The “One, Big, Beautiful” reconciliation bill making its way through Congress, which would make permanent provisions in the 2017 Tax Cuts and Jobs Act set to expire this year, includes massive cuts to Medicaid and Affordable Care Act marketplace coverage. An analysis of six potential Medicaid cuts proposed in the bill finds that if enacted, the number of uninsured Americans may increase by 7.6 million and that the number of medically preventable deaths could rise to 16,642 annually.
These figures don’t include harms from lowering provider payments and shrinking benefits, as well as potential repercussions from states increasing taxes or shifting expenditures from other needs to make up for the shortfalls in Medicaid funding, according to the study authors. “The cuts under consideration, intended to offset the cost of tax cuts that would predominantly benefit wealthier Americans, would strip care from millions and likely lead to thousands of medically preventable deaths,” wrote Gaffney et al in the Annals of Internal Medicine.
Study Methodology
The researchers identified six potential Medicaid cuts that the House of Representatives’ Budget Committee estimates would each reduce the federal government’s Medicaid outlays by at least $100 billion over 10 years.
The six areas of potential cuts include:
- Reduction of the Medicaid matching floor
- Reduced funding of the Affordable Care Act Medicaid Expansion
- Medicaid per capita caps
- Medicaid work requirements
- Reduced Medicaid provider taxes
- Repeal of the Biden-era Medicaid eligibility rules, which are intended to improve access to Medicaid services.
Using House Budget Committee figures, Congressional Budget Office analyses, and peer-reviewed studies of previous Medicaid expansions and contractions, the study authors arrived at their projection of the effects of these six largest budget cuts on the number of Americans likely to become uninsured, as well as the impacts of those coverage contractions on access to health care, financial strain, and health outcomes, including mortality.
Results
The researchers found that each of the six options individually would reduce federal Medicaid outlays by between $100 billion and $900 billion over a decade; increase the ranks of the uninsured by between 600,000 and 3,900,000 and the annual number of persons forgoing needed medical care by 129,060 to 838,890; and result in 651 to 12,626 medically preventable deaths annually.
Enactment of the House bill advanced in May, according to the researchers, would increase the number of uninsured persons by 7.6 million and the number of deaths by 16,642 annually, according to a midrange estimate. These figures exclude harms from lowering provider payments and shrinking benefits, as well as possible repercussions from states increasing taxes or shifting expenditures from other needs to make up for short-falls in federal Medicaid funding.
Medicaid cuts would also likely increase uncompensated care, stressing hospitals and safety-net clinics, and impact care for other patients.
“Policymakers should weigh the likely health and financial harms to patients and providers of reducing Medicaid expenditures against the desirability of tax reductions, which would accrue mostly to wealthy Americans,” concluded the study authors.
Adam W. Gaffney, MD, MPH, Assistant Professor of Medicine at Cambridge Health Alliance and an instructor at Harvard Medical School, is the corresponding author of the Annals of Internal Medicine article.
Disclosures: For full disclosures of the study authors, visit acpjournals.org.
