Texas leaders have displayed decades of antipathy toward Medicaid, the federal government health insurance program that covers millions of low-income and vulnerable residents.
They turned down additional federal money that, under the Affordable Care Act, would have allowed Medicaid to offer health insurance to more low-income families. The state was one of the last to insure women for a whole year after childbirth. And when the federal government last year ended a policy that required states to keep people on Medicaid rolls during the coronavirus pandemic, Texas authorities were quick to expel those they deemed unfitignoring constant warnings that the fast-track process could lead to the wrongful removal of some people.
In January, when Donald Trump becomes president for a second term, Texas leaders may have another chance to cut the program — this time with fewer restrictions.
Trump has not shared any plans to cut Medicaid, which covers about 80 million Americans, and his campaign did not respond to requests for comment. But health care advocates and experts say his past attempts to cut the program, as well as the positions of conservative groups and Republican lawmakers who support him, indicate it is likely to be the target of major cuts.
“We expect Republicans to move very quickly to dramatically cut Medicaid and actually end its coverage guarantee as it exists today,” said Joanne Alker, executive director of Georgetown University’s Center for Children and Families in Washington, DC.
Currently, the federal government covers an average of nearly 70% of Medicaid costs, with states covering the rest. (A state’s share varies largely based on what percentage of its residents are impoverished.) Any decisions to cut federal spending are likely to cause states to reduce the number of people they deem eligible and the benefits they qualify for entrants, according to Alker and other experts said.
That would be especially devastating in Texas, which already has one of the nation’s lowest percentages of residents covered by Medicaid and where officials lack the political will to make up the funding gap with public money, experts say. Parents with two children, for example, should earn less than $285 per month to qualify for Medicaid.
“Our elected officials would have to decide if they want to cut health care for pregnant women, children, people with disabilities or the elderly, because that’s essentially who Medicaid covers in Texas,” Adriana Kohler, Director on policy Texans Care for Children, a statewide nonprofit that advocates for families, said in a statement.
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Spokesmen for Gov. Greg Abbott, a Republican, and the state Health and Human Services Commission did not respond to repeated requests for comment. During Abbott’s previous role as state attorney general, he helped lead a successful lawsuit against the federal government, ensuring that states did not risk losing Medicaid funding entirely if they did not want to cover more residents under the Affordable Care Act.
Even if Texas does offer Medicaid coverage to its most vulnerable residents, state officials have put in place a system that often creates insurmountable barriers to getting help. A Dallas Morning News investigation in 2018 found that some insurance companies that Texas hired to provide Medicaid benefits expensive and sometimes life-saving treatment was systematically denied to increase profits. Critics say problems with the system persist despite legislative reforms prompted by the series of stories.
Texas insures more than 4 million residents through Medicaid, a smaller percentage of its total population than almost any other state. But given its enormous size, the state still encompasses the third largest population in the country, second only to California and New York. The program helps 3 out of 8 children, 3 out of 5 nursing home residents and 2 out of 7 people with disabilities in Texas. according to KFFnational health policy research organization. It is the main funder of nursing homes and long-term care services for the disabled and elderly, and it pays almost half of all births in the state
Michael Morgan, a 75-year-old retired nurse who lives in Fort Worth, is among those who worry that if Trump limits or cuts the amount of money the federal government spends on Medicaid, the state could make it more difficult for his daughter, Hannah, to get insurance. She has Down syndrome and schizencephaly, a malformation of the brain, she is deaf and partially blind, she does not speak and needs help to walk and eat.
Morgan is using her limited savings to pay for Hannah’s health care costs after she lost her Medicaid coverage earlier this year when she turned 19. He filed a new application for her in May — she must be eligible for Medicaid because of her disability. State officials denied her coverage in November, claiming Morgan missed a deadline to return a form agreeing to the agency’s access to his daughter’s medical and financial records. Morgan, who plans to appeal the denial, said in an interview that he received the form a day before the deadline.
“I don’t know how much more they can cut,” he said of Medicaid in Texas.
During his first term, Trump unsuccessfully tried to repeal the Affordable Care Act, which provides health care to 45 million Americans. His administration has also repeatedly supported spending caps on Medicaid, including block grants that would give states a fixed amount of federal funding regardless of how many people need insurance or how much their health care costs. Medicaid currently covers all people who qualify, regardless of cost.
While the effort has made little progress during Trump’s first term, Republicans will hold majorities in the House and Senate in January and have said they are open to imposing spending caps and requiring that most adults in the program be employed. places They argue that Medicaid spending is unsustainable and that the program is susceptible to waste, fraud and abuse.
Republicans who have supported such measures include U.S. Sen. John Cornyn and U.S. Rep. Jody Arinton, a Lubbock Republican who chairs the House Budget Committee.
Primers of the policy of the Republican Party — including Project 2025published by the conservative think tank The Heritage Foundation, and one of the Republican studiesa conservative group in Congress — also called for cuts to Medicaid.
Arrington, whose spokesmen did not respond to repeated requests for an interview, told reporters last month that it supports “the demand for responsible and intelligent work”. Professor of public health at Harvard University, who studied a prior work mandate in Arkansas that Trump authorized during his first term found that most adults on Medicaid were already employed or eligible for exemptions, but thousands of residents still lost their health care, at least in part because of the arduous process of continuing to certify their eligibility.
This is not the first time Arinton has raised work requirements and sought to reduce the share of health care costs that the federal government pays to states. He is earlier proposed cutting federal Medicaid spending by more than a quarteror $1.9 trillion.
Cornyn, whose representatives have also repeatedly declined to comment, said last month that he would not support cuts to Medicare, the federal health insurance program for the elderly and disabled, or Social Security. However, he suggested that Medicaid cuts were on the table.
“We can’t just keep doing things the way we’ve done them before.” Cornyn told Politico Proadding that “block grants make a lot of sense.”
William T. Smith, a 65-year-old retired construction worker who lives along the U.S.-Mexico border in Brownsville, said he voted for Trump in part because he agrees there’s “too much fat out there” and supports cutting some federal programs.
Smith has chronic obstructive pulmonary disease, which affects his lungs and makes breathing difficult. He said he also has bipolar disorder, sleep apnea and chronic pain from decades of manual labor.
Smith said Medicaid, which he’s been trying to get since the summer, shouldn’t be where the federal government is looking to cut spending. Instead, he said, the federal government should save by cutting other programs and direct the money to help more people.
“I don’t think they’re going to take health care away from people,” he said. “If they do, I would be very angry.”
And Kimakhil filed a report.
