WASHINGTON (AP) - The House Republican budget would leave up to
44 million more low-income people uninsured as the federal
government cuts states' Medicaid funding by about one-third over
the next 10 years, nonpartisan groups said in a report issued
The analysis by the Kaiser Family Foundation and the Urban
Institute concluded that Medicaid's role as the nation's safety net
health care program would be "significantly compromised ... with
no obvious alternative to take its place," if the GOP budget is
The plan passed by House Republicans last month on a party-line
vote calls for sweeping health care changes, potentially even more
significant than President Barack Obama's insurance overhaul. So
far, most of the attention has gone to the Republican proposal to
convert Medicare into a voucher-like system for future retirees.
But Medicaid would also be transformed.
The Republican budget has no chance of passing the
Democratic-led Senate, or being signed into law by Obama. But
individual components could advance as part of debt reduction talks
between Vice President Joe Biden and congressional leaders.
A spokesman for the author of the GOP budget, Rep. Paul Ryan of
Wisconsin, challenged the study's assumptions. The Republican plan
will allow Medicaid to grow "at a sustainable rate, so that the
health care safety net will be there for those that need it most,"
said Conor Sweeney. Obama's overhaul will force millions more into
a broken system, relegating vulnerable people to second-class care,
Medicaid is a federal-state partnership that now covers more
than 60 million low-income children and parents, seniors, including
most nursing home residents, and disabled people of any age. Under
the GOP plan, Medicaid would be converted from an open-ended
program in which the federal government pays about 60 percent of
the cost of services, into a block grant that would give each state
a fixed sum of money.
The budget would also do away with the right to Medicaid
benefits under federal law, and repeal a coverage expansion to
low-income adults included in Obama's health care law.
Republican governors say they can save taxpayers billions
through a block grant that would let them clear away federal red
tape and design health care systems tailored to local needs. But
the study cast doubt on whether governors would have enough money
coming in from Washington to adequately meet the needs of their
states and avoid sharp cuts in services.
Under current laws, Medicaid is expected to cover 76 million
people in 2021, the end of the ten-year estimating window used in
federal budgeting. Of those, some 17 million would gain coverage
under Obama's expansion.
The study estimated that 36 million to 44 million people would
lose coverage from the combined impact of the block grant and
repealing Obama's law. Researchers said they gave a range to
account for different approaches that states might take to reduce
their Medicaid rolls. Under the worst case, Medicaid enrollment
would plunge by nearly 60 percent from current projected levels.
The study found that federal spending for Medicaid would decline
by $1.4 trillion from 2012-2021, a reduction of about one-third
from what is now budgeted. Southern and mountain states would face
the steepest cuts. Florida, for example, would take a 44 percent
hit, while Nevada would get a 41 percent reduction.
Hospitals, community health centers and other health care
providers that serve low-income people would be disproportionately
affected. In 2021 hospitals would face Medicaid funding cuts of $84
billion, the study said, at a time when growing numbers of
uninsured people would be going to emergency rooms for treatment.
"Some cuts in payments to hospitals are inevitable if health
care spending is to be reduced," the report said. "But these
reductions are of such a magnitude that they have quite serious
implications ... higher levels of uncompensated care facing
hospitals would inevitably lead to increased spending by state and
Kaiser Family Foundation: www.kff.org
(Copyright 2011 by The Associated Press. All Rights Reserved.)