Aging in America: Looming Medicaid Cuts

Part One - How The Proposed Republican Budget Cuts Could Impact You, Your Family, and Your Communities

In past posts, I indicated that I was following the proposed budget cuts targeting Medicaid. This week, the House begins its budget discussions. The budget framework approved by Republicans seeks at least $880 billion in cuts, which will likely target Medicaid and ACA assistance and weaken the Inflation Reduction Act (IRA) drug policies, increasing seniors’ drug costs.

Given the failure of the Republican-controlled Congress to use its voice to represent the voices of their constituents rather than their party elites and corporate sponsors, it appeared that Medicaid would be stripped to the bone, no questions asked, no discussion necessary, and no concern for the most vulnerable Americans who need Medicaid to survive.

But in mid-April, twelve Republican House Members, labeled by the media as moderate and vulnerable to re-election, delivered a letter to their leadership, stating they would not support a final budget bill if it included Medicaid cuts. This could be a deal-changer if they stand by their public stance because House leaders need almost every Republican’s support to pass any bill. However, those of us who follow the political game understand that backroom deals and agreements are the norm, and by the time the House votes, these twelve men may have sold their souls to the Devil-in-the-White-House.

I have been researching Medicaid, its history, who it serves, why it costs so much, and the impact of significant cuts on individuals and the healthcare system. It’s a complex program serving millions of people who are financially shut out of our for-profit healthcare system. To keep it readable and simplified, I am using the writer’s 5 W’s checklist: what, who, where, when, and why.

What is Medicaid?

The US is the only highly developed country without universal healthcare, a system that offers healthcare access to its entire population.¹ As a result, the US has cobbled together a costly healthcare system that has bankrupted citizens while making billions for insurance and medical corporations, while leaving millions of Americans uninsured. Medicaid was established in 1965 along with Medicare by Lyndon Johnson’s Great Society programs, which focused on reducing the impacts of poverty and providing a safety net for many Americans.

Who does it serve?

Medicaid provides health care coverage to nearly one in five Americans, including individuals and families with low incomes, children, pregnant women, elderly adults, and people with disabilities.

In 2024, 80 million Americans had healthcare insurance through Medicaid, making it the most extensive health insurance program in the US and essentially a cornerstone of our healthcare system. Eligibility requirements for Medicaid coverage vary from state to state and are based on income, family size, disability status, and age.

Almost half of the children in the US (40 million) are covered by Medicaid or the Children’s Health Insurance Program.

Seventeen million older Americans rely on Medicaid.

Medicaid provides comprehensive health and long-term care coverage to one in three Americans with disabilities, including 2.3 million children, 8.8 million working-age adults, and 4.4 million adults ages 65 and older.

My focus in this article is on people in the last decades of their lives who rely on Medicaid.

From AARP:

Medicaid provides health care coverage for Americans throughout their lifespan, including more than 17 million people ages 50 and over.

Medicaid is a safety net for low-income adults on Medicare who face unaffordable out-of-pocket costs.

Medicaid pays for a broad range of long-term care services for people who need them, including more than 2 million older adults.

Medicaid provides important support for family caregivers, including health care coverage and services for those they care for.²

When is it needed?

Medicaid has been viewed as a temporary solution for working individuals and families who could eventually find health insurance through employment. It’s often called a trampoline for working families: a soft place to land until they can get back into the for-profit insurance system.

People with disabilities, long-term health conditions, and older Americans cost the most in the Medicaid system because of the increased complexity of health conditions and their treatments, and the increased lifespan, due in part to the success of healthcare access and treatment.

From the non-profit Kaiser Family Foundation:

Overall, children account for 37% of full-benefit enrollment, but 15% of the spending, while seniors and individuals with disabilities account for 21% of enrollment but 52% of the spending. The disproportionate spending on certain eligibility groups stems from variation in spending per enrollee across the eligibility groups. Spending per enrollee was highest for seniors aged 65 and older ($18,923) and individuals with disabilities ($18,437). Those groups had per-enrollee spending approximately six times higher than child enrollees ($3,023), which had the lowest spending of any eligibility group.³

Where is Medicaid offered?

Every state offers eligible people access to Medicaid. In addition to federal money, Medicaid is partially funded by each state. Under the 2010 Affordable Care Act (ACA), access to Medicaid was increased by raising the income limits, allowing millions of uninsured Americans to become eligible. The additional Medicaid users increased the states’ contributions, which were challenged in our judicial system. In 2012, the US Supreme Court ruled that states did not have to expand coverage under the ACA, and ten states selected that option.⁴

Medicaid funding is crucial for long-term care provided by nursing homes and assisted living programs. Over 60% of long-term care residents are funded through Medicaid.

For decades, Medicaid has been viewed as a program that “other” people use. In a recent poll by the non-profit Kaiser Family Foundation, nearly ⅔ of Americans have family members who have used Medicaid at some point. The same poll indicates that Americans understand and value the benefits of Medicaid for their families and their communities and do not want it to be cut.⁵

Why is it threatened?

The Heritage Foundation’s Project 2025, a 900-page conservative policy manual used by Trump and the Republican Party to significantly reduce federal programs, has targeted Medicaid as one way to reduce federal spending and participation.

“Project 2025’s authors claim that Medicaid is currently a “cumbersome, complicated, and unaffordable burden on nearly every state” and is failing some of the most vulnerable patients.

The plan proposes changing Medicaid eligibility requirements and funding to reduce costs. These changes include policies designed to “disincentivize permanent dependence” on Medicaid, such as adding work requirements for “able-bodied” beneficiaries to receive coverage and setting a lifetime cap on time spent receiving Medicaid benefits.”⁶

Increasing Need for Help with Healthcare Access

Medicaid enrollment is rising, with a 66% increase in applications since 2022. During the pandemic, an additional 14 million adults were enrolled in Medicaid.⁷ As Americans live longer, many will require medical support and care. Home and community-based care, assisted living, and nursing homes are not covered by Medicare or health insurance. States are experiencing increased contributions from their annual budgets. The primary Republican proposals for defunding Medicaid involve transferring more fiscal responsibility to state governments, leaving each state to determine how to sustain or defund its Medicaid programs.

Image from Kaiser Family Foundation

Republican Silence & Insulting “Explanations”

Attempts to understand why Republicans have targeted a program that serves so many Americans and their communities are met with mostly silence and the now-standard alarmed cry about waste and fraud. The rural Congressional district I live in has the highest Medicaid enrollment in my state, but my Republican representative has refused to hold a town hall, as instructed by his leadership, since he was re-elected. Feeling the pressure of phone calls, emails, and social media, he responded in a newsletter to his constituents as if they were idiots.

He mansplained that cuts were not yet being discussed (despite what his party has repeatedly messaged), but he was deeply (and I might add, suddenly) concerned about all the waste and fraud in Medicaid. The federal government has developed oversight and recovery efforts for several decades in its agencies through Inspectors General, most of whom were fired early into Trump’s second term. They issue annual reports of both criminal successes and recovered monies.

Fraud, waste, and fiscal abuse exist throughout the US healthcare system, and these issues should be addressed. However, as noted by the Georgetown Public University McCourt School of Public Policy: “…shifting federal costs to the states has nothing to do with reducing waste and abuse. It has everything to do with knee-capping the nation’s largest health insurer for children and families.”⁸

Image: Michelle Henderson @ Unsplash

Until We Know More

Numerous articles and reports explain how significant cuts to Medicaid would impact older Americans, children, families, people with disabilities, and communities. Specifically, rural America would be most affected by the loss or reduction of Medicaid funding. Hospitals, clinics, and long-term facilities face possible closure or a significant decrease in services.⁹ I will follow up in Part Two once we learn what the Republicans will do to Medicaid to achieve the massive cuts they desire to provide tax cuts for the wealthy.

What You Can Do

Universal healthcare is the ideal destination for our healthcare system and innovative programs to support the most vulnerable, benefiting all Americans, whether they directly access Medicaid or not. But so far, the lobbying efforts of the insurance and medical for-profit industries have sponsored many of our Congressional members and parties, who, in turn, tell us it can’t work here. The moral impetus to care for all of our citizens that resulted in the Affordable Care Act (though it remains insurance-based and expensive) is notably absent in the current Republican Congress and administration.

• Become informed about Medicaid and Medicare. There are several recorded videos about advocating humane healthcare for aging Americans at Justice for Aging.

• Note that defunding Medicaid is only the beginning. Medicare, Social Security, Veterans’ care, and future cuts are also under the scope, as described here.

• If Republican Congressional members feel threatened by re-election (their primary concern), they may choose not to support these attacks on their constituents.

• Call your representatives - every day! Congress experienced record numbers of calls during the first 100 days of Trump's Terror. The organization 5Calls offers contact information and simple scripts for calling. It takes less than two minutes.

• Write letters to the editors of your local newspapers.

• Find out how Medicaid cuts will impact your community.

1. https://factmyth.com/factoids/the-us-is-the-only-very-highly-developed-country-without-universal-healthcare/

2. https://www.aarp.org/pri/topics/health/coverage-access/medicaid-older-adults/

3. https://www.kff.org/medicaid/issue-brief/a-look-at-variation-in-medicaid-spending-per-enrollee-by-group-and-across-states/

4. https://en.wikipedia.org/wiki/Medicaid

5. https://www.kff.org/medicaid/poll-finding/7-charts-about-public-opinion-on-medicaid/

6. https://www.americanprogress.org/article/project-2025-medicaid-lifetime-cap-proposal-threatens-health-care-coverage-for-up-to-18-5-million-americans/

7. https://www.kff.org/coronavirus-covid-19/issue-brief/analysis-of-recent-national-trends-in-medicaid-and-chip-enrollment/

8. https://ccf.georgetown.edu/2025/01/27/the-truth-about-waste-and-abuse-in-medicaid/

9. https://www.axios.com/2025/04/29/state-nursing-homes-medicaid-data

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  What are your thoughts about Medicaid? Has your family benefited from it? Any advice on advocating for it?