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One of the most contentious parts of the budget bill in Congress is cuts to Medicaid. That's the public health insurance program for Americans who are disabled or have limited income. To understand the numbers and what they mean, A Martínez spoke with health economist Lindsay Allen at Northwestern University's Feinberg School of Medicine.
A MARTÍNEZ, BYLINE: So, Lindsay, the Congressional Budget Office estimates a savings of about $625 billion to the national deficit. The office also thinks that up to 10.3 million people could lose coverage over a decade. Is this gamble even worthwhile?
LINDSAY ALLEN: I don't know that I can say the gamble is worthwhile because the CBO estimates actually rely on some pretty big assumptions. One of them is assuming that the states are going to somehow replace the lost federal funding, and that's something that many of the states just can't or won't do. So in practice, the cost burden is just shifting to states and local governments and hospitals and families, and we suspect that more people are going to lose coverage than the CBO estimated.
MARTÍNEZ: So ultimately, you're saying someone has to pay.
ALLEN: Absolutely. It just shifts the burden of paying for that care to someone else.
ALLEN: Yeah. So let's take a step back for a second. Broadly, what does it mean to Medicaid recipients to lose coverage? What's the impact on their health, and also maybe their wallet?
ALLEN: Yeah, absolutely. So Medicaid is a health and economic engine. And so when you receive Medicaid, you end up being able to get care for conditions that need treating. So if you lose Medicaid, you don't end up actually having that need for care go away.
ALLEN: Yeah. OK, so let's dig into some of the specific proposals here. One is to require able-bodied adults without dependents to prove they're working or training for a job as a condition to secure Medicaid coverage. If this requirement, Lindsay, goes through, how could that impact coverage?
ALLEN: Well, that sounds wonderful, in theory. But something like 91% of the individuals that this bill would be targeting with work requirements are caring for family, they're in school, or they're dealing with health issues that aren't always visible or formally diagnosed. So the policy is not really changing behavior. It's just stripping coverage from people who are already contributing in ways that the system just doesn't recognize.
MARTÍNEZ: You know, I happened to be in Georgia at the time when Governor Brian Kemp was really, really pushing work requirement for Medicaid coverage - 80 hours of work or volunteer activities. I know that Arkansas was the first state to do it, back in 2018. How has that turned out for these states?
ALLEN: What we've seen, so especially in Arkansas and now, more recently, Georgia, is that the coverage loss is happening not because people aren't eligible, but because they get stuck in paperwork. So the red tape is dense and confusing, especially for people who are juggling multiple jobs, or they're caregiving, or they're dealing with their health issues.
MARTÍNEZ: So what would be some other ways to streamline Medicaid and maybe better serve its most vulnerable beneficiaries without drastically reducing access to health care?
ALLEN: Sure. So if we want to cut Medicaid costs without hurting people, the data point us toward things like reducing prescription drug prices or cracking down on high-cost, low-value care, or investing in preventive services that are what actually lower long-term costs - unlike policies that just cut people off.
MARTÍNEZ: That's health economist Lindsay Allen. She's an assistant professor at Northwestern University's Feinberg School of Medicine. Lindsey, thank you.
ALLEN: Thank you, A.
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