Phil Galewitz, KFF Health News
The final time a Republican-controlled Congress and President Donald Trump moved to slash Medicaid spending, in 2017, a key political drive stood of their means: GOP governors.
Now, as Congress steamrolls towards passing historic Medicaid cuts of about $1 trillion over 10 years by way of Trump’s tax and spending laws, red-state governors are saying little publicly about what it does to well being care — at the same time as they face reductions that can punch multibillion-dollar holes of their states’ budgets.
Medicaid, a program collectively run by states and the federal authorities, covers greater than 70 million low-income or disabled individuals, together with almost half of the nation’s kids. Republicans say the $900 billion-a-year program was allowed to develop too giant below Democrats Barack Obama and Joe Biden by including nondisabled adults they are saying don’t deserve government assistance, they usually have lengthy sought to scale it again.
Some of the most important well being cuts within the laws Trump calls the “One Big Beautiful Bill” are achieved by way of new insurance policies that would cut back enrollment by imposing extra paperwork calls for on enrollees, together with a requirement that many show they’re working. Those insurance policies would have an effect on solely states that expanded Medicaid to extra low-income individuals below the Affordable Care Act.
Nineteen of these states are led by Republican governors. Their silence on the invoice’s well being measures is giving political cowl to GOP lawmakers from their states as they search to chop Medicaid protection for tens of millions of people that gained it inside the final decade.
KFF Health News contacted all 19 governors for touch upon the laws’s Medicaid cuts. Only six responded. Most mentioned they backed imposing a piece requirement on grownup Medicaid enrollees.
“Implementing work requirements for able-bodied adults is a good and necessary reform so that Medicaid is being used for temporary assistance and not a permanent entitlement,” mentioned Drew Galang, a spokesperson for Gov. Patrick Morrisey of West Virginia.
“Governor Rhoden supports workforce participation as a requirement of Medicaid expansion eligibility,” mentioned Josie Harms, a spokesperson for South Dakota Gov. Larry Rhoden, including that congressional lawmakers have the governor’s assist: “South Dakota has an excellent federal delegation, and Governor Rhoden trusts them to fight for South Dakota’s priorities while delivering on President Trump’s promises.”
In an indication of how the political winds have modified, not one of the governors mentioned something about one other of the laws’s vital cuts, to provider taxes — a software that almost all of their states use to assist pay their share of Medicaid and acquire further funds from the federal authorities. That change is predicted to price states billions.
No Longer a Bipartisan Issue
In distinction to the radio silence from GOP governors, Democratic governors have campaigned towards the megabill for weeks.
Pennsylvania Gov. Josh Shapiro posted on the social platform X that Trump and congressional Republicans had been deceptive Americans by saying they had been reducing solely waste, fraud, and abuse in Medicaid.
“They’re rushing to kick hundreds of thousands of Pennsylvanians off their healthcare — and lying about it,” he posted. “The damage this will do here in Pennsylvania and across America is staggering and will be felt for years to come.”
In New York, Gov. Kathy Hochul on July 1 charged that Trump’s laws would devastate hospitals and will result in greater than 34,000 job cuts in her state.
“The collective impact of the GOP reconciliation bill in Washington, D.C., could force hospitals to curtail critically needed services such as maternity care and psychiatric treatment, not to mention to downsize operations, and even close entirely,” she mentioned in a statement.
In 2017, the refrain was bipartisan, as Republican governors in Ohio, Nevada, and Massachusetts spoke out towards reducing Medicaid. Trump’s invoice to repeal a lot of the Affordable Care Act and roll again its Medicaid enlargement narrowly failed within the Senate.
“It’s been surprising that red-state governors, particularly those in Medicaid expansion states, haven’t spoken out against Medicaid cuts,” mentioned Larry Levitt, government vice chairman for well being coverage at KFF, a well being data nonprofit that features KFF Health News. “Republican governors were a potent political force in the failed 2017 effort to repeal and replace the ACA, including Medicaid expansion.”
What’s modified since 2017, coverage specialists say, is that there are fewer reasonable Republican governors, and GOP state executives who advocated for Medicaid enlargement over a decade in the past are now not in workplace.
Additionally, seven of the then-red states that expanded Medicaid did so via ballot initiative, principally over opposition from their governors.
In reality, the Medicaid work requirement is backed by many Republican governors, even when it means much less federal Medicaid cash and results in fewer individuals coated.
Several states, together with Arkansas and Ohio, have already handed state legal guidelines to implement a requirement that adults enrolled below the ACA’s Medicaid enlargement work, volunteer, go to highschool, or take part in job coaching. Most states have but to convey work requirement packages to fruition as a result of they’re ready for federal authorities approval.
Charles “Chip” Kahn, president of the Federation of American Hospitals, a commerce group of investor-owned hospitals, mentioned that whereas fewer governors have engaged publicly in attempting to dam Medicaid cuts below the invoice, federal lawmakers are listening to from legislators of their states.
A political dilemma for Republican governors is that, not like in 2017, the invoice earlier than Congress is just not laws aimed expressly at repealing Obamacare. With a scope broader than well being care, it could prolong a lot of Trump’s tax cuts and direct billions in new spending towards border safety, immigration enforcement, and the navy, whereas additionally reducing well being care spending.
“It’s like playing multidimensional chess rather than focusing on one issue,” Kahn mentioned.
Larry Jacobs, director of the Center for the Study of Politics and Governance on the University of Minnesota, mentioned some Republican governors might have expressed issues privately to their states’ GOP senators however will not be talking out publicly for concern of drawing Trump’s wrath.
“Why are they being cagey? Trump and not wanting to be ‘Liz Cheney’d,’” Jacobs mentioned, referring to the Republican former Wyoming lawmaker whom Trump helped oust after she served as vice chair of an inquiry into his makes an attempt to overturn the outcomes of the 2020 election.
Walking Political Tightropes
The political peril Republican lawmakers face in publicly difficult Trump stays specific. On June 29, Sen. Thom Tillis (R-N.C.) introduced he wouldn’t run for reelection after he voiced issues in regards to the invoice and the president threatened to again a major challenger. Tillis was one in all three GOP senators to vote towards it on July 1, although it nonetheless narrowly handed.
In addition to the work requirement, the most important Medicaid cuts within the invoice stem from its restrictions on supplier taxes — levies that states impose on hospitals, nursing houses, and different well being care establishments to assist enhance their federal reimbursement. Much of the extra cash is then returned to the well being care suppliers within the type of increased funds for his or her Medicaid sufferers.
The follow, which has been adopted in each state however Alaska, has been criticized by some Beltway Republicans as “money laundering” — although the taxes are permitted by state lawmakers and the federal Centers for Medicare & Medicaid Services and have been allowed below federal regulation for many years.
The Senate invoice would restrict the cash states may elevate — a transfer that may imply billions in funding cuts to states and their hospitals.
The states with Republican governors that expanded Medicaid are Alaska, Arkansas, Idaho, Indiana, Iowa, Louisiana, Missouri, Montana, Nebraska, New Hampshire, Nevada, North Dakota, Ohio, Oklahoma, South Dakota, Vermont, Virginia, West Virginia, and Utah.
One of the governors who expressed issues about repealing the Obamacare Medicaid enlargement in 2017 was Jim Justice of West Virginia, a Democrat on the time.
In a June 2017 letter to West Virginia Sen. Shelley Moore Capito, a Republican, Justice wrote: “Since so many of our people count on Medicaid, any cut to Medicaid would destroy families in West Virginia.” He added that “the consequences would be beyond catastrophic.”
On July 1, Justice — elected to the Senate as a Republican final 12 months — voted for Trump’s megabill, together with its Medicaid cuts.
“The Senator believes this bill strikes a good balance between protecting the most vulnerable and those who rely on the program while rooting out waste, fraud, and abuse to ensure the program is run efficiently for those deserving,” William O’Grady, a Justice spokesperson, mentioned in an electronic mail July 2.
KFF Health News correspondent Arielle Zionts contributed to this report.