Although not explicit in the budget blueprint passed by the House, most analysts agree that Medicaid, the state-federal partnership that contributes to health care costs for 24% of the U.S. population, is under threat. UCLA has experts to help make sense of what’s at stake and some of the politics, past and present.
Mark Peterson, a political scientist and professor of public policy at the UCLA Luskin School of Public Affairs, is an expert on the interactions among the President, Congress and interest groups in creating public policy, particularly with regard to national health care. He says potential cuts to Medicaid would target a wide range of extremely vulnerable individuals and institutions:
“As the largest single source of health insurance coverage in the U.S., about half of all children are implicated, and something like 40% of births. The U.S. already has among the worst maternal and infant mortality rates in the world. Medicaid pays for about half of nursing home expenditures, meaning for elderly and disabled individuals with severe care needs, most of whom were middle class and spent down their assets once in these facilities.Families need this support. The Affordable Care Act Medicaid expansions have reduced major medical debt and helped assure that the working poor can remain healthy and well, and keep working.”
“Let’s also note that the vast majority of those on Medicaid who can work, do work. Rural populations are extensively represented among Medicaid recipients, and yet more hospitals in their communities, already in a financially precarious position, would likely close, including their emergency rooms, without continued funding levels.”
The UCLA Luskin Center for History and Policy recently released a paper on the history of Medi-Cal, California’s Medicaid program. Asked how different presidential administrations have treated Medicaid in the past, postdoctoral fellow Ben Zdencanovic, lead author of the paper, says Republican policymakers and officeholders have been historically hostile to the program:
“Unlike Medicare — which is an entitlement program for the elderly — Medicaid is ‘means-tested,’ meaning one has to fall below a threshold of annual income for eligibility. As such, it has often carried the stigma of a ‘welfare’ program that disproportionally benefits people of color, the working class and foreign-born populations. President Trump’s attitude toward Medicaid reflects this historical antipathy of his party. When Trump was previously in office, his administration approved waivers that capped financing and would have allowed 13 states to impose unprecedented work requirements and other eligibility restrictions on Medicaid recipients. The Biden administration removed many of these waivers, but it’s likely that Trump will seek to reimpose them. It’s also possible the new administration will attempt to tighten eligibility requirements and possibly impose block grants — rather than the guaranteed match to states — to cut federal funding to the program.”
