​What tactics is Donald Trump considering to reduce the size of Medicaid? Here are the potential cuts 

19/01/2025
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10:14
CSTThis year, Congress could make some pretty tough choices about the nation’s largest health care program to pay for other things, and that could be a disaster for state budgets and the health care system in general.When Biden was president, the number of people on Medicaid hit an all-time high and the percentage of people without health insurance hit a record low. The word is that if Trump returns to the White House and Republicans control the Senate and the House, all of that is going to change in a big, conspicuous way.As for the government’s health care program, which costs nearly $900 billion a year and, along with children’s health insurance, covers some 79 million Americans, most of them low-income or disabled, Republicans say they want to cut the budget and change regulations to level off a lot of Medicaid.Block grants: Republicans propose switching to a system of fixed annual grants for Medicaid, giving states more control over spending but reducing federal funding. This idea has been rejected in the past.ACA Medicaid funding: Medicaid expansion under the ACA could see its federal funding cut from 90% to 60%, particularly affecting states that took up the expansion.Federal Matching Funds: The federal matching rate is proposed to be reduced, affecting wealthier states that receive the current 50% matching rate the most.Work requirements: There is interest in adding work requirements for Medicaid enrollees, although this has been struck down by the courts. It is argued that it could save money but would add bureaucracy.Enrollment barriers: There are proposals in some states to eliminate continuous eligibility, forcing beneficiaries to renew their coverage annually, which could disrupt care and lead to medical debt.Out-of-pocket costs not typically found in Medicaid, such as high co-pays and deductibles, could become a heavy burden for low-income people, both Democratic lawmakers and health experts warn. If the Republican Party succeeds in its proposals to cut Medicaid, this group could be forced to turn to private insurance. That would mean facing great financial hardship, not only to cover monthly premiums but also to pay the high out-of-pocket costs that often characterize commercial insurance, costs they do not face in Medicaid.