A nonpartisan analysis said millions of Americans could lose Medicaid health insurance coverage under different Republican Congressional proposals to cut spending to support President Donald Trump's tax cuts and domestic policy agenda.
The estimates of people who could lose Medicaid coverage range from 2.3 million to 8.6 million under different proposals floated by Congressional Republicans, according to an analysis by the nonpartisan Congressional Budget Office
The CBO did the analysis at the request of Sen. Ron Wyden, D-Oregon, and Rep. Frank Pallone, D-N.J., who released a letter detailing the congressional scorekeeper's estimates on May 7.
The Congressional Democrats asked the CBO to analyze five scenarios that Republicans have reportedly discussed as the House Energy and Commerce Committee seeks $880 billion in savings and spending reductions from Medicaid and other programs under its jurisdiction.
The CBO estimated reducing federal payments to states that have expanded Medicaid enrollment under the Affordable Care Act would save $710 billion but would cut coverage for 5.5 million enrollees.
Many states tax hospitals or medical providers to afford the state match to collect the lucrative federal share of Medicaid payments. Eliminating state provider taxes would save the federal government $668 billion, but 8.6 million people would lose Medicaid coverage, the CBO said.
The CBO examined three other potential cuts: Capping spending per enrollee for the entire Medicaid population, capping spending per enrollee under the ACA's Medicaid expansion or repealing a Biden administration rule on Medicaid eligibility. The number of people who would lose coverage under those scenarios range from 2.3 million to 5.8 million.
“This analysis from the non-partisan, independent CBO is straightforward: the Republican plan for health care means benefit cuts and terminated health insurance for millions of Americans who count on Medicaid,” Wyden said in a statement.
However, it's unclear what Medicaid cuts Republicans might pursue. House Speaker Mike Johnson told reporters on May 6 that Republicans have ruled out reducing federal payments to states that have expanded Medicaid. Johnson also appeared to be leaning against per-capita caps on states that have expanded Medicaid.
“I think we’re ruling that out as well, but stay tuned,” Johnson said.
Wyden and Pallone did not ask the CBO to examine a potential fix that Johnson said remains in the mix − a work requirement for non-disabled Medicaid enrollees. Congressional Republicans also have floated more frequent eligibility checks and removing coverage for noncitizens.
Conservatives say a work requirement for healthy enrollees would compel people to seek employment and potentially secure health insurance through the workplace, saving taxpayers money. In 2023, the Congressional Budget Office estimated a Medicaid work requirement would save $109 billion in federal spending over a decade.
A recent survey by the health policy nonprofit KFF found about 2 in 3 people on Medicaid are employed full or part time, and others would qualify for an exemption from the work requirement because they are caregivers or students. The survey said only 8% were not working due to inability to find work, retirement or other reasons.