In what would be a brutal, not “beautiful,” budget bill, Republicans in Washington are plotting to make massive cuts to Medicaid coverage through budget reconciliation so they can give tax breaks to the rich. Covering almost 72 million Americans, Medicaid, America’s largest health insurance program, is so integral to health care finance and delivery that the GOP’s threatened cuts would prompt a deadly domino effect, leading to inferior, more expensive health care — and, therefore, worse health — for virtually all Americans, including those with insurance provided by their employers. The impact wouldn’t just be felt by individuals, but it would also be felt by state governments and by hospitals and health workers.
The impact wouldn’t just be felt by individuals, but it would also be felt by state governments and by hospitals and health workers.
House Republicans, who insist they don’t intend to cut Medicaid, have offered proposals that would do just that, such as per-capita caps, block grants, reducing the federal match for the ACA Medicaid expansion, slashing provider taxes, and work requirements as possibilities. While the details matter, let’s not get lost in the weeds. No matter how they style it, all the above count as Medicaid cuts, and all the above would be costly and deadly.
For example, depending on what Republicans choose to do, one example of a domino falling would likely be hundreds of thousands of people, if not millions of people, losing coverage with no backup insurance option. Others could face significantly higher premiums and copays, putting health care out of reach. Pills would be split, prescriptions would go unfilled and more workdays would be lost to sicknesses. Medical debt, a uniquely American problem, would increase. Tens of millions of families would struggle more than they already do to afford food, housing and health care.
Since the 1980s, Republican politicians have tried — and, thankfully, failed — to cut Medicaid. There was an attempt to cut the program during President Donald Trump’s first term, but even Trump’s own pollster recently described Medicaid cuts as unpopular, stating, “Our recent survey shows there is no appetite across the political spectrum for cutting Medicaid to pay for tax cuts.”
Americans don’t want Medicaid cuts because many of us remember life before Medicaid. We remember family, friends and neighbors dying from conditions that were preventable, treatable or curable — because they lacked insurance. We remember our grandparents and parents being forced into nursing homes because they couldn’t access care to stay in their homes. We remember workers who weren’t offered insurance through their employers losing their jobs because they got sick or couldn’t manage a chronic condition. Everyone knows that in this country, you need health coverage to access health care, and in our patchwork of coverage, Medicaid is an essential piece.
We don’t want Medicaid cuts because we all benefit from this lifesaving program. Medicaid covers us in recessions and after unexpected layoffs. Medicaid covers our children when our employers don’t offer us coverage. Medicaid, not Medicare, pays for in-home care and nursing homes for those of us who cannot pay about $10,000 a month out-of-pocket nursing home rates. Medicaid enables millions of us to get preventive and primary care, so that hospitals aren’t overwhelmed by providing emergency care to people made sicker from lack of access.
Critically, Medicaid insures beneficiaries broadly and cheaply, which helps lower health care costs and premiums for employer-based insurance.
If congressional Republicans and Trump include Medicaid cuts in the federal budget, then they’d start a dramatic nationwide cascade of harm in red and blue states — and in rural, suburban and urban areas. In addition to the one mentioned above, below are some of the additional dominoes proposed cuts to Medicaid threaten to topple.
Even those who would still have Medicaid coverage could experience worsened health.
Domino two: Even those who would still have Medicaid coverage could experience worsened health — because of reduced access to needed preventive care, primary care, prenatal care, diagnostics, dental care and behavioral health care. Medicaid cuts could disrupt access to tests and care for pregnancy and for conditions such as diabetes, asthma, heart disease, HIV and cancer. Further, such cuts could cause older adults and people with disabilities to have less access to long-term care, services and supports, which, in turn, could cost them their ability to live in their own homes or work.
Domino three: According to KFF, House Republicans’ proposed Medicaid cuts would leave state governments with budget holes of hundreds of millions, and in many cases, billions of dollars. These budget gaps would prompt tax increases or massive cuts to health and social services, education and infrastructure, resources we all depend on.
Domino four: Republicans’ proposed Medicaid cuts would make it harder, even for people with private insurance, to access care at hospitals and clinics. Because people who lose Medicaid coverage would use emergency rooms more frequently, it would make those emergency rooms more crowded. Rising uncompensated care costs at hospitals and clinics would devastate safety net and rural health centers. Plummeting Medicaid reimbursements would cause hospitals to pass along higher charges to patients and private insurers. The insurers, in turn, would increase premiums for those with employer-based coverage. Some hospitals and clinics that depend heavily on Medicaid reimbursements would stop offering whole lines of service — such as emergency care — and many would likely shut their doors entirely. Domino five: Reduced Medicaid reimbursements would force hospitals and clinics to cut hours and lay off workers, who would lose income and health coverage themselves, harming their families and all our communities. Remaining health workers would become even more overworked and overwhelmed, degrading everyone’s quality of care. Domino six is the big one: For all the reasons above, Republicans’ proposed Medicaid cuts would increase rates of sickness, infections, suffering and early deaths — not only for Medicaid beneficiaries, but also for virtually all of us — as we experience worse, less accessible and costlier health care and reduced preventive care. Across the U.S., unfair gaps in health and life expectancy would widen. In short, Republicans’ proposed Medicaid cuts would be inhumane and catastrophic, making this a brutal budget bill indeed. It does not have to be this way. It isn’t this way right now. Republicans choosing tax breaks for the rich over all our well-being would be unwise, unnecessary and repugnant.
Wesley Epplin
Wesley Epplin, MPH, is the policy director at Chicago-based Health & Medicine Policy Research Group, where he focuses on public health and health care policy.
Julie Justicz
Julie Justicz, JD, is the executive director of the Legal Council for Health Justice, which focuses on fair access to health care in Illinois. 
