The Breakthrough
What, Who, Why, and How?
Basic facts about what is happening in the US government, in plain language
Written by DNWML Community Engagement Coordinator, Eliot Carter
Issue 1: The Future of Medicaid
What?
Medicaid is a government program that helps people get health care even if they don’t have a lot of money. Medicaid also does other things, like paying for transportation to get to work and doctor’s appointments, and paying for the workers that come to people’s homes for health care and other things. About 15 million people with disabilities (35% of people with disabilities) in America use Medicaid. (1)
Who?
There are lots of people who are using their power to try to change how Medicaid works. A new president gets to choose people to run different parts of the US government, usually called agencies or departments. President Trump picked Dr. Mehmet Oz to run the Centers on Medicare and Medicaid Services, also called CMS. President Trump is also getting help from Elon Musk to achieve his goal of reducing the amount of money the US government spends on its people. However, it is congress (not the president) that has the power to control how the money the US government has is spent.
Since the US government does a lot of things, congress has a lot of committees, or smaller groups of congressmembers, to focus on specific issues. The committee that has the biggest role in deciding what happens with Medicaid is the House Committee on Energy and Commerce. The Chairman of this committee is Rep. Brett Guthrie, a Republican from Kentucky. There are two congressmembers from Michigan who are on this committee – Rep. Debbie Dingell, who is a Democrat, and Rep. John James, who is a Republican.
Why?
Survey data shows that most people think Medicaid is a good program. (2) Sometimes the president and Dr. Oz say they will cut Medicaid spending and other times they say they will not. What we know is that President Trump has requested that the Committee of Energy and Commerce cuts how much they spend by $88 billion a year for the next 10 years. Since this is such a large amount, some money will have to come out of Medicaid or Medicare. The White House has said they will not cut Medicare spending, so it is likely that most of this money will be taken away from Medicaid.
The main reason that the president wants to take away so much spending is because he wants to keep taxes low for large businesses. Taxes are how governments get money to fund things like Medicaid. President Trump needs to reduce the amount of money that the government spends, because if taxes are lowered for people and businesses that make a lot of money, the government will have less money to do the things it normally does.
How?
$880 billion (the total amount the president wants to cut) represents 10% of what Medicaid would spend over the next 10 years. This might not sound like a lot at first, but since Medicaid is such a big program, it will affect millions of people. Disability advocates are worried about Home and Community Based Services (HCBS) going away because the law says it is an optional Medicaid program. However, HCBS is the difference between a person with a disability being able to live in their own community or being forced to live in an institution.
Only part of the money that Medicaid uses comes from the US (federal) government. It is a “cost-sharing” program between the federal government and each state’s government. That means Medicaid money comes from both the US budget and each state’s budget. The federal government pays for more than half of all Medicaid services in Michigan. The portion that comes from the federal government is called the FMAP, or Federal Medical Assistance Percentage. One way the federal government could reduce Medicaid spending is by reducing the FMAP. This means states will have to pay a higher percentage to keep up with the current needs of Medicaid. States will not be able to make up for this difference without cutting other state funds or raising taxes, so they will likely have to eliminate many Medicaid programs like HCBS.
Another way the government could reduce Medicaid spending is by telling states in advance how much money the federal government will give them to use on Medicaid services. This is called a block grant. So, instead of the government saying, “we will pay for about 70% of how much Michigan spends on Medicaid in a year,” it would say “here is how much money we will give you to spend on Medicaid, and we will not give you any more than that.” Because this administration’s goal is reducing overall spending, it is very likely that states will have a lot less money to spend on their Medicaid programs like HCBS. The Michigan Department of Health and Human Services has released a report that goes into more detail about the different ways the federal government could reduce Medicaid spending and how that would impact Michiganders. You can read it at this link.
How can you take action?
More people, especially people in the government, need to know how important Medicaid is to people with disabilities. If you use Medicaid, you can call or write to your representative to tell them how Medicaid helps you in your daily life. The Autistic Self Advocacy Network (ASAN) has a guide on talking to calling and emailing your elected officials about Medicaid. Check it out here: Link to ASAN Medicaid Action Alert
Disability Network Washtenaw Monroe Livingston wants to help you connect with your legislators. Representatives come home throughout the year, and many will hold public meetings, or “coffee hours.” We can also help you prepare for these meetings or try to set up an appointment to talk to your legislator. Call our office and ask for Eliot to start your advocacy journey!
Yours in the struggle,
Eliot
1 5 Key Facts About Medicaid Coverage for People with Disabilities | KFF