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Republican leaders in Congress have directed the committee that oversees Medicaid to cut $880 billion from the next budget. They say these cuts aren’t necessarily aimed at Medicaid, the insurance program for 72 million poor and disabled Americans. The cuts could come from Medicare, for instance. But Trump has vowed not to touch that very popular program. And a sum this large can’t come from anywhere else.

The Republican process is just getting started, and we don’t yet know how lawmakers will change the program. Most Medicaid money goes to states, so the best way to think about the proposal is as a cut to state budgets. State lawmakers could react by dropping coverage, raising taxes or slashing other parts of their budget. In today’s newsletter, I’ll explain a few possible scenarios.

Spending overseen by the House Committee On Energy and Commerce

$25 trillion

Medicaid

Medicare

Other

Health

Non-health

Cuts required

$880 billion

$25 trillion

Medicaid

Medicare

Other

Health

Non-health

Cuts required

$880 billion

Each square represents $250 billion in 10-year gross mandatory spending.

Source: Analysis of federal budget data by Richard Kogan, Center on Budget and Policy Priorities

By The New York Times

Who’s covered

Medicaid was designed to divide a patient’s medical bills: the federal government and the state would each pay a set share. (A state’s contribution depends on how poor it is.)

The law is precise about what Medicaid must cover — cancer screenings and kidney transplants, for instance, but not prosthetic legs — and Republicans can’t change that with a budget bill. Every state has to cover certain populations, including poor children, pregnant women, people with disabilities and patients in nursing homes who run out of money.

Most states also choose to cover an optional group that was added as part of Obamacare in 2014: anyone who earns less than a certain income (around $21,000 for a single person). Republicans want to impose a work requirement on this group for people who aren’t disabled. That idea is popular with the public but would save the federal government only around $100 billion, not enough to meet the G.O.P. target.

Percentage of Americans covered by Medicaid A graphic that shows the percentage of people covered by Medicaid. There are six groups: all Americans, of which 21% are covered by Medicaid, births, of which 41% are covered, 63% of nursing home residents, 16% of all adults, 48% of poor adults, 41% of adults with disabilities, 39% of children, 80% of poor children and 59% of children with disabilities. The charts are displayed in a grid, each one of them with a hundred dots, which are filled with color corresponding to the percentage of each group that is covered by Medicaid.

Nursing

home residents

All

Births

21%

41%

63%

Adults

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with disabilities

Adults

Poor adults

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16%

48%

41%

Children with

disabilities

Children

Poor children

39%

80%

59%

Nursing

home residents

All

Births

21%

41%

63%

Adults

with disabilities

Poor adults

Adults

16%

48%

41%

Children with

disabilities

Children

Poor children

39%

80%

59%

Percentages for adults are for ages 19 to 64.

Source: KFF

By The New York Times

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