The defining feature of the Senate Republican health care bill is that, over the long term, it would absolutely decimate Medicaid—moreso even than the House legislation passed last month. And it accomplishes this wrecking job with surprising efficiency, a mere six lines of text in a 142-page document.
Here’s what that translates to. Like their House colleagues, Senate GOPers want to cap the amount of money Washington gives the states each year to pay for each Medicaid patient (currently, there’s no limit to how much the feds can spend). Between 2020 and 2024, they would increase that funding each year based on the consumer price index for medical expenditures—which is already expected to grow more slowly than Medicaid would.
So far, this is the same as the House bill. Here’s where those six lines come up. In 2025, the bill takes a draconian turn. Instead of using the CPI for medical expenditures, it would use the normal consumer price index—which includes everything from groceries to cellphones to home furnishings. This would amount to a devastating budget cut to Medicaid. As the Urban Institute has shown, we are talking about a difference of hundreds of billions of dollars over time.
Medicaid is America’s largest health insurance program by enrollment. It covers 62 million Americans—almost as many as Medicare and the entire individual market combined. It helps the poor, the disabled, the elderly, and—thanks to Obamacare’s expansion of it, which Republicans would roll back—many working-class families. As the New York Times recently noted, it insures about half of all births and 40 percent of children. It is indispensible, and Senate Republicans are planning to throttle it.