The GOP war on Medicaid is alive and well. Republicans are targeting Medicaid for deep budget cuts as part of a reconciliation bill coming early next year in order to fund tax breaks for the wealthiest Americans. Medicaid is an essential pillar of our health care system. It is the largest health insurance program in the country, providing health care to more than 70 million Americans — nearly a quarter of the country. Medicaid is jointly funded by the federal government and the states, and it is supported by 76 percent of Americans. It covers one in five Americans, including kids, moms, seniors, people of color, rural Americans, and people with disabilities.
Five key ways Republicans could cut federal Medicaid funding and leave millions of Americans uninsured and unable to afford health care include: imposing lifetime caps on coverage, slashing the federal matching rate for traditional Medicaid and Medicaid expansion, implementing bureaucratic reporting requirements, block granting Medicaid, and introducing per capita caps. All of these policies mean that millions would lose their coverage, state budgets would be strained, and rural hospitals would be more likely to close. Every family knows someone who counts on Medicaid. If MAGA Republicans get their way, Medicaid will be decimated — taking health care away from hardworking families across the country all to pay for more tax breaks for the wealthy.
By The Numbers
- Republican threats to Medicaid put health care at risk for 72 million (21 percent) of Americans including:
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- 31.5 million children
- 9.1 million people with disabilities
- 8.3 million seniors
- Republicans will create a $50 billion hole in state Medicaid budgets to pay for tax breaks for the wealthy and corporations.
- If Republicans decrease federal funding for people in the Medicaid expansion population, it would immediately rip health care away from over 4.2 million Americans across eleven states and jeopardize health care for about 21 million people.
- Republicans threaten care for 18.5 million people on Medicaid by imposing lifetime caps.
- Republicans could deny coverage to 21 million Americans through burdensome bureaucratic reporting requirements.
Five Ways The GOP Plans To Gut Medicaid
- The GOP Will Impose Lifetime Caps For People On Medicaid. Republicans want to enact the Project 2025 playbook by imposing lifetime caps for people on Medicaid. Proposals have suggested people remain eligible for just 36 months, potentially over their entire lifetime. If enacted, the Center For American Progress found that these caps would strip benefits from hardworking families and people with complex medical conditions, particularly in states that have not expanded Medicaid, endangering coverage for the 18.5 million people with Medicaid who qualify based on income alone.
- Republicans Want To Slash Federal Funding for Medicaid By Reducing the Amount of Federal Funding That Matches State Medicaid Funding. As part of their plans to slash spending, Republicans could achieve their longtime goal of eliminating federal funding for Medicaid expansion and decreasing funding for traditional Medicaid. The Affordable Care Act provided for states to expand Medicaid eligibility by offering matching federal funds as an incentive. Some recent proposals have suggested lowering the federal match rate to 90 percent or lower, which would create a $50 billion hole in state Medicaid budgets. Research shows Medicaid expansion improves people’s health, keeps hospitals open, increases families’ financial security, and saves lives – and, in turn, helps reduce racial and ethnic, rural, and other health disparities. As of 2024, 41 states (including DC) have expanded Medicaid under the ACA. However, eleven of these states – Arizona, Arkansas, Idaho, Illinois, Indiana, Iowa, Montana, North Carolina, New Hampshire, Virginia, and Utah – have a trigger law, which means that health care will be at risk or immediately be ripped away from 4,291,000 people across the country if the GOP succeeds in gutting funding for Medicaid expansion.
- Republicans Want To Impose Burdensome Bureaucratic Reporting Requirements. Several recent Republican budget proposals have included plans to introduce bureaucratic work reporting requirements as a mandatory part of Medicaid enrollment and verification. By imposing work reporting requirements, Republicans are only seeking to cut Medicaid and kick millions of people off the rolls. Research shows that work reporting requirements cost states money and do not improve people’s ability to find work. In Georgia, a GOP alternative to Medicaid expansion emphasizing work requirements cost taxpayers $26 million, only provided coverage to 3,500 people, and resulted in consulting firms pocketing 90 percent of the funding. If Republicans succeed in implementing work reporting requirements, up to 21 million Americans could be denied Medicaid coverage.
- Republicans Want To Radically Restructure Medicaid Through Block Grants, Resulting In Deep Cuts. Another way MAGA Republicans want to radically restructure Medicaid is by changing it into five block grants. In March, the Republican Study Committee released a proposal to do just that. Block grants would shift costs to states and inevitably result in deep cuts to Medicaid programs by capping the amount of federal Medicaid funding states receive. As CBPP found in 2017, a block grant would force states to make deep cuts to their Medicaid programs to compensate for the federal funding cuts. Currently, the federal government pays between 50 percent and 77 percent of enrollees’ Medicaid costs, and more for certain high-value services. Republicans’ proposals to slash billions in federal funding from Medicaid would strain state budgets and leave tens of millions of people uninsured.
- Republicans Want To Introduce Per Capita Caps For Medicaid, Shifting Costs To States. Past Republican budget proposals have established a per capita cap for states on Medicaid enrollment. This type of spending cap imposes a restriction on the amount the federal government will contribute per capita to states’ Medicaid budgets. The proposals also increase the amount states must contribute to their Medicaid programs. In practice, per capita caps only increase costs for Medicaid beneficiaries – often in the form of higher premiums and out-of-pocket costs, all but ensuring that even if one qualifies for Medicaid, the services may not be affordable. It also means Medicaid would not have the flexibility to take on an influx of new patients during public health emergencies.