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Under President Joe Biden, enrollment in Medicaid hit a record high and the uninsured rate reached a record low.
Donald Trump’s return to the White House — along with a GOP-controlled Senate and House of Representatives — is expected to change that.
Republicans in Washington say they plan to use funding cuts and regulatory changes to dramatically shrink Medicaid, the nearly $900-billion-a-year government health insurance program that, along with the related Children’s Health Insurance Program, serves about 79 million mostly low-income or disabled Americans.
The proposals include rolling back the Affordable Care Act’s expansion of Medicaid, which over the last 11 years added about 20 million low-income adults to its rolls. Trump has said he wants to drastically cut government spending, which may be necessary for Republicans to extend 2017 tax cuts that expire at the end of this year.
Trump made little mention of Medicaid during the 2024 campaign. The first Trump administration approved work requirements in several states, though only Arkansas implemented theirs before a federal judge said it violated the law. The first Trump administration also sought to block grant funding to states.
House Budget Committee Chair Jodey Arrington (R-Texas) told KFF Health News that Medicaid and other federal entitlement programs need major changes to help cut the federal debt. “Without them, we will watch this country sadly enter into fiscal collapse.”
Rep. Chip Roy (R-Texas), a member of the Budget Committee, said Congress needs to explore cutting federal spending on Medicaid.
“You need wholesale reform on the health care front, which can include undoing a lot of the damage being done by the ACA and Obamacare,” Roy said. “Frankly, we could end up providing better service if we do it the right way.”
Advocates for poor people fear GOP funding cuts will leave more Americans without insurance, making it harder for them to get care.
“Medicaid is an obvious target for huge cuts,” said Joan Alker, executive director of Georgetown University’s Center for Children and Families. “An existential fight about Medicaid’s future likely lies ahead.”
Medicaid, which turns 60 in July, is nearing the end of a disruptive period, after covid pandemic-era coverage protections expired in 2023 and all enrollees had to prove they still qualified. More than 25 million people lost coverage over the 18 months after the “unwinding” began, though it has not notably increased the number of people without insurance, according to the latest census data.
The unwinding’s disruptions could pale in comparison to what happens in the next four years, said Matt Salo, former executive director and founder of the National Association of Medicaid Directors. “What we are going to see is an even bigger seismic shift in who Medicaid covers and how it operates,” he said.
But Salo said any efforts to shrink the program will face pushback.
“A lot of powerful entities — state governments, managed-care organizations, long-term care providers, and everyone under the sun who wants to do well by doing good — wants to see Medicaid work efficiently and be adequately funded,” he said. “And they will be highly motivated to push back on something they see as draconian cuts, because it could affect their business model.”
The GOP is looking at several tactics to reduce the size of Medicaid:
- Shifting to block grants. Switching to annual block grants could lower federal funding for states to operate the program while giving states more discretion over how to spend the money. Currently, the government matches a certain percentage of state spending each year with no cap. Republican presidents since Ronald Reagan have sought to block-grant Medicaid with no success. Arrington said he favors ending the open-ended federal funding to states and replacing it with a set annual amount based on how many people each state has in the program.
- Cutting ACA Medicaid funding. The ACA provided financing to cover, through Medicaid, Americans with incomes up to 138% of the federal poverty level, or $20,783 for an individual last year. The federal government pays 90% of the cost for adults covered through the law’s Medicaid expansion, which 40 states and Washington, D.C., have adopted. The GOP may try to lower that funding to the same match rate the feds pay states for everyone else in the program, which averages about 60%. “We should absolutely note that we are subsidizing the healthy, able-bodied Medicaid expansion population at a higher rate than we do the poorest and sickest among us, which was the original intent of the program,” Arrington said. “That’s not right.”
- Lowering federal matching funds. Since Medicaid began, the federal match rate has been based on the relative wealth of a state’s population, with poorer states receiving a higher rate and no state receiving less than a 50% match. Ten states get the base rate — all but two are Democratic-run states, including New York and California. The GOP may seek to cut the base rate to 40% or less.
- Adding work requirements. During the first Trump term, federal courts ruled that Medicaid law doesn’t allow coverage to be conditioned on enrollees’ working or seeking jobs. But the GOP may try again. “If we can get strict work requirements on able-bodied adults, that can be a huge cost savings by itself,” Rep. Tom McClintock (R-Calif.) told KFF Health News. Because most Medicaid enrollees already work, go to school, or serve as caregivers, critics say such a requirement would simply add red tape to obtaining coverage, with little impact on employment.
- Placing enrollment hurdles. About 10 states offer some populations what’s called continuous eligibility, whereby people stay enrolled for years without having to renew their coverage. That policy’s been shown to prevent enrollees from falling out of the program for short periods because of hardships or paperwork problems, which can lead to surprise medical bills and debt. The Trump administration could seek to repeal waivers that allow states to grant multiyear continuous eligibility, which would require people in those states to reapply for coverage annually.
If the GOP’s plans to shrink Medicaid are realized, Democrats and health experts say, low-income people forced to buy private insurance would face challenges paying monthly premiums and the large copayments and deductibles common to commercial plans that typically don’t exist in Medicaid.
The Paragon Health Institute, a leading conservative think tank run by former Trump adviser Brian Blase, has issued reports saying the billions in extra money states took to expand Medicaid under the ACA has been a boon to private insurers that manage the program and relatively wealthier people it says shouldn’t be enrolled.
Josh Archambault, a senior fellow with the conservative Cicero Institute, said he hopes the Trump administration holds states accountable for overpaying providers and enrolling people in Medicaid who are not eligible. Conservatives have cited CMS reports saying states improperly pay Medicaid providers billions of dollars a year, though the federal government notes that is mostly due to lack of documentation.
He said the GOP will look to scale back Medicaid to its “traditional” populations of children, pregnant women, and people with disabilities. “We need to rebalance the program that most people think is underperforming,” he said. Most Americans, including large majorities of both Republicans and Democrats, view the program favorably, according to polls.
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having secured control of both chambers of the U.S. Congress and the White House starting in January, Republicans are making no secret of their intention to pursue sweeping healthcare cuts that would raise costs and imperil insurance coverage for millions of people across the country.
Rep. Jodey Arrington (R-Texas), chairman of the House Budget Committee, told reporters earlier this week that the GOP is looking to use the filibuster-evading reconciliation process to pursue cuts to "mandatory programs"—a category that includes Medicare, Medicaid, and Social Security.
Bobby Kogan, senior director of federal budget policy at the Center for American Progress, noted in response to Arrington's comments that Republicans attempted to cut both Medicaid and Affordable Care Act (ACA) tax credits that help enrollees afford health insurance.
The Republican Study Committee, of which Arrington is a member, proposed eliminating the ACA tax credits in its 2025 budget proposal—a move that could result in around 4 million peoplelosing insurance.
:{The tax credits are set to expire next year, meaning Republicans could just do nothing and allow them to lapse.
Last time Republicans had a federal trifecta, they tried and failed to fully repeal the ACA—an effort that sparked a wave of civil disobedience on Capitol Hill.
Both President-elect Donald Trump and House Speaker Mike Johnson (R-La.) said on the campaign trail that they're looking to try again.
"We're going to replace it," Trump said during his lone debate with Vice President Kamala Harris in September—while admitting that he did not have a fully formed alternative plan.
Johnson, for his part, said during a campaign stop in Pennsylvania last month that "healthcare reform's going to be a big part of the agenda." When a voter posed the question, "No Obamacare?" Johnson replied in the affirmative, "No Obamacare."
"The ACA is so deeply ingrained, we need massive reform to make this work," he added, "and we've got a lot of ideas on how to do that."
Sarah Lueck and Allison Orris of the Center on Budget and Policy Priorities wrote Wednesday that Trump's return to the White House and the GOP's capture of both chambers of Congress poses "big risks to people's ability to access and afford health coverage in Medicaid and the marketplaces."
"While Republicans have moved away from talking about their plans for changing health coverage in the U.S. as 'repeal,'" Lueck and Orris added, "Trump's first term and Republicans' recently released policy agendas suggest they may pursue policies that would have much the same result: higher costs for people, reduced access to care for vulnerable groups, and more people who are uninsured."
https://www.alternet.org/house-republicans-invoke-greg-abbott/
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twenty-two House Republicans have signed on to a motion filed in federal court requesting to be allowed to join Governor Greg Abbott in defending the Texas Republican against a federal government lawsuit alleging his 1000 feet of razor wire and floating buoys constructed of circular saw blades, designed to prevent migrants from crossing into the United States from Texas, are illegal.
They have invoked the Bible’s Book of Genesis, including Noah’s Ark, to make their case.
“In a motion filed on behalf of U.S. Rep. Jodey Arrington, R-Lubbock, and other GOP members, lawyers for the conservative Texas Public Policy Foundationhave asked to be part of the case and targeted how a key law is interpreted in it,” the Houston Chronicle reports.
The Texas Public Policy Foundation is the right-wing organization The New York Times last year profiled as “The Texas Group Waging a National Crusade Against Climate Action.”
RELATED: Supreme Court in Hand, Far Right Wing Prepares to ‘Take the Reins of Government’
The buoys, deployed on the Rio Grande river, may have led to the deaths of two migrants, possibly including a child.
Democratic U.S. Rep. Joaquin Castro of Texas called the buoys “barbaric,” and in video showed they are constructed of circular saw blades. In that video Congressman Castro also points to Governor Abbott’s razor wire fences.
Sawyer Hackett, a senior advisor to former Obama Cabinet Secretary Julián Castro, referred to the floating fences as “razor wire death trap buoys.”
“A key point to the Arrington group’s defense is whether the 1,900-mile Rio Grande should be defined as a navigable waterway despite being used by thousands of boats every year,” The Chronicle explains. “They point to a court case from 1870 that suggested that the term navigable waterway is intended to mean moving commerce from one state to another or to a different country and not just one where any small boat occasionally uses the river.”
READ MORE: Critics Blast Top US Conservative Think Tank President for Applauding Italy’s Election of ‘Neo-Fascist’ Prime Minister
That’s where the Bible and Noah’s Ark come in.
“Indeed, if one takes the Book of Genesis literally, then the entire world was once navigable by boats large enough to carry significant amounts of livestock,” the proposed amicus brief reads. “Under the federal government’s theory, these anecdotes would render any structure built anywhere in Texas an obstruction to navigationsubject to federal regulation.”
Governor Abbott has had a long partnership with theTexas Public Policy Foundation.
In 2016, as NCRM reported, Abbott while at the Texas Public Policy Foundation, unveiled a major policy plan toalter the U.S. Constitution, adding nine amendments,the result of which could have lead to same-sex marriage bans and anend of LGBTQ protections.
According to Congressman Arrington, the list of signatories to his amicus brief include: Rep. Jodey Arrington, Dr. Michael Burgess, Rep. August Pfluger, Rep. Brian Babin, Rep. Andy Biggs, Rep. Roger Williams, Rep. Lance Gooden, Rep. Beth Van Duyne, Rep. Jake Ellzey, Rep. Vern Buchanan, Rep.Chip Roy, Rep. Nathaniel Moran, Rep. David Rouzer, Rep. Pete Sessions,Rep. Ronny Jackson, Rep. Sam Graves,Rep. Clay Higgins, Rep. Michael Cloud,Rep. Keith Self, Rep. John Carter, Rep. Jeff Duncan, Rep. Kat Cammack.
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https://arrington.house.gov/news/documentsingle.aspx?DocumentID=1063
Watch the video above or at this link.
'Very scary': Former RNC staffer dishes on the more terrifying members of GOP's right-wing
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PRESS RELEASES
Arrington Leads Colleagues in Filing Texas Border Lawsuit Amicus Brief
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Washington, August 9, 2023
WASHINGTON, D.C. – Today, Rep. Jodey Arrington filed an amicus brief, with 21 Members of Congress – including House Border Security Caucus Co-Chairs Rep. Brian Babin and Rep. Andy Biggs – in opposition to the Biden Department of Justice suing the State of Texas for placing buoy barriers in the Rio Grande River.
“Sovereign states do not have to be passive victims of Biden’s border crisis and a failed federal government. Article IV Section 4 and Article I Section 10 of the Constitution grant Governor Abbott the explicit right to defend the border and protect Texans, and the construction of the buoy barrier is completely within his constitutional power and authority,” said Rep. Arrington. “Biden’s DOJ is stretching far and wide; this time,by using obscure laws and regulations to impede the Governor of Texas from protecting his citizens against the “imminent danger” and “invasion” of drugs and crime pouring into our state by terrorist drug cartels. I’m proud to lead this Amicus Brief in support of the Governor as he stands his ground on the firm foundation of the US Constitution and his sovereign right to secure the southern border and keep Texans safe.”
“Texas has worked tirelessly to fill the void left by this administration and defend us against the invasion taking place at our southern border,” said Congressman Brian Babin (TX-36), House Border Security Caucus Co-Chair. “The Lone Star State has the constitutional right to protect its borders in the wake of the president’s outright refusal to do so, and I fully support that effort.”
“It is the proper role for the courts to constrain the Biden Administration to the statutory limits set by Congress. In this case, the federal government has not offered sufficient evidence to support its injunction motion, which then must be denied,” said Robert Henneke, Executive Director and General Counsel for Texas Public Policy Foundation (TPPF).
“The way the Court decides this motion matters,” said Chance Weldon, Senior Attorney and the Director of Litigation for Center for the American Future at TPPF. “The Rivers and Harbors Act extends federal criminal jurisdiction over ordinary Americans well outside of the politically charged confines of this case. Given these stakes, it is not too much to insist that the federal governmentput some boots on the ground and collect actual evidence before it can claim jurisdiction.”
Background:
In early July, Texas placed a series of buoys in the Rio Grande River to deter illegal immigrants from crossing the border.
Rep. Arrington as long argued that states have the sovereign right to defend the border when the federal government fails to do so.
For the past two congresses, Arrington has introduced legislation affirming Texas’ right to defend its sovereignty, protect its citizens, and enforce the law.
Last month, Arrington led a press conference with his Texas colleagues emphasizing Texas’ right to protect their border from invasion.
On July 24th, the Biden Administration Department of Justice filed a lawsuit against Texas, claiming Governor Abbott violated federal law by installing the buoys and asked a judge to order the defendants to “promptly remove the unauthorized obstruction.”
The DOJ’s lawsuit cites the Rivers and Harbors Appropriation Act of 1899, which bars the “creation of any obstruction not affirmatively authorized by Congress, to the navigable capacity of any of the waters of the United States,” and claims Governor Abbott failed to obtain a permit through the U.S. Army Corps of Engineers before installing the buoys.
Rep. Arrington’s Amicus Brief outlines the following points:
The federal government is one of limited and enumerated powers. Unlike the states, which have general police powers, the federal government must point to an explicit grant of authority from the Constitution when it chooses to regulate.
The Department of Justice has failed to provide sufficient evidence that the Rivers and Harbors Act explicitly grants the federal government the authority to stop Texas from constructing buoy barriers.
The Department of Justice’s attempt to argue that a decades-old deeming of the Rio Grande River as “navigable” should hold true today is unserious and insufficient.
Read the full text of the brief here.
List of signers: Rep. Jodey Arrington, Dr. Michael Burgess, Rep. August Pfluger, Rep. Brian Babin, Rep. Andy Biggs, Rep. Roger Williams, Rep. Lance Gooden, Rep. Beth Van Duyne, Rep. Jake Ellzey, Rep. Vern Buchanan, Rep. Chip Roy, Rep. Nathaniel Moran, Rep. David Rouzer, Rep. Pete Sessions, Rep. Ronny Jackson, Rep. Sam Graves, Rep. Clay Higgins, Rep. Michael Cloud, Rep. Keith Self, Rep. John Carter, Rep. Jeff Duncan, Rep. Kat Cammack
https://acrobat.adobe.com/link/review?uri=urn%3Aaaid%3Ascds%3AUS%3Abf7d2f17-a55c-49d5-a924-fab4ba08c6df
IN THE UNITED STATES DISTRICT COURT FOR THE WESTERN DISTRICT OF TEXAS AUSTIN DIVISION UNITED STATES OF AMERICA, Plaintiff, v. GREG ABBOTT, in his capacity as GOVERNOR OF THE STATE OF TEXAS, and THE STATE OF TEXAS,
Defendants. Case No. 1:23-CV-00853-DII
MOTION OF UNITED STATES REPRESENTATIVES JODEY C. ARRINGTON, ET AL FOR LEAVE TO FILE AN AMICI CURIAE BRIEF IN OPPOSITION TO PLAINTIFF’S MOTION FOR PRELIMINARY INJUNCTION Pursuant to Local Rules CV-7 Amicus Curiae, twenty members of the United States Congress, respectfully request leave to file the accompanying short amicus curiae brief (Ex. 1) in opposition to the Plaintiff’s Motion for Preliminary Injunction. Amici have reached out to the parties in this case. Defendants consent to the filing
...
MOTION OF UNITED STATES REPRESENTATIVES JODEY C. ARRINGTON, ET AL FOR LEAVE TO FILE AN AMICI CURIAE BRIEF IN OPPOSITION TO PLAINTIFF’S MOTION FOR PRELIMINARY INJUNCTION
Pursuant to Local Rules CV-7 Amicus Curiae, twenty members of the United States Congress, respectfully request leave to file the accompanying short amicus curiae brief (Ex. 1) in opposition to the Plaintiff’s Motion for Preliminary Injunction. Amici have reached out to the parties in this case. Defendants consent to the filing of this brief. Plaintiff takes no position. Amici take no position on the ultimate merits of this case. Instead, Amici seek to file a short brief regarding the proper test that this Court should apply when interpreting the Rivers and Harbors Act. As members of Congress, amici have a strong interest in ensuring that federal administrative agencies are bound by the text of Congressional statutes. This is particularly important when, as here, the statute at issue contains a jurisdictional element tying federal authority to Congressional power under the Commerce Clause. Moreover, amici represent constituents who live and work adjacent to rivers and streams. These ordinary Americans are also subject to Rivers and Harbors Act— a statute with both civil and criminal penalties. Amici therefore have a strong interest in ensuring that federal agencies do not adopt an over-broad reading of the statute. Finally, Amici’s counsel, the Texas Public Policy Foundation, has substantial experience litigating the meaning of the term “navigable waters,” and the scope of the Commerce Clause. See, e.g., BST Holdings, L.L.C. v. OSHA, 17 F.4th 604 (5th Cir. 2021) (Commerce Clause); Terkel v. CDC, 521 F. Supp. 3d 662 (E.D. Tex. 2021) (Commerce Clause); Orchard Hill Bldg. Co. v. United States Army Corps of Eng'rs, 893 F.3d 1017 (7th Cir. 2018) (navigable water). The attached amicus brief would therefore aid the Court in deciding these important issues. Because this brief is filed simultaneously with Defendants’ response, the brief is timely and neither party will be prejudiced. Amici therefore respectfully request leave to file the attached amicus curiae brief.
/s/Chance Weldon ROBERT HENNEKE TX Bar No. 24046058 rhenneke@texaspolicy.com CHANCE WELDON TX Bar No. 24076767 cweldon@texaspolicy.com TEXAS PUBLIC POLICY FOUNDATION 901 Congress Avenue Austin, Texas 78701 Telephone: (512) 472-2700 Facsimile: (512) 472-2728 Counsel for Amici Curiae