LEILA FADEL, HOST:
Some of the most controversial provisions of the big tax and spending bill would make large cuts to Medicaid.
A MARTÍNEZ, HOST:
That's the shared federal-state health program that currently provides insurance coverage to more than 70 million Americans with low incomes. Republicans have long wanted to roll back expansions to Medicaid made by Democrats, especially those made by the Affordable Care Act.
FADEL: With us to talk about what the budget bill might mean for those on the program is Julie Rovner. She's the chief Washington correspondent for KFF Health News. Good morning, Julie.
JULIE ROVNER: Good morning, Leila.
FADEL: So just - I mean, how big are the cuts to Medicaid? What are we talking about here?
ROVNER: Well, according to the Congressional Budget Office, which is the bill's official scorekeeper, the Senate bill that passed Tuesday would reduce federal Medicaid spending by an estimated $930 billion over the next decade. That's about 10% of the program's total budget. And that cut is $100 billion bigger than the cut the House voted for back in May.
FADEL: OK. President Trump and House and Senate Republicans say this bill would not actually take Medicaid away from anyone who's currently eligible; it only deals with waste, fraud and abuse. Is that the case?
ROVNER: Well - again, this is according to the CBO - the Senate bill would increase the number of Americans without health insurance, including many who will technically still be eligible for the program. Right now there are about 26 million Americans with no health insurance. That would go up by a third because of this bill, so an additional 12 million uninsured in 2034. And that doesn't even count several million more people who could lose coverage as a result of changes to other insurance programs, like the private plans sold on the Affordable Care Act marketplaces.
FADEL: Why would so many people lose coverage?
ROVNER: Well, the primary way people will be separated from their insurance is increased paperwork. For example, right now people need to prove their eligibility for Medicaid just once a year. This bill would double that to every six months. And it isn't just filling out a form. People need to upload lots of documentation to prove that what they're claiming about their income or health status is correct. That's hard enough as it is. But it can be particularly difficult for people who are sick, either physically or mentally. And obviously, that's why many people are eligible for Medicaid in the first place.
FADEL: What about the work requirements we've heard about? Is that also expected to reduce the Medicaid rolls?
ROVNER: Yes. The CBO estimates that about half the people who'd lose their Medicaid coverage would lose it because of the work requirements. And it's not that the requirements themselves are particularly onerous. Most adults on Medicaid who don't have young kids would only be required to work or volunteer or go to school 80 hours per month. But again, it's the paperwork, not the work. States that have tried work requirements have found that proving you've done these things can be quite difficult. And many, many eligible people end up having their coverage ended, either temporarily or permanently, because they can't navigate the reporting requirements. They'd have to report their activities once a month, in many cases. I've heard it described as like having to file your income taxes every single month.
FADEL: Oh. You said the Senate bill would cut more deeply into Medicaid than what the House bill had proposed. But was there anything that the Senate pulled back on?
ROVNER: Well, not on purpose. But the Senate parliamentarian said the bill couldn't ban Medicaid from covering care for transgender people, so that provision of the House bill got dropped. And while the House voted to ban Medicaid from funding any kind of medical care at Planned Parenthood for 10 years, not just abortion care, the parliamentarian also made senators reduce that to only a single-year ban. Still, according to Planned Parenthood, that could force the closure of hundreds of clinics where people get cancer screenings and contraception and other types of medical care.
FADEL: Julie Rovner of KFF Health News. Julie, thank you.
ROVNER: Thank you. Transcript provided by NPR, Copyright NPR.
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