Medicaid cuts would affect states led by GOP governors, but they’re silent : Shots

The Governor of Virginia-Western Patrick Morrisey is one of the 19 republican governors of states that lose federal Medicaid funds if the Congress adopts the tax bill with reductions proposed to the program.

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Andrew Harnik / Getty images

The last time a congress under republican control and President Donald Trump moved to Slash Medicaid, in 2017, a key political force was held on their way: the governors of the GOP.

From now on, while the congress is revealed to the success of the historic Medicaid reductions of approximately 1 billion of dollars over 10 years thanks to the legislation on taxes and expenditure of Trump, the governors of the red state are not very publicly saying what it does to health care – even if they are confronted with reductions which will unravel holes of several billion dollars in the budgets of their states.

Medicaid, a program jointly led by the States and the federal government, covers more than 70 million people with low income or disabled, including almost half of the children in the country. Republicans say that the $ 900 billion program a year has been authorized to become too large under the Democrats Barack Obama and Joe Biden by adding unabled adults who, they believe, do not deserve government assistance, and they have long sought to withdraw it.

Some of the greatest health reductions in the legislation that Trump calls “Big Beautiful Bill” are made thanks to new policies that would reduce inscriptions by imposing more requests for paperwork on the registrants, including a requirement that many prove that they work. These policies would only affect the states that have extended Medicaid to more with low -income persons under the Act respecting affordable care.

Nineteen of these states are led by republican governors. Their silence on the health measures of the bill gives political coverage to the GOP legislators of their states as they seek to reduce the coverage of Medicaid for millions of people who have won it in the last decade.

KFF Health News contacted the 19 governors to comment on the medical cuts of the legislation. Only six responded. Most said that they had supported the imposition of a work requirement to the registrants of Medicaid adults.

“The implementation of work requirements for valid adults is a good and necessary reform so that Medicaid is used for temporary assistance and not a permanent right,” said Drew Galang, spokesperson Patrick Morrisey de Virginie-Western.

“Governor Rhoden supports the participation of the workforce as a requirement for the eligibility for the expansion of Medicaid,” said Josie Harms, spokesperson for the governor of southern Dakota, Larry Rhoden, adding that the legislators of the Congress have the support of the governor: “South Dakota has an excellent federal delegation, and the governor has trusted Dakota.

In a sign of how political winds have changed, none of the governors said nothing about the repression of legislation on another significant reduction, to supplier taxes – a tool that almost all their states use to help pay for their Medicaid share and to obtain additional funds from the federal government. This change should cost billions of states.

A bipartite question no longer

Unlike the radio silence of the governors of the GOP, the Democratic governors campaigned against the Megabill for weeks.

Pennsylvania Governor Josh Shapiro posted on the X social media platform that Trump and the Congress Republicans were misleading the Americans saying that they only cut waste, fraud and abuse in Medicaid.

“They rush to launch hundreds of thousands of Pennsylvanians from their health care-and lie about it,” he posted. “The damage that it will do here in Pennsylvania and through America is amazing and will be felt for the years to come.”

In New York, Governor Kathy Hochul on July 1 accused that Trump’s legislation devastates hospitals and could lead to more than 34,000 job cuts in his state.

“The collective impact of the GOP reconciliation bill in Washington, DC, could force hospitals to reduce the necessary services critically such as maternity care and psychiatric treatment, not to mention workforce reduction operations, and even close entirely,” she said in a statement.

In 2017, the refrain was bipartite, while the republican governors of Ohio, Nevada and Massachusetts spoke against the reduction of Medicaid. Trump’s bill to repeal a large part of the affordable care law and withdraw its expansion from Medicaid has narrowly failed in the Senate.

“It was surprising that the governors of the red state, in particular those of the Midicaid expansion states, did not speak about Medicaid cups,” said Larry Levitt, executive vice-president of health policy at KFF, a non-profit organization of health information that includes Kff Health News. “Republican governors were a powerful political force in the failure effort of 2017 to repeal and replace ACA, including the expansion of Medicaid.”

What has changed since 2017, say the experts in politics is that there are fewer moderate republican governors, and the leaders of the GOP state who pleaded for the expansion of Medicaid more than a decade are no longer in power.

In addition, seven from the United States then red which expanded Medicaid did it via the election initiative, mainly on the opposition of their governors.

In fact, the work requirement of Medicaid is supported by many republican governors, even if it means less federal MEDICAIDI and leads to fewer covered people.

Several states, including Arkansas and Ohio, have already adopted states laws to implement a requirement that adults have registered in the work of expansion of Medicaid of the ACA, voluntary, go to school or participate in vocational training. Most states have not yet made work obligation programs a reality, as they await approval of the federal government.

Charles “Chip” Kahn, president of the Federation of American Hospitals, a commercial group of hospitals belonging to investors, said that fewer governors are publicly committed to trying to block Medicaid cups under the bill, federal legislators hear legislators from their states.

A political dilemma for republican governors is that, unlike in 2017, the bill before the congress is not legislation expressly aimed at the repeal of Obamacare. Its scope is broader than health care and would extend many Trump tax cuts and lead billions of new expenses to border security, the application of immigration and the military, while reducing health care expenses.

“It’s like playing multidimensional chess rather than focusing on a problem,” said Kahn.

Larry Jacobs, director of the Center for the Study of Politics and Governance at the University of Minnesota, said that some Republican governors may have expressed private concerns to the Senators of the GOP of their states, but do not speak publicly for fear of drawing the clarity of Trump.

“Why are they Cagey? Trump and don’t want to be” Liz Cheney’d “, said Jacobs, referring to the former Republican Wyoming legislator that Trump helped to move after being a vice-president of an investigation into his attempts to overthrow the 2020 election results.

Political controls on foot

Political dangers are confronted with republican legislators in Trump’s public, remains explicit. On June 29, Senator Thom Tillis (Rn. Tillis was one of the three GOP senators to vote against him on July 1, although he still succeeded.

In addition to the work requirement, the greatest discounts of Medicaid in the bill arise from its restrictions on service providers – from direct debits that impose on hospitals, nursing homes and other health establishments to help increase their federal reimbursement. A large part of the additional money then returned to health care providers in the form of higher payments for their Medicaid patients.

The practice, which has been adopted in all states but in Alaska, was criticized by some Beltway Republicans as “money laundering” – even if taxes are approved by state legislators and federal centers for Medicare & Medicaid services and have been authorized under federal law for decades.

The Senate bill would limit the money that states could increase – a decision that would mean billions of funding for states and their hospitals.

States with republican governors who have expanded Medicaid are Alaska, Arkansas, Idaho, Indiana, Iowa, Louisiana, Missouri, Montana, Nebraska, New Hampshire, Nevada, Dakota of the North, Ohio, Oklahoma, South Dakota, Vermont Virginie-Western and Utah.

One of the governors who expressed his concerns about the abrogation of the expansion of Obamacare Medicaid in 2017 was Jim Justice of Virginia-Western, Democrat at the time.

In a letter in June 2017 to the senator from Virginie-Western Shelley Moore Capito, a Republican, the judge wrote: “Since so many of our people have reached Medicaid, any cut in Medicaid would destroy families in Virginia-Western.” He added that “the consequences would be beyond the catastrophic”.

On July 1, the judge – elected to the Senate as a republican last year – voted for the megabill of Trump, including his Medicaid cups.

“The senator believes that this bill establishes a good balance between the protection of the most vulnerable and those that count on the program while eliminating waste, fraud and abuse to ensure that the program is managed effectively for those who deserve,” said William O’grady, a spokesperson for the judge, in an email.

Kff Health News correspondent Arielle Zionts contributed to this report.

Kff Health News is a national editorial room that produces in -depth journalism on health problems and is one of the main operating programs in Kff.