Republicans from the House of Representatives published a plan on Sunday night that would cause millions of poor Americans to lose the health coverage of Medicaid and millions more to pay higher rates when they go to the doctor, but that was not stopped in a review that would make the most deep cuts to the program.
The proposal, which is a radical bill to promulgate the national agenda of President Trump, including large tax cuts and a higher military expense, omits the structural changes to Medicaid than the ultraconservative Republicans have demanded. On the other hand, it is inclined to the wishes of a group of legislators of the most moderate and politically vulnerable Republican Party whose seats could be at risk if they adopt deep medical cuts.
It was published on Sunday night for the Energy and Commerce Committee of the House of Representatives, which under the budget Blueprint of the Republican Party had to find $ 880 billion in savings for a decade. The panel is scheduled to meet Tuesday afternoon to discuss and refine the package.
Republicans have worked to gather a series of cuts large enough to meet that goal, on which the fiscal hawks have insisted, while they appease the legislators of the districts where the registration of Medicaid is widespread.
In general, the legislation would reduce federal expenditure by an estimated $ 912 billion during the decade and cause 8.6 million people not to ensure, according to a partial analysis of the Congress Budget Office that distributed the Democrats in the Committee. Most of those cuts, $ 715 billion, would come from changes to Medicaid and the low -price health care law.
The remaining savings of the legislation would largely come from the changes in energy policy, including the repeal of two regulations of the Biden era that affect car pollution and automotive efficiency.
But the portion of Medicaid was the most divisive and it is likely that it will continue to be the most debated as the proposal, which must be approved by the Committee and then approve the Chamber and the Senate, it makes its way through Congress.
The legislation published on Sunday attempts to divide the difference between the Republicans who agitate the deep cuts to Medicaid and those anxious to protect their states from the changes that could force them to assume much higher costs. It excludes several policies in consideration that would create large holes in state budgets and, on the other hand, focuses on the policies that cause the beneficiaries of Medicaid, particularly those who were covered as part of a low Obamacare expansion, to pay more rates and complete more documents to use their coverage.
“Congress did not take an ax for the expansion group,” said Julian Polaris, a partner of Manatt Health, a consulting firm that focuses on Medicaid. “But they have made it much more challenging to be covered for that group and take care of that group.”
He also adds a work requirement to Medicaid for poor and without children, which requires them to prove that 80 hours are working every month to stay registered. That is a less flexible version of a work requirement briefly imposed in Arkansas in 2018 that caused 18,000 people to quickly lose coverage.
Even some Republicans in the Senate who have expressed their opposition to reduce the benefits of Medicaid, including Susan Collins de Maine and Josh Hawley Senators of Missouri, have said they are open to add some work requirements to the program. Trump, who has remained firm that he did not want to do anything that could be characterized as a medicaid cut, has also supported politics.
But despite the broad adoption of work requirements, the legislation significantly delays the implementation until January 2029, after the next presidential elections.
But the legislation also increases paperwork requirements throughout the program, by allowing states to verify the income and residence of the beneficiaries more frequently, and by allowing them to finish the coverage for people who do not respond immediately. The use of such strategies had been reduced under a regulation published during the Biden administration.
An analysis of the paper change published by the Congress Budget Office last week suggested that it would cause 2.3 million people to lose the coverage of Medicaid, many older and disabled poor people who are also registered in Medicare, but use Medicaid to cover the co -payment they cannot pay. Because this population has a special risk, the budget office found, the policy would cause only 600,000 Americans more to lose any form of health insurance, but it would make many more have problems paying medical care.
The bill would also require that Medicaid beneficiaries who win more than the federal poverty limit, about $ 15,650 for a single person, pay the co -payments for the medical visits. In general, Medicaid requires a very limited shared cost of its beneficiaries, given its low income. The legislation would require copagos of up to $ 35 for many medical services.
Democrats in Congress immediately assaulted the package as an attack on health coverage for vulnerable populations.
“In unequivocal terms, millions of Americans will lose their medical care coverage, hospitals will close, older people will not be able to access the attention they need and premiums will increase for millions of people if this bill approves,” representative Frank Pallone of New Jersey, the main Democrat in the Energy and Commerce Committee, said in a statement.
The provision is more likely to affect state budgets is a change to long -standing rules that allow states to impose taxes on hospitals, nursing homes and other suppliers and use various accounting maneuvers to use taxes to obtain more federal funds. The bill would freeze all state taxes at their current rates and prevent states from using related special payments to pay hospitals higher prices for Medicaid services than Medicare payments.
The bill also points directly to a handful of states controlled by Democrats who finance health coverage for undocumented immigrants, who are prohibited from the law of registering in Medicaid. The legislation would reduce federal funds for all adults without children without disabilities to 80 percent of 90 percent if the State subsidized coverage for such persons. The change would mean significant fund cuts to the states, including California, New York and Washington unless they eliminated their state programs that register undocumented people.
The legislation includes numerous other small changes in Medicaid, including one to prevent faces housing owners from obtaining elderly household coverage, another coverage of gender attention for transgender minors and several provisions aimed at purging the immigrants and people who have died.
A disposition is directly aimed at reducing federal money for Planned Parenthood. The bill would prevent Medicaid from financing health providers who also offer abortion services. Republicans of the House of Representatives inserted a similar language in their failed legislation to repeal the law of low -price health care, commonly known as Obamacare, in 2017.
The bill would also make numerous changes in registration processes for people who buy their own insurance coverage in Obamacare markets. The legislation would shorten the registration periods, it would apprehend the verification of income, it would restrict access to immigrants in the Deferred Action Program for children in childhood and make it difficult for some people to automatically renew the coverage at the end of the year.
On energy, it is projected that the unscrew of the environmental rules of the Biden era increase federal income because less efficient car conductors pay more in gasoline taxes. It would also rescind the money not spent in a series of environmental programs that were created as part of the inflation reduction law and facilitated the construction of new energy pipes, a change that generates rates for the government.
