Five Reasons Republicans Won’t Cut Medicaid (Much) – Billy Wynne/HealthAffairs
Dear President Trump, Congress, and DOGE: Ignorance is no defense. Chopping down Medicaid will hurt not just the poor – but people who can fight back.
Like most analyses of Medicaid spending, the excellent article above by a former Hill staffer focuses on Medicaid’s critically important role in providing medical care for low-income Americans. Lopping off about 10% of Medicaid’s budget over 10 years would be devastating for many of these people. The points he and others make would be even stronger if they mentioned that most Medicaid spending still goes toward home and institutional care for elderly and disabled people. Medicaid spending on long-term care in nursing homes, group homes, and at home functions as a silent form insurance against destitution for most families.
Politicians may be underestimating the potential damage and resulting backlash from middle-class and even highly-paid professional citizens whose family members are protected by Medicaid from financial ruin. It’s one thing to cut medical care for poor people who lack the power to fight back. It’s another to antagonize middle- and professional-class families that rely on Medicaid from protection from destitution and living on the street.
Americans at age 65 have about a 70% chance of needing serious and expensive long-term care before they die and a 20% chance of needing more than five years of it. Most Americans do not know that Medicare does not cover long-term care and that they must pay for nursing home and other such services before spending down to income and asset levels to qualify for Medicaid.
People can’t be blamed for not knowing all of the complex ways that Medicaid protects them. But ignorance will be no defense if someone unexpectedly has a stroke or develops Alzheimer’s disease requiring hundreds of thousands of dollars in services and housing. Ignorance will be no defense for elected officials from the political consequences of cutting vital services and financial protection for all but the wealthiest American families.