Episode 1 of The 80 Million Podcast: Medicaid is on the Brink. What’s at Risk?
Our inaugural episode of The 80 Million Podcast considers the seismic changes to the Medicaid program, and whether they’re deeply structural or an opportunity to strengthen our nation’s safety net.
Author: Patti Boozang and Cindy Mann
Editor: Amanda Eisenberg
tl;dr
Medicaid, which covers nearly 80 million people, is facing unprecedented and converging pressures: nearly $1 trillion in federal funding cuts, strained state budgets and new federal mandates like work reporting requirements that, alone, are projected to jettison nearly 6 million people from coverage.
The Trump administration and Congressional leadership frame these policy changes as a needed response to rooting out so-called fraud, waste and abuse and to “right size” the program to include only the “deserving.”
Instead of focusing on specific reforms, the H.R. 1 cuts — which were designed to help finance tax changes — and the rubric advanced to justify those cuts threaten access for millions for Americans. The first episode of The 80 Million Podcast dives into how H.R. 1 and related federal policy actions could fundamentally undermine Medicaid’s critical coverage role, and what systemic change might look like that improves, not weakens, the program.
The 80 Million Impact
Medicaid, which is jointly funded by states and the federal government, has always operated under pressure, but this moment feels different. The program is facing a unique period of change, defined by factors that are significant on their own but far more consequential together. Centrally, the 2025 health care cuts to Medicaid and beyond, to the tune of $1 trillion over the next decade, will add nearly 10 million people to the uninsured ranks. These cuts will also trigger state budget holes and new funding gaps for the nation’s health care safety net.
The funding cuts are compounded by new administrative burdens for consumers because of new Medicaid work reporting requirements and other red-tape hoops people will need to jump through to get and keep coverage. Paperwork is a tried-and-true method for reducing enrollment, undermining decades of bipartisan efforts to streamline enrollment while ensuring program integrity through data-driven verification of eligibility. State Medicaid agencies will also feel the pinch as they operate with steep new administrative costs and fewer resources, and health providers who continue to serve low-income populations will be faced with patients churning in and out of coverage and a rise in uncompensated care.
All these effects are compounded by federal actions and threats to withhold Medicaid funding from some states, primarily Democrat-led ones, under the new “war on Medicaid fraud.” Fraud has no place in Medicaid or any health care program, and states and the federal government share the same goal in rooting it out. But when the focus becomes punitive rather than collaborative, and the rhetoric gets ahead of the facts, it’s counterproductive to effective program integrity efforts and damaging to the program
The Trump administration and other critics of the Medicaid program have argued our nation’s safety-net payer has strayed from its original purpose, yet the program’s evolution has been both intentional and necessary. Since its creation in 1965, Medicaid has evolved to fill critical gaps in the health care system — covering children, pregnant people, older adults, those with disabilities and, more recently with the enactment of the Affordable Care Act (ACA), low-income parents and other adults who would otherwise be uninsured. Rolling back that evolution would mean returning to a system with significantly higher uninsured rates, greater cost shifting, and worse access to care and health outcomes for Americans.
It also raises a more fundamental question: Who is “deserving” of coverage?
Do we want a system where a teenager covered by Medicaid loses eligibility simply by turning 19? Or where a parent working a minimum-wage job earns too much to qualify? Or where a 55-year-old with limited income has no hope of coverage until Medicare kicks in at age 65?
The 1965 version of Medicaid does not make sense anymore. It’s one that we’ve moved beyond for good reason through incremental improvements made over decades. The vast majority of Americans support and value Medicaid coverage, including the ACA effort to fill remaining gaps with expansion coverage, as vital to keeping their families and neighbors safe, healthy and financially secure.
The Bottom Line
Listen to the full conversation of The 80 Million Podcast to hear how Medicaid is experiencing seismic shifts, and what can be done to strengthen the program.
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