May 15, 2023
As prepared for delivery
The Senate just heard compelling arguments from senators from Massachusetts and Pennsylvania on the importance of Medicaid. Now, I’m going to lay out three key arguments about the House Republican proposal to cut the program.
Most Americans covered by Medicaid are already working if they can.
The House Republican plan to cut Medicaid will put millions of Americans at risk, including seniors in nursing homes.
The track record shows that labor reporting requirements are a bureaucratic nightmare for Americans. It’s hard to understand how so-called “small government Republicans” have become so fond of bureaucracy.
Here’s why House Republicans want to cut Medicaid by the billions. They say it’s a matter of work. But really, it’s about getting an ideological trophy on the evidence-less proposition that Americans near the poverty line actively choose to stay there instead of work. So this work declaration requirement is really about snatching health care coverage from Americans that Republicans have deemed unworthy.
Don’t believe me: An analysis from the Kaiser Family Foundation paints a clear picture of those at risk of losing coverage. In 2021, 25 million adults between the ages of 19 and 64 were enrolled in Medicaid. 43% work full time and 18% part time. I’ll stop there and note that this equates to the national labor force participation rate of 61%.
Now who else with Medicaid coverage is not actively working: 13% are caring for a child or parent. 11% are unable to work due to illness or disability. 6% are educated. The remaining 9%, or about 2 million Americans, are out of work because they are retired or unable to find work.
Here’s the catch: Under the House Republican plan, the majority of these Americans will be forced to report to their state whether and how much they work each month or risk losing their health insurance. My fellow Republicans like to share their “little government in good faith,” but to me, that sounds like a lot of bureaucratic government paperwork. Worse still, the Congressional Budget Office found in an analysis last year that work demands do not increase employment.
I will now explain how this ill-conceived proposal will hurt more Americans than those subject to work reporting requirements. Republican House bill cuts Medicaid by more than $100 billion. This reduction comes from one source: Americans are getting kicked out of their Medicaid coverage. The only way Americans will retain Medicaid coverage will be for states to take over the entire tab. And that just shifts the federal share of Medicaid to states that don’t want to burden their health care programs with bureaucratic bureaucracy that has never been shown to increase employment.
Shifting Medicaid costs to states has real consequences; it is not an abstract exercise. When the federal government reduces the amount of its contribution to a state’s Medicaid program, the state ends up with the bag to make up the difference. That means states face tough choices about which Americans will get health coverage and whether hospitals and nursing homes will face funding cuts that threaten their ability to stay open.
Physicians could see their pay cut. State options like a full year of postpartum care, which Congress created on a bipartisan basis last year, would be subject to reversal. These cuts will jeopardize your parents’ or spouses’ access to Medicaid nursing benefits, or cut resources for home care, which allow people with disabilities and the elderly to receive care at home instead to move to an institution.
Unfortunately, there are concrete examples to illustrate what happens when a state implements work reporting requirements. During the Trump administration, federal health agencies allowed Arkansas to conduct this work report experiment. In the first year, 18,000 people lost their Medicaid coverage, about a quarter of those subject to work declaration. A year later, almost 90% of those who had lost their coverage had not re-enrolled.
Those enrolled in “Arkansas Works” painted a grim picture. Reporting their work was nothing but red tape. The website was down on nights and weekends, supposedly for maintenance. It was error-ridden and difficult to access on mobile devices. Calling the helpline resulted in an endless parade of robotic questions and dead ends. These are just a few examples of the hurdles these work reporting requirements are designed to create in order to deprive Americans of health coverage. Keep in mind that these are families walking an economic tightrope. Many do not have reliable access to the internet or a mobile phone – especially those in rural areas.
It’s no secret that affordable health coverage is essential to staying healthy and financially stable. If you need medical treatment but cannot afford it, finding and keeping a job will be that much more difficult. This is why this policy is upside down and particularly cruel: it slams the door and throws the key to the Americans who are trying to get back on their feet. The reality is that Medicaid medical coverage supports Americans’ ability to join the workforce — it doesn’t discourage them.
And it’s not just Medicaid that House Republicans want to come after. Their agenda would also smother food aid like SNAP and anti-poverty programs like TANF with the same bureaucratic red tape.
Even in the early months of this Congress, it is clear that there is plenty of room for bipartisan agreement on health care. I work closely with my finance committee partner, Senator Crapo, to take on drug middlemen known as pharmacy benefit managers. And I’m confident there are other areas where Republicans and Democrats can come together and make positive change for American families.
Here’s my bottom line: Cutting Medicaid and creating a whole new layer of bureaucracy and red tape just to take health care coverage away from more Americans is not a proposition that Senate Democrats support. I will fight policies that come after Medicaid every step of the way.