Medicaid

NOTE: This is an updated version of a blog post I published in 2019 in light of the House GOP's #OneBigUglyBill pending in Congress today.

From The Hitchhiker's Guide to the Galaxy:

But the plans were on display…”
“On display? I eventually had to go down to the cellar to find them.”
“That’s the display department.”
“With a flashlight.”
“Ah, well, the lights had probably gone.”
“So had the stairs.”
“But look, you found the notice, didn’t you?”
“Yes,” said Arthur, “yes I did. It was on display in the bottom of a locked filing cabinet stuck in a disused lavatory with a sign on the door saying ‘Beware of the Leopard.”

From a June 2019 story about Arkansas' "Designed to Fail" Medicaid work requirement disaster:

A couple of days ago I took a look at the letter sent by the Congressional Budget Office (CBO) to Democratic ranking committee members which broke out the ~16 million Americans expected to lose healthcare coverage via the #MAGAMurderBill passed by House Republicans, assuming they also fail to extend the IRA tax credits beyond the end of 2025.

There was a lot to unpack there, all of it pretty horrible...but I felt one provision in particular was worth its own separate post:

Funding Cost-Sharing Reductions.

Enacting section 44202 would affect the cost-sharing reductions that the ACA requires insurers to offer to eligible people who purchase silver plans through the marketplaces. Those reductions increase the actuarial value—the average share of covered medical expenses paid by the insurer—above the amount in other silver plans, resulting in lower out-of-pocket costs for eligible enrollees. To be eligible for cost-sharing reductions an enrollee’s income must generally fall between 100 percent and 250 percent of the FPL; the subsidy varies with income.

The Congressional Budget Office has published several projections about how many people would lose healthcare coverage and/or become uninsured (these aren't the same thing) under various versions of the #OneBigUglyBill Act passed by House Republicans, which is currently beginning its next phase over on the Senate side of the Capitol.

Their most recent projection put the total at around 11.7 million when you include some technical weirdness which I'm a little vague about...plus another 3.8 million if you include their projection from December 2024 regarding the impact of the upgraded ACA subsidies included in the Inflation Reduction Act being allowed to expire at the end of this year. This placed the grand total at around 15.5 million...except they more recently sent a letter to the House Energy & Commerce Committee which bumped this estimate up a bit more, putting the combined total at 15.9 million.

The Musk/Trump Regime has published an update to the official Medicaid/CHIP enrollment data:

January 2025 Key Findings

Medicaid and CHIP Enrollment

• In January 2025, 78.8 million individuals were enrolled in Medicaid and CHIP.
  • 71.4 million individuals were enrolled in Medicaid, and 7.3 million individuals were enrolled in CHIP.
  • 41.4 million adults were enrolled in Medicaid, and there were 37.4 million Medicaid child and CHIP enrollees.

Medicaid and CHIP Applications Received

Over the past month or so, as Congressional Republicans have pulled out all the stops in their attempt to ram through their budget bill which would gut Medicaid and ACA exchange enrollment (along with SNAP and numerous other desperately-needed social aid programs), you may have noticed that they keep using an oddly specific talking point:

Mike Johnson: Medicaid Is Not for 29-Year-Old Males Sitting on Their Couches Playing Video Games

--CNN, February 27, 2025

Mike Johnson on Medicaid: "What we've talked about is returning work requirements ... you return the dignity of work to young men who need to be out working instead of playing video games all day. We have a lot of fraud, waste, and abuse in Medicaid."

Welp. House Republicans did indeed follow through with passing their horrific (and disgustingly-titled) "One Big Beautiful Bill" Act which will effectively repeal the bulk of the ACA without officially repealing it, and that's just for starters.

The final vote was 215 - 214, with every Republican except a handful voting for it (and the two who voted against it openly admitted to the NY Times that they would have voted for it if their votes had been needed), and every Democrat voting against it. There were 2 Republican "no" votes...but both of those were only because they wanted the final bill to be even more draconian.

The Congressional Budget Office projected the bill, if enacted, will result in at least 13.7 million more Americans losing healthcare coverage (and that was based on a prior version of the bill; the new version is even more extreme).

There's so many awful things included in the bill, many of which are of course healthcare-related, and it would take hundreds of blog entries to discuss them all...but I want to focus on one in particular.

Pennsylvania Democratic Representative Brendon Boyle, on MSNBC last night:

Rep. Boyle: The one thing I would point out, though, is this bill is actually significantly worse [than the GOP's ACA repeal attempt in 2017], because this piece of legislation will throw 13.5 million, almost 14 million Americans off their healthcare.

First, you're cutting people off Medicaid. But second, this does include very deep cuts to Obamacare as well. And finally, I have breaking news for you tonight, that literally just came out in the last few minutes as I've been sitting here: The nonpartisan Congressional Budget Office, the official authority on these figures, has now confirmed that this bill, in addition to Medicaid cuts, in addition to Obamacare cuts, includes $500 BILLION WORTH OF CUTS TO MEDICARE that is now in this bill as well.

So, the Congressional Budget Office has published updated estimates of the budgetary impact of the House Republican budget plan (officially called the "One Big Beautiful BIll Act" (seriously); more appropriately called the #MedicaidMassacre bill by certain individuals (ahem) were to pass & be implemented.

In addition to all the dollar amounts tossed around, however, the spreadsheet also includes some important footnotes, including the following (h/t Larry Levitt of KFF for the heads up):

Under the Title IV - Energy & Commerce tab is this:

With the House Republican budget bill having made it past its second significant hurdle last night (the House Budget Committee vote), it's time tot ake a cold, hard look at just what the impact of the bill will be in pure partisan terms.

The logic Congressional Republicans (or at least Donald Trump, who pretty much has complete control over the Congressional Republican hivemind) seem to be going with is that targeting the Medicaid expansion population is good politics for them because:

UPDATED 5/22/25: Welp. House Republicans did indeed follow through with passing their horrific (and disgustingly-titled) "One Big Beautiful Bill" Act which will effectively repeal the bulk of the ACA without officially repealing it, and that's just for starters.

The final vote was 215 - 214, with every Republican except a handful voting for it (and the two who voted against it openly admitted to the NY Times that they would have voted for it if their votes had been needed), and every Democrat voting against it. There were 2 Republican "no" votes...but both of those were only because they wanted the final bill to be even more draconian.

The Congressional Budget Office projected the bill, if enacted, will result in at least 13.7 million more Americans losing healthcare coverage (and that was based on a prior version of the bill; the new version is considered even more extreme).