Health Care

The Senate TrumpCare Bill Destroys Medicaid as We Know It


The Senate’s version of the TrumpCare bill is out, and it’s as monstrous as we thought it would be. It fails people with pre-existing conditions and would drive up costs for Americans.

But perhaps the worst part is what it would do to Medicaid. In order to give billions of dollars in tax breaks to the wealthy and corporations, TrumpCare makes the deepest cuts to Medicaid in its 52-year history. Not only does it end the Medicaid expansion, it fundamentally (and permanently) restructures Medicaid in a way that threatens the well-being of low- and middle-income families across the country.

Even if your Senator claims to be a “no” on this bill right now, don’t fall for the charade. It’s all a trick. It’s so that they can later claim that they’ve worked to “fix” the bill, when in reality this bill is beyond repair. This is especially true for Senators who will tell you they worked to get a longer “glidepath” or “phaseout” for Medicaid. They have no plans for how to transition their state out of Medicaid—whether it’s in 3, 5, or 7 years. Here’s how this bill destroys Medicaid as we know it, and why you should demand that your Senator vocally and unwaveringly oppose it.

It ends the Medicaid expansion

One of the key ways the Affordable Care Act so successfully increased the number of people with health care coverage was by expanding the groups of Americans that are eligible for Medicaid. 11 million Americans got coverage through the expansion of Medicaid. And, importantly, this expansion is paid almost entirely by the federal government—at 100 percent initially and then at 90 percent after 2020. This means that states can insure more of their residents without incurring many additional costs. It’s a win for states and a win for hardworking American families. If passed, TrumpCare would end that expansion, wiping out those important gains and putting American families at risk.

A Medicaid “phase-out” still rips health care from millions of Americans

“Moderate” Republicans who have negotiated parts of the bill in recent weeks claim to have lessened the blow by “phasing out” the expansion starting in 2021. But whether the expansion ends now or ends later, what it means in real terms is that millions of Americans will lose their coverage. It means that individuals who are now eligible for Medicaid will be unable to enroll, and many will be left without any coverage options at all.

It fundamentally transforms traditional Medicaid

Not only does the Senate version of TrumpCare end Medicaid expansion—it also makes deep cuts into traditional Medicaid. We can’t overstate what a fundamental remaking of Medicaid this is. Currently, Medicaid is an open-ended commitment. If you’re covered by Medicaid and you receive medical care, the federal government helps the state pay your insurance company for the services you received. And just as importantly, if you happen to be eligible for Medicaid, you get it. Period.

That is not the vision contemplated by TrumpCare: for the first time, Medicaid funding would be capped under a system called “per capita caps.” This means that access to Medicaid, even if you’re eligible, won’t be guaranteed. In practice, the caps in the Senate TrumpCare bill mean Medicaid funding will be cut deeper and deeper each year, covering fewer people, fewer services, or both. That’s because, as CBO confirmed, Republicans hid their deepest Medicaid cuts in the second decade. That’s when the growth rate for Medicaid starts growing at a slower rate than medical costs. What does all this mean In real terms? Millions of Americans would have to go without the care they need. Some might find themselves on waiting lists, and others on plans that are inferior to what they get now.

It hurts the elderly, children, and people with disabilities the most

A common misconception is that Medicaid is program that only serves low-income Americans. The truth is that Medicaid helps more people than commonly thought. Sixty-four percent of all nursing home residents use Medicaid. Seventy-six percent of all low-income children receive some kind of help from Medicaid. Children with disabilities receive Medicaid-funded help in school, even for services like speech-pathology, which this bill would end. In all, 20 percent of all Americans get some kind of help from Medicaid. This bill threatens all of them.