Millions could lose Medicaid coverage, even in best scenario, report says

Hospitals have been warning that changes to Medicaid programs would mean millions of Americans would lose coverage in the near future, and a new analysis offers an estimate on how many would be affected.

As many as five to 10 million Americans would lose coverage from Medicaid in 2028, according to a report released Wednesday by the Urban Institute and the Robert Wood Johnson Foundation.

Between 3 million and 7 million could lose Medicaid coverage due to new work requirements, while 2 million to 3.1 million will lose coverage due to their eligibility being checked more frequently, the report states.

Researchers also expect fewer people getting coverage under the Affordable Care Act after the expiration of tax subsidies, with enrollment falling 27-55%.

Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation, said in a statement accompanying the report that older adults, those who are self-employed and those with mental and physical health conditions are especially at risk of losing coverage.

“Even in a best-case scenario, work requirements will cause millions of people to lose their Medicaid coverage, and if states do not implement the law with care, that number could double,” Hempstead said in a statement.

Matthew Buettgens, senior fellow at the Urban Institute, said many who qualify for Medicaid, including some meeting work requirements, may have trouble submitting the needed paperwork.

“The Medicaid coverage of several million people will depend on state implementation choices and federal guidance that help ensure that people are not wrongfully denied coverage or disenrolled,” Buettgens said in a statement accompanying the report.

‘An enormous concern’

President Trump and Congress approved legislation known as HR 1 that reduces Medicaid spending by $1 trillion over the next decade. The Congressional Budget Office has projected millions could lose coverage.

Hospitals and health systems have said the cuts will mean they will see more patients without insurance, even as they expect less aid from Medicaid programs. Hospital executives warn that some health systems may have to reduce services or possibly close facilities.

Rick Pollack, president and CEO of the American Hospital Association, talked about the impact of cuts in Medicaid at a hearing before the House Energy & Commerce Committee last week.

“We've been very vocal in expressing our concerns relative to the impact of the significant Medicaid cuts that are now coming down the pike,” Pollack said. “And so it's an enormous concern.”

Pollack told Chief Healthcare Executive® in an interview last month that Medicaid cuts will hurt access to care for everyone, with more uninsured patients arriving in emergency departments for care.

“As a practical reality, they all end up at our ED doors in many ways, and that's not good for not only the patients from a care perspective, but it affects everyone, and not just Medicaid beneficiaries,” Pollack says.

‘Permanent new reality’

Robert E. Andrews, chief executive officer of the Health Transformation Alliance, told Chief Healthcare Executive in an interview this week that the Medicaid cuts are going to place more pressures on hospitals, especially as they see more uninsured patients.

“They have to continue to provide care to whomever comes into the emergency room,” Andrews says. “They’ve got to treat them, but the revenue to support those patients isn't there. And so I think that's an unfortunate but fairly permanent new reality.”

Dr. Georges Benjamin, CEO of the American Public Health Association, says cuts to Medicaid are going to pose big challenges. Benjamin ran Maryland’s Medicaid program as the state’s health secretary, and he says Medicaid programs aren’t funded sufficiently now. Now, states will have to figure out what areas will be cut.

With provider payments being cut, he told Chief Healthcare Executive® in an interview last week, “Less providers will be in the program, which ultimately becomes an access problem.”

“If you remove people from the program, that creates an access problem. And then, if you cut benefits, that creates an access problem,” Benjamin says.

The Trump administration has said it wants to focus more on preventing illness than treating people in hospitals. But Benjamin says the Medicaid cuts will leave more Americans without access to doctors, raising the risk that they end up in hospitals with more advanced conditions that could have been treated sooner.

“The problem is right diagnosis, wrong therapy, wrong solutions, wrong health policy,” Benjamin says. “You can't say you want to do more primary care and cut a trillion dollars out of the Medicaid program.”

Medicaid also supports services in schools, support for those with disabilities, and many of those in America’s nursing homes.

“Individuals in nursing homes are funded through the Medicaid program,” Benjamin says. “So it's not just moms and kids, it's not just low-income men who are working, or singles. It's also long-term care. And you know that's going to be another problem.”

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