SCOTT DETROW, HOST:
Health care coverage for millions of Americans could be in jeopardy under proposals in Congress that would cut the program known as Medicaid expansion. Now in both Democrat- and Republican-led states, leaders worry they will get stuck with more of the cost or that they'll have to kick people off of coverage. One state with a particular dilemma could be Missouri. We're joined now by St. Louis Public Radio's Jason Rosenbaum. Hey there.
JASON ROSENBAUM, BYLINE: Thank you for having me.
DETROW: Jason, let's start with this nationally. How many people are we talking about across the U.S. who rely on this program, and what does it do for them?
ROSENBAUM: There are more than 20 million Americans who currently get health care coverage through Medicaid expansion. And that was a key part of the Affordable Care Act under the Obama administration, where the federal government picked up 90% of the cost to cover the working poor, like individuals making about $21,597 a year. Most states signed up for this plan, including Missouri, where voters passed a constitutional amendment, implementing Medicaid expansion in 2020.
And so backers of Medicaid expansion say it helps keep rural hospitals afloat by cutting down on uncompensated care for the poor. And they also say it incentivizes people in the program to go to the doctor earlier before health problems become deadly and cost more money.
DETROW: So let's say that these proposals do go into law. The federal government cuts the 90% it pays now. What are leaders in Missouri worried would happen next?
ROSENBAUM: They're worried because there are more than 300,000 people in Missouri covered by Medicaid expansion. And as I mentioned earlier, Medicaid expansion is in the Missouri Constitution. Cutting people off of the program would likely need another statewide vote. And if it remains in the Constitution, Missouri budget leaders say it could lead to a budgetary hole in the hundreds of millions of dollars. We even saw Missouri GOP Senator Josh Hawley warn against Medicaid cuts in the budget process. He says, basically, it could backfire politically, even upsetting Republican voters.
DETROW: So Missouri, as you're talking about, has this particular problem. Let's talk more broadly. What are other states doing about this?
ROSENBAUM: I spoke with Robin Rudowitz of KFF, a nonprofit health policy research polling and news organization. She noted that 12 states have so called trigger provisions, ending or reducing coverage for the Medicaid expansion pool if the federal government ends that 90-10 match. And she says lots of states could face cutting people off of the program.
ROBIN RUDOWITZ: States would then need to say, well, am I going to increase my revenue, so increase taxes? Can I cut education? That's the biggest piece of state budgets. Or do I have to make cuts to my Medicaid program, which could involve rolling back coverage, lowering provider rates or limiting benefits, all of which would restrict access?
ROSENBAUM: And this would affect GOP-dominated states quite a bit. KFF found that more than 780,000 people in deep red Louisiana, where House speaker Mike Johnson is from, are covered under Medicaid expansion, and millions more are encompassed in states President Trump won last year, such as Pennsylvania, Michigan, Ohio, Arizona and Indiana.
DETROW: You look at political history, and there's a pretty clear track record here that when benefits like this are cut, it's politically unpopular. Where does this stand politically at this point in time?
ROSENBAUM: It's not clear that Republicans and Congress are going to cut Medicaid expansion, but some GOP lawmakers and think tanks contend that Medicaid is too expensive and complicated, people are on it who shouldn't be eligible - in other words, fraud - but the extent of that is widely disputed. Especially with demand among GOP lawmakers for big budget cuts, eliminating the Medicaid federal match could be attractive to them.
DETROW: That's Jason Rosenbaum from St. Louis Public Radio. Thanks so much.
ROSENBAUM: Thank you.
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