Recent changes to President Trump’s tax and spending bill would cut roughly $1.1 trillion in health care spending over the next decade, according to the nonpartisan Congressional Budget Office. It also found the bill would result in 11.8 million people losing health insurance by 2034 with the majority of those cuts hitting Medicaid. Laura Barrón-López discussed the impact with Larry Levitt of KFF.
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Amna Nawaz:
Recent changes made by Senate Republicans to President Trump's budget bill would cut roughly $1.1 trillion in health care spending over the next decade. That's according to the nonpartisan Congressional Budget Office.
Our White House correspondent, Laura Barron – Lopez, is here now with more on the bill's impact for millions of Americans.
Laura Barron – Lopez: Amna, that Congressional Budget Office estimate also found the bill would result in 11.8 million people losing health insurance by 2034, the vast majority of those cuts hitting Medicaid.
To discuss this, I'm joined by Larry Levitt, executive vice president for health policy at the nonpartisan KFF.
Mr. Levitt, thanks so much for joining us today.
Larry Levitt, Executive Vice President For Health Policy, KFF:
Thanks for having me.
Laura Barron – Lopez: So the Senate Republicans made a number of changes recently to this bill, and this bill would make the largest cuts to Medicaid in the history of the program. If Republicans end up passing it, what is the real-world impact for people who could lose coverage?
Larry Levitt:
That's right. This would be the biggest cut to Medicaid, in fact, the biggest cut to health care in history.
And that number that the Congressional Budget Office has put out, that 11.8 million more people would be uninsured, really tells the story here. I mean, it's low-income kids. It's adults who are working, but don't have health insurance through their jobs. It's people with disabilities. It's seniors who need help paying their Medicare premiums or who are in nursing homes. Medicare does not cover nursing home or long-term care, so it's really Medicaid that ends up picking up the slack there.
I mean, this would roll back many of the gains that the Affordable Care Act or Obamacare has succeeded in reducing the number of people with health insurance. And many more people would find themselves uninsured and without access to health care.
Laura Barron – Lopez: President Trump and Republicans have repeatedly claimed that part of this is about kicking undocumented migrants off of Medicaid. Today, White House Press Secretary Karoline Leavitt claimed that that would total some 1.4 million undocumented people.
What's the reality here? And are undocumented immigrants eligible for Medicaid?
Larry Levitt:
No, the reality is undocumented immigrants are not eligible for any federally funded program, whether that's Medicaid, Medicare, or the Affordable Care Act.
Some states have used their own money to provide health care to undocumented immigrants, and there was a proposal in this bill to cut off federal funding, to reduce the amount of federal funding for Medicaid to those states to effectively penalize them for using their own funds to cover undocumented immigrants.
Laura Barron – Lopez: As Republicans are trying to message and sell these cuts to Medicaid, the Trump administration announced today that it filed criminal charges in health care fraud schemes involving more than $14.6 billion.
Where does health care fraud typically occur? And can you put today's announcement in context for us?
Larry Levitt:
Yes, I think this action by the Justice Department really illustrates what kind of fraud we see in programs like Medicaid. That fraud is generally perpetrated by rogue health care providers who are billing for services that they don't provide.
Fraud in Medicaid is not being perpetrated by individual enrollees trying to get access to health care. Republicans have tried to frame the cuts in this reconciliation bill as eliminating fraud, waste, and abuse. But there is just not a trillion in fraud, waste, and abuse in Medicaid. And, in fact, there is very little in this bill that would actually go after the kind of fraud that the Justice Department announced today.
Laura Barron – Lopez: I want to drill down a little bit more on the changes that Senate Republicans have made to this bill. First, one change puts a new cap on taxes for medical providers. This cap is something that GOP senators like North Carolina's Thom Tillis strongly oppose.
And that Republican Senator Tillis called the Medicaid cuts a betrayal. He said that President Trump was being advised by amateurs. What are provider taxes exactly and how do they help states pay for Medicaid cuts?
Larry Levitt:
Yes, this gets super complicated super fast, and I will try to explain it simply.
States put taxes on hospitals to help fund their share of Medicaid expenses. And states in turn use that revenue to then increase the rates they pay hospitals for care they provide to Medicaid enrollees to ensure those rates are adequate. And because the federal government shares in the cost of Medicaid, that brings additional federal money into states.
So really the bottom line is these taxes on hospitals, which sounds like something hospitals wouldn't like, are actually a way of ensuring that hospitals get adequate rates to provide care for Medicaid enrollees. And that's especially true in rural areas. And many rural hospitals are operating right on the edge. And without these taxes, without adequate rates for providing care under Medicaid, those hospitals could go under.
Laura Barron – Lopez: This bill already created work requirements for Medicaid for the first time in the program's history, but the Senate added even stricter work requirements. What are those and what effect could they have?
Larry Levitt:
That's right.
And work requirements are the biggest source of cuts in this bill. And it's an idea that I think resonates with a lot of people that people should have to work in order to qualify for public benefits like Medicaid. The reality is, most Medicaid enrollees are already working. About two-thirds of them are working. And if you look at the kind of exemptions that people would qualify for, in fact, 92 percent of adults on Medicaid are either working or would likely qualify for an exemption.
But this work requirement would still save a lot of money and kick millions of people off of Medicaid, not because they're not working or not qualified for an exemption, but because they would fail to navigate the paperwork, the red tape they would have to go through to report their work on, potentially as often as a monthly basis.
Laura Barron – Lopez: Larry Levitt of KFF, thank you for your time.
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