Texas officials could seize the opportunity to reduce the program if Trump cuts Medicaid

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Leaders in Texas have long fought Medicaid, the federal-state health insurance program that provides coverage to millions of vulnerable and low-income citizens.

They turned down greater federal funding that would have allowed Medicaid to cover more low-income families’ medical expenses under the Affordable Care Act. The state was among the last to offer postpartum women full-year insurance coverage.

Despite repeated warnings that the accelerated process could lead to some people being wrongfully removed, Texas officials hurried to kick off those they deemed ineligible when the federal government ended a policy requiring states to keep people on Medicaid during the coronavirus pandemic last year.

Texas officials may get another chance to scale back the program, this time with less restrictions, when Donald Trump assumes office for the second time in January.

About 80 million Americans are covered by Medicaid, and Trump has not made any announcements about intentions to reduce it. His campaign has also not answered questions.

On the other hand, health care advocates and experts think that his prior attempts to eliminate the program, along with the stances of conservative organizations and Republican senators who back him, suggest that it will probably be the target of severe cuts.

“We anticipate that the Republicans will act swiftly to drastically reduce Medicaid and, in fact, terminate its current coverage guarantee,” stated Joan Alker, executive director of Georgetown University’s Center for Children and Families in Washington, DC.

Nearly 70% of Medicaid funding is now funded by the federal government, with the other portion being covered by the states. (The percentage of residents living in poverty is the main factor that determines a state’s share.)

According to Alker and other analysts, states would almost likely cut back on the number of persons they consider eligible and the services to which participants are entitled if federal funds were to be cut.

According to analysts, it would be particularly disastrous in Texas, which already has one of the lowest Medicaid coverage rates in the nation, and policymakers do not have the political will to use state monies to close the financing gap. Parents with two children must make less than $285 a month in order to qualify for Medicaid.

In a statement, Adriana Kohler, policy director for Texans Care for Children, a statewide nonprofit that supports families, said, “Our elected officials would have to decide whether they want to cut health care for pregnant women, children, people with disabilities, or seniors, because that is basically who Medicaid covers in Texas.”

Several attempts for comment were not answered by representatives of the state’s Health and Human Services Commission or Republican Governor Greg Abbott.

In his prior role as the state’s attorney general, Abbott spearheaded a successful legal battle against the federal government to guarantee states Medicaid funds in the event that they declined to cover additional residents under the Affordable Care Act.

Texas policymakers have allowed a system that often creates insurmountable barriers to accessing care, even when the state offers Medicaid coverage to its most disadvantaged citizens.

Some of the insurance firms Texas contracted to manage Medicaid benefits repeatedly refused costly and sometimes life-saving treatments in order to boost profits, according to a 2018 Dallas Morning News investigation. Despite legislative revisions spurred by the series of stories, critics assert that systemic issues still exist.

More over 4 million people in Texas are covered by Medicaid, a smaller fraction of the state’s population than in nearly every other state. The state nevertheless has the third-largest population in the US, after California and New York, despite its enormous size.

Three out of every five nursing home residents, two out of every seven individuals with disabilities, and three out of every eight youngsters in Texas are served by the program, according to KFF, a national health policy research group.

In addition to covering almost half of all births in the state, it is the biggest funder of nursing homes and long-term care services for the aged and disabled.

Michael Morgan, a 75-year-old retired nurse from Fort Worth, is among many worried that the state may make it much harder for his daughter Hannah to obtain care if Trump restricts or cuts federal Medicaid spending.

She has schizencephaly, a brain abnormality, along with Down syndrome. She needs help to walk and eat because she is deaf and partially blind and cannot speak.

Hannah lost her Medicaid coverage when she turned 19 earlier this year, so Morgan is using his meager resources to pay for her medical bills. He filed a fresh application for her in May; given her condition, she ought to qualify for Medicaid.

State officials denied her coverage in November, stating that Morgan had not returned a form by the deadline that would have allowed the agency access to his daughter’s financial and medical records. In an interview, Morgan said he received the form one day before to the deadline and intends to appeal the refusal.

Regarding Medicaid in Texas, he stated, “I’m not sure how much more they can cut it.”

Trump made an unsuccessful attempt to dismantle the Affordable Care Act, which covers 45 million Americans, during his first term in office.

Additionally, his administration consistently promoted Medicaid expenditure limitations, including block grants, which would provide states a fixed amount of federal cash regardless of the number of individuals in need of insurance or the cost of their medical treatment. All eligible individuals are currently covered by Medicaid, regardless of cost.

Republicans will control both the House and the Senate in January, and they have expressed an openness to imposing spending limitations and mandating that the majority of adults in the program work, even if those attempts did not yield much during Trump’s first term. They contend that Medicaid expenditure is prone to waste, fraud, and abuse and cannot be sustained.

Rep. Jodey Arrington, a Republican from Lubbock who chairs the House Budget Committee, and U.S. Senator John Cornyn are among the Republicans who have backed such bills.

Medicaid cuts have also been promoted by Republican policy primers, such as Project 2025, which was released by the conservative think tank The Heritage Foundation, and one from the Republican Study Committee, a conservative legislative caucus.

In response to repeated demands for an interview, Arrington’s spokesperson said last month that he was in favor of a reasonable and responsible work requirement.

The majority of adults who used Medicaid were already employed or eligible for an exemption, according to Harvard University health professors who examined a previous work mandate in Arkansas that Trump approved during his first term. However, thousands of residents were unable to access health care, at least in part because of the burdensome process of continuously proving their eligibility.

Prior to this, Arrington advocated for work requirements and a reduction in the federal government’s part of state-paid health care costs. In the past, he suggested reducing federal Medicaid spending by $1.9 trillion, or more than 25%.

Last month, Cornyn, whose representatives have consistently refrained from commenting, declared that he would not back cuts to Social Security or Medicare, the government health insurance program for the elderly and disabled. He did, however, imply that Medicaid cuts were possible.

Cornyn told Politico Pro, “We can’t just keep doing things the way we’ve been doing them.” Block grants are really logical.

William T. Smith, 65, a retired construction worker who lives in Brownsville, close to the US-Mexico border, said he voted for Trump in part because he favors reducing some federal programs and feels there is too much fat.

Smith’s lungs are damaged by chronic obstructive pulmonary disease, which makes breathing challenging. Due to decades of hard labor, he claimed to suffer chronic pain, sleep apnea, and bipolar disorder.

Smith claimed that the federal government shouldn’t prioritize cost-cutting measures in Medicaid, which he has been trying to acquire since the summer. Rather, he suggested that the federal government finance more people’s care by using savings from other programs.

He told reporters, “I don’t think they’re going to yank health care away from people.” I’d be furious if they did.

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