House Republicans included massive cuts to federal social safety net programs, like Medicaid, in the reconciliation package they passed in May. Experts tell TPM that the cuts to the programs amount to an effort to repeal elements of the Affordable Care Act.
This week, Senate Republicans signalled they might go even further in that ACA repeal effort than their counterparts in the lower chamber.
The Senate Finance Committee, which oversees changes to Medicare and Medicaid, dropped their portion of edits to the massive budget bill on Monday afternoon, proposing even deeper cuts to Medicaid to pay for Trump’s key policy priorities — including making the 2017 Trump tax cuts permanent.
Experts point out the proposed Medicaid cuts included in the legislation targets many key components of Obamacare.
“They are stripping a number of the ACA provisions down to its bone …. really decimating provisions of the ACA,” Allie Gardner, senior policy analyst on the Center for Budget and Policy Priorities health policy team, told TPM.
Repealing Obamacare is a goal congressional Republicans have tried and failed to pull off many times before — including during the first Trump administration when the House passed an Obamacare repeal bill in 2017. But Senate Republicans’ “skinny repeal” efforts were tanked by the late Sen. John McCain (R-AZ).
Since that largely unpopular scheme to dismantle the ACA failed, the repeal efforts have grown much quieter. Republicans have tried to target the program without saying they are actually trying to repeal Obamacare.
Experts told TPM the cuts specifically targeting the expansion population — the individuals eligible to receive health insurance as a part of the expansion that took effect under the ACA — in the reconciliation package add up to a similar effort.
“It’s not an outright repeal, but I think it’s hard to not see the parallels between the efforts to totally repeal the ACA and what’s going on now,” Gardner said.
The Senate Finance Committee’s reconciliation text includes a provision that would lower provider taxes from 6% to 3.5% by 2031 for states that have expanded Medicaid under the Affordable Care Act. For states that do not have an expansion population, the bill would place a moratorium on new or increased provider taxes. That means states wouldn’t be able to increase their provider taxes but can keep them at the levels they are even if they are higher than 3.5%.
A big shift in provider taxes and the ability to control those taxes would put states in a difficult position, forcing them to either make cuts to benefits or eligibility or find other financing options in their state budgets to cover the cost themselves, the health policy experts told TPM. And if they can’t find a way to replace the money they make from provider taxes — which experts say many states would struggle with — millions will lose access to healthcare.
Senate Republicans are also embracing House Republicans’ plans to implement work requirements for the Medicaid expansion population. That proposal is not as divisive as the outright cuts proposed in some of the other provisions, likely because it is an easier political sell for Republicans.
In fact even the Republican senators who have been the most vocal in warning against cuts to the popular program have said they support implementing work requirements.
“I’m all for work requirements,” Sen. Josh Hawley (R-MO) has been telling reporters since early May.
The push around work requirements are not new. The idea has long been popular among Republican lawmakers and is one that congressional Republicans coalesced around early on in the reconciliation process as they looked for ways to obfuscate cuts to the program, as TPM has reported.
“The Medicaid expansion group has been targeted by state legislatures since 2017,” Gardner told TPM, adding that Republicans have tried to impose work requirements and other kinds of barriers that specifically targeted the expansion population.
But the upper chamber Republicans are also taking their attack on the expansion population a step further by adding a provision that would require adults with dependent children older than 14 to prove they work, attend school or perform community service for 80 hours a month in order to be eligible.
“It’s a more explicit demonstration of what we’ve seen kind of patchwork across states over the past almost a decade of targeting the expansion group specifically,” Gardner told TPM.
