Republicans say Medicaid is safe. But budget math says otherwise

Summary

Consider This from NPR: Republicans Say Medicaid Is Safe. But Budget Math Says Otherwise

Release Date: March 10, 2025

In this episode of NPR’s “Consider This,” host Ailsa Chang delves into the contentious debate surrounding Medicaid budget cuts proposed by House Republicans. Joined by Edwin Park, a health policy expert from Georgetown University's McCourt School of Public Policy, the discussion unpacks the complexities of the federal budget, Republican claims, and the potential real-world impacts of proposed spending reductions on Medicaid.

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1. The Republican Budget Proposal and Medicaid

Ailsa Chang introduces the central issue: House Republicans aim to pass substantial tax cuts, a priority emphasized by President Trump, which necessitates significant spending reductions. Medicaid emerges as a potential target, despite Republican assurances to the contrary.

Key Quote:

“Congress is acting on one of President Trump's top domestic priorities.”
— Ailsa Chang [00:01]

Edwin Park emphasizes the magnitude of the proposed cuts, highlighting the challenge of finding $880 billion over a decade without impacting essential programs like Medicaid or Medicare.

Key Quote:

“It cannot be done without touching Medicaid unless you're cutting Medicare.”
— Edwin Park [04:55]

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2. Republican Assertions vs. Budget Realities

House Republicans assert that Medicaid will remain untouched, claiming that $880 billion in cuts can be achieved through eliminating waste, fraud, and abuse. Representative Tim Burchett reinforces this stance, suggesting that healthcare coverage will remain intact.

Key Quote:

“That is exactly what I'm saying, ma'am. That is exactly what I'm saying.”
— Representative Tim Burchett [00:53]

However, Park counters these claims by referencing the nonpartisan Congressional Budget Office's (CBO) analysis, which indicates that achieving such deep cuts without affecting Medicaid is mathematically unfeasible.

Key Quote:

“Finding $880 billion in cuts over a decade simply cannot be done without touching Medicaid.”
— Edwin Park [02:19]

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3. Analyzing the Proposed Cuts

The budget resolution passed by Republicans does not explicitly mention Medicaid, Medicare, or Social Security. House Speaker Mike Johnson maintains that these programs are off the table for cuts, yet the CBO's letter to lawmakers suggests otherwise.

Key Quote:

“If you take Medicare off the table, Medicaid constitutes 93% of all mandatory spending that remains.”
— Edwin Park [02:31]

Ailsa Chang questions whether the alleged $50 billion in Medicaid fraud justifies the proposed cuts.

Key Quote:

“Speaker Johnson has talked about how there is about $50 billion worth of fraud in Medicaid each year. Is that an accurate estimate?”
— Ailsa Chang [06:18]

Park clarifies that most improper payments in Medicaid are due to administrative errors, not fraud, undermining the argument for significant cuts based on fraud elimination.

Key Quote:

“The vast majority of improper payments are not because the payment shouldn't have been made.”
— Edwin Park [06:28]

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4. Proposed Solutions and Their Shortcomings

Republicans propose measures such as instituting work requirements for Medicaid recipients and eliminating healthcare provider taxes to achieve the necessary savings.

Work Requirements: Park explains that instituting work requirements could save approximately $120 billion, a fraction of the $880 billion target. Moreover, these requirements are projected to disqualify 1.5 million individuals from Medicaid without significantly boosting employment.

Key Quote:

“According to the Congressional Budget Office, it would save about $120 billion or so in federal Medicaid spending.”
— Edwin Park [07:33]

Eliminating Healthcare Provider Taxes: Advocates like the Committee for a Responsible Federal Budget argue that removing these taxes could save over $600 billion. However, Park warns that since most states rely on these taxes to fund their Medicaid contributions, eliminating them would force states to make drastic cuts to Medicaid services.

Key Quote:

“They’re going to have to make cuts. So, you know, are there ways to ensure that states are in full compliance with these federal rules related to provider taxes? Certainly. But requiring blunt changes… would result in big cuts that would ultimately harm beneficiaries.”
— Edwin Park [09:06]

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5. The Human Impact of Medicaid Cuts

A proposed $880 billion reduction in federal Medicaid funding, roughly equating to an 11% cut, would have severe implications. Park foresees millions losing coverage and access to essential healthcare services. States, grappling with reduced federal support, would face the difficult decision of cutting eligibility, benefits, or provider payments.

Key Quote:

“Millions of people would lose coverage and millions of additional people would lose access to needed care as a result.”
— Edwin Park [10:45]

This scenario not only affects individual health outcomes but also places additional burdens on state budgets and economies.

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6. Conclusion: The Unsustainable Budget Path

Despite Republican assurances, the mathematical reality of the proposed budget cuts reveals an imminent threat to Medicaid funding. Edwin Park emphasizes that without cutting Medicaid or Medicare, the budget cannot achieve the necessary savings, fundamentally challenging the feasibility of the Republican fiscal plan.

Key Quote:

“It's simply the case that these cuts are large, they're significant… they could face.”
— Edwin Park [10:45]

Ultimately, the episode underscores the tension between fiscal conservatism and the imperative to maintain essential social safety nets, highlighting the broader implications for American healthcare and federal budgeting.

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About the Speakers:

• Ailsa Chang: Host of NPR’s “Consider This.”
• Edwin Park: Health policy expert at Georgetown University's McCourt School of Public Policy.

Produced by: Mallory Yu, Connor Donovan, and Mark Rivers
Edited by: Sarah Handel and Nadia Lancy
Executive Producer: Sami Yenigun

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This summary excludes advertisements, introductory segments, and other non-content sections to focus solely on the substantive discussion regarding Medicaid and federal budget cuts.

Transcript

[Ailsa Chang]

Congress is acting on one of President Trump's top domestic priorities.

[Edwin Park]

And the next phase of our plan to deliver the greatest economy in history is for this Congress to pass tax cuts for everybody there.

[Ailsa Chang]

But achieving that goal will require trillions of dollars in spending cuts, which will dramatically reshape the federal budget. And one big potential target for those spending cuts is Medicaid. That was Democratic Representative Al Green disrupting Trump's address to Congress last week after he was removed from the chamber. He spoke with reporters.

[Edwin Park]

And I was making it clear to.

[Ailsa Chang]

The president that he has no mandate to cut Medicaid. Now, House Republicans have said that cuts to Medicaid are totally off the table. Here's Republican Representative Tim Burchett of Tennessee with NPR's Layla Fadel.

[Edwin Park]

So what I, what I think I.

[Ailsa Chang]

Hear you saying is that this 880 billion of proposed cuts that people believe will hit Medicaid, you're saying it won't hurt people's coverage because that's really important to constituents. No, ma'am. Yeah. Yeah, I believe that is exactly what I'm saying, ma'am. That is exactly what I'm saying. And, and in politics. But that's a lot of money for it not to hit the actual health care coverage.

[Edwin Park]

It's a whole heck of a lot of money.

[Ailsa Chang]

But, but we're finding that over and over and over again that, that there is, there is waste, fraud and abuse, and that's just the bottom line. And House Speaker Mike Johnson said this last week on NBC' with Kristen Welker. Are cuts to Medicaid, Medicare and Social Security off the table?

[Edwin Park]

Yes.

[Ailsa Chang]

And don't take my word for it, Kristen. Go do a word search of the.

[Edwin Park]

Budget resolution that we passed on Tuesday. There is not one mention of Medicare.

[Ailsa Chang]

Medicaid, or Social Security, which is true. Those words are not in the legislation. But the reality is Republicans likely will not be able to meet their budget target without major cuts to Medicaid. That's just math. It was all laid out in a letter last week sent to lawmakers by the nonpartisan Congressional Budget Office. And with major cuts to Medicaid, the end result is, I think millions of.

[Edwin Park]

People would lose coverage and millions of additional people would lose access to needed care as a result.

[Ailsa Chang]

That's Edwin Park, a health policy expert at Georgetown University's McCourt School of Public Policy. He says finding $880 billion in cuts over a decade simply cannot, cannot be.

[Edwin Park]

Done without touching Medicaid unless you're cutting Medicare. And both Speaker Johnson, other House Republican leaders and President Trump have said that they do not want to cut Medicare. So if you take Medicare off the table, Medicaid constitutes 93% of all mandatory spending that remains.

[Ailsa Chang]

Consider this. House Republicans have claimed that spending cuts will not impact Medicaid coverage, but experts say that's just impossible. We'll explain the math coming up from npr. I'm Ilsa Chang. This message comes from NPR sponsor satva. Founder and CEO Ron Rudson shares the story of how he got started creating.

[Edwin Park]

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[Ailsa Chang]

And I bought the most popular luxury mattresses.

[Edwin Park]

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[Ailsa Chang]

The analysis that I had done that I was able to sell that level mattress, but with a very affordable price. To learn more, go to swatva.com NPR this message comes from Carvana. Finance your next car the convenient way with customizable, transparent terms, all online, make your budget work for you and swap hassle for convenience with Carvana. It's consider this from npr. Edwin park is a health policy expert at Georgetown University's McCourt School of Public Policy, and he joined me to explain all of the math on this. Now, the budget bill does not specifically mention Medicaid, but that's because the budget just gives instructions to lawmakers on the committee that oversees Medicaid to find $880 billion in cuts over the next decade. The legislation doesn't explain exactly where lawmakers should make those cuts. So I started by asking park very simply, can Congress find $880 billion in federal savings without cutting spending for Medicaid?

[Edwin Park]

It cannot unless you're cutting Medicare. And both Speaker Johnson, other House Republican leaders, and President Trump have said that they do not want to cut Medicare. So if you take Medicare off the table, Medicaid constitutes 93% of all mandatory spending that remains under the jurisdiction of the Energy and Commerce Committee.

[Ailsa Chang]

Okay. Well, that argument has been floated, but Republicans say that they can cut spending without cutting any benefits in either Medicare or Medicaid because they're going to do this by eliminating waste and fraud. Here's another question. Is there $880 billion worth of waste and fraud in the system?

[Edwin Park]

Simply no. If you look at the major Medicaid cut proposals that are under consideration, they're the same proposals that were included in the failed 2017 repeal and replace plans. And they all involve major cost shifts for the cost of Medicaid onto states because of the federal government and state share in the cost of the program, making it harder for States to finance their share of the cost of Medicaid or imposing more red tape on those who are already working or who aren't able to work because they're disabled, have chronic conditions, they may be caregivers or in school.

[Ailsa Chang]

Speaker Johnson has talked about how there is about $50 billion worth of fraud in Medicaid each year. Is that an accurate estimate? I'm just curious.

[Edwin Park]

It is not. What he's trying to do is equate a measure that's used in the federal government to assess improper payments. But he's trying to equate these improper payments as fraud. And the vast majority of improper payments are not because the payment shouldn't have been made. But there were some errors in terms of the documentation related to that payment or errors in terms of some of the procedural steps that were taken in making those payments. But there's no finding that that was actually fraud or even payments that should not have been made.

[Ailsa Chang]

Okay. Well, one proposal that Republicans have talked about is instituting what's called a work requirement for adults who receive Medicaid, but who do not have disabilities or young children. This is actually a broadly popular idea. Like it's an idea that former Democratic Senator Joe Manchin of West Virginia had talked about in his exit interview with npr. But realistically, how much would that work requirement save the federal government?

[Edwin Park]

According to the Congressional Budget Office, it would save about $120 billion or so in federal Medicaid spending. Far cry from 880 billion, certainly. And the reason that it produces savings is not because it encourages employment or increases hours worked, as the Congressional Budget Office has confirmed, but it's actually about the owner's red tape in terms of reporting your employment, reporting your hours, trying to navigate a very complicated process to get an exemption because you're a person with disability or you're in school, you're a caregiver, whatever the exemption may be. This is something that applies to all states, to most non elderly adults. And as a result, people get dis enrolled. According to the Congressional Budget Office, one and a half million people would lose coverage under such a work requirement.

[Ailsa Chang]

Okay. There's another proposal to cut Medicaid spending and that is to reduce or eliminate health care provider taxes which states use to finance their portion of Medicaid. And to be fair, there is some buy in on on this idea, like the Committee for a Responsible Federal Budget, which is a nonpartisan group focused on cutting the national debt. They call those taxes a state financing gimmick. And they say getting rid of healthcare provider Taxes could actually save more than $600 billion. So tantalizing. Is that actually a way to cut spending without cutting benefits?

[Edwin Park]

Actually, no. All states but Alaska rely on these provider taxes to finance their share of the cost of Medicai. And the reason such a proposal would cut federal spending, even though this is about a restriction on what states are able to do, is because states would be unable to replace the lost revenues from these provider taxes. These are assessments on hospitals, nursing homes, other health care providers. They've been used under rules that have been in place since the early 1990s. And because they can't replace those revenues, they're not going to be able to maintain their current Medicaid programs. So they're going to have to make cuts. So, you know, are there ways to ensure that states are in full compliance with these federal rules related to provider taxes? Certainly. But requiring blunt changes that restrict the ability of states to continue to raise the funds they need to finance Medicaid would result in big cuts that would ultimately harm beneficiaries, whether it's losing their eligibility, they're having to pay more in premiums and cost sharing, they have fewer benefits covered, or they can't find a provider that they need.

[Ailsa Chang]

Okay, well, I want to step back just for some perspective here. $880 billion would be something like what, an 11% cut to federal funding for Medicaid? Right. So, like, however that cut of 880 billion happens, what would it mean for Medicaid if we see more than a tenth of the federal spending on the program eliminated?

[Edwin Park]

I think millions of people would lose coverage and millions of additional people would lose access to needed care as a result. It's simply the case that these cuts are large, they're significant, and many of the proposals that are being considered to achieve this $880 billion target involve shifting costs to states are making it harder for states to finance their share of the cost of Medicaid. So states are essentially left holding the bag. They're going to have to make the painful choices in terms of cutting eligibility, cutting benefits, cutting payments to providers like hospitals and nursing homes that serve Medicaid beneficiaries. And in fact, that's one of the reasons it's politically attractive to some federal policymakers, is because they're not explicitly cutting Medicaid benefits. They're making states legislatures. Governors have to make the politically difficult choices, the politically painful choices that they'll have no choice but to make in light of these massive cost shifts that they could face.

[Ailsa Chang]

Edwin park with Georgetown University's McCourt School of Public Policy. Thank you so much for making this so clear.

[Edwin Park]

Thank you for having me.

[Ailsa Chang]

This episode was produced by Mallory Yu, Connor Donovan and Mark Rivers. It was edited by Sarah Handel and Nadia Lancy. Our executive producer is Sami Yenigun. It's Consider this from npr. I'm Ailsa Chang. This month, Short Wave is featuring a science and dog collab for the ages, because sometimes scientists need help and have to call in dogs to get the research done. Their powerful noses have earned some of them a job as conservation detection dogs, helping biologists sniff out things that are hidden or hard to find, like whale poop in the ocean. Here are the surprising ways dogs are pushing conservation work forward on Short Wave, the science podcast from npr. Want to hear this podcast without sponsor breaks? Amazon prime members can listen to Consider this sponsor free through Amazon Music. Or you can also support NPR's vital journalism and get consider this [e-mail] that's plus.NPR.org.