend the 2017 GOP tax law.
The House and Senate must agree to adopt a budget resolution to unlock the reconciliation process that will allow them to pass their legislation without Democratic votes in the upper chamber.
The House’s budget resolution, which the Senate GOP plans to alter, proposes the Energy and Commerce Committee cut at least $880 billion from programs under its jurisdiction — which include Medicaid.
President Donald Trump has essentially said Republicans won’t “touch” Medicaid (or Medicare or Social Security), but he’s left the door open to addressing fraud.
Here is a brief explanation of why Medicaid exists, who relies on the program, what exactly is known about fraud and how the federal government splits the cost with states:
Why did Congress establish Medicaid?
President Lyndon B. Johnson signed the Social Security Amendments of 1965 into law in July of that year, formally establishing Medicare, the nation’s health program for people over 65 and some younger people with disabilities, and Medicaid, which also includes some seniors.
But, the National Archives writes that debate “over the program actually began two decades earlier when President Harry S. Truman sent a message to Congress asking for legislation establishing a national health insurance plan.
“At that time, vocal opponents warned of the dangers of ‘socialized medicine.’ By the end of Truman’s administration, he had backed off from a plan of universal coverage, but administrators in the Social Security system and others began to focus on the idea of a program aimed at insuring Social Security beneficiaries whose numbers and needs were growing.”
