On Tuesday the U.S. House of Representatives passed their budget resolution by a vote of 217-215 along party lines. The resolution calls for $880 billion in cuts to health care to pay for tax cuts for wealthy people and big corporations. There had been some hope that some Republican members were concerned enough about Medicaid cuts to vote against the bill. Unfortunately, they decided to vote for the bill, putting health coverage for their constituents at risk. This was a disappointing outcome after advocates and constituents spent weeks making calls and sending emails to ask members of Congress to vote against the resolution and protect people’s health care. However, it is just the beginning of the process.
Congress is using a process known as reconciliation to pass their budget. This is a tool Congress can use when it wants to pass legislation with only a simple majority, avoiding filibuster rules in the Senate that require 60 votes to pass most legislative changes. There are rules that govern what changes can be passed through reconciliation, the most important being that all provisions must have an impact on the budget – either increasing or decreasing spending or revenue. Reconciliation is often used when one party controls Congress and wants to pass legislation without needing votes from the other party. It is the same process that was used to finalize the Affordable Care Act (ACA) in 2010.
The House vote is just one step toward passing their policy agenda. The Senate must agree and pass the same budget resolution. Next, key committees must draft policy proposals to meet the spending targets put forward in the budget. Then, both the House and the Senate must pass these proposals.
The House budget resolution instructs the House Energy and Commerce Committee, which oversees the largest health care programs (Medicare, Medicaid, and the ACA subsidies) to find savings (cuts) worth $880 billion. This is nearly half of all the cuts proposed in the budget resolution overall. Because House leadership indicated that Medicare cuts were off the table almost all of it would have to come from Medicaid. There is simply no way to cut this extraordinary amount of money from Medicaid without broad changes that will fundamentally gut the program. States will face impossible budget demands, and health care will be ripped away from millions of people across the country.
Cuts could jeopardize access to life-saving care for everyone enrolled in Medicaid. In Massachusetts, Medicaid, known as MassHealth, covers 1 in 3 residents, including nearly half of children and over 500,000 seniors and people with disabilities. It accounts for half of all nursing home and health center revenue. Losing Medicaid coverage would significantly raise costs for people, squeezing family budgets and forcing many into medical debt and even bankruptcy.
Medicaid cuts also threaten the financial stability of health care providers including hospitals, nursing homes, health centers and mental health clinics, potentially forcing them to scale back services or even close. Medicaid is the largest source of federal revenue to the state, so any cuts to Medicaid would have an immense impact on the state budget. State leaders would need to make impossible decisions about what to fund – not only health care, but also other important priorities like education or housing. A cut to Medicaid is a cut to health care jobs, access to providers and economic stability for everyone.
However, this isn’t over yet. Only two or three legislators need to change their position to stop these Medicaid cuts. All of the members of the Massachusetts Congressional delegation opposed the House budget resolution, but we need everyone to speak out about the impact these cuts would have. Each step in the budget reconciliation process is an opportunity to change votes by making the stakes clear to members of Congress. Continue to follow HCFA for information about how you can get involved by signing up for the newsletter and following us on social media – we’re on Facebook, X and Instagram.
Alex Sheff is HCFA’s Senior Director of Policy & Government Relations
Suzanne Curry is HCFA’s Director of Government Initiatives