If Trump cuts Medicaid, Texas officials may seize the chance to further reduce the program
Texas leaders have long shown opposition to Medicaid, the federal-state health insurance program that supports millions of low-income and vulnerable residents.
The state rejected additional federal funds under the Affordable Care Act that would have expanded Medicaid to more low-income families. Texas was also one of the last states to provide year-long health coverage for women after childbirth. When the federal government ended the pandemic-era policy that kept people on Medicaid rolls, Texas quickly began removing people it deemed ineligible, despite warnings that the rapid process could cause wrongful removals.
With Donald Trump set to return to the presidency in January, Texas leaders may again have an opportunity to further reduce Medicaid, this time with fewer restrictions.
While Trump has not announced any plans to cut Medicaid, which covers about 80 million Americans, his previous efforts to scale back the program, along with the positions of conservative groups and GOP lawmakers, suggest Medicaid could face severe cuts.
Joan Alker, executive director of Georgetown University’s Center for Children and Families, said, “We expect the Republicans to move very quickly to cut Medicaid dramatically and indeed end its guarantee of coverage as it exists today.”
Currently, the federal government covers nearly 70% of Medicaid spending, with states responsible for the rest. Cuts to federal funding would likely lead states to shrink the number of people they cover and the services available, experts warned.
This would be especially harmful in Texas, which already has one of the lowest percentages of residents covered by Medicaid. State officials are unlikely to make up the funding gap with state money. For example, a family of four must earn less than $285 per month to qualify for Medicaid.
Adriana Kohler, policy director for Texans Care for Children, a statewide nonprofit, said, “Our elected officials would have to decide whether they want to cut health care for pregnant women, kids, people with disabilities, or seniors because that is essentially who Medicaid covers in Texas.”
Spokespeople for Gov. Greg Abbott and the state’s Health and Human Services Commission did not respond to multiple requests for comment. Abbott, during his time as attorney general, helped lead a lawsuit that prevented states from losing Medicaid funding entirely if they did not expand coverage under the Affordable Care Act.
Even when Texas provides Medicaid coverage to vulnerable residents, the system often creates significant barriers to care. A 2018 investigation found that insurance companies hired by Texas to manage Medicaid benefits regularly denied expensive treatments to cut costs. Despite reforms prompted by the investigation, critics say issues with the system persist.
Texas insures more than 4 million residents through Medicaid, covering a smaller percentage of its population than nearly every other state. However, it ranks third in the nation for the number of people covered by the program, behind California and New York. Medicaid serves 3 in 8 children, 3 in 5 nursing home residents, and 2 in 7 people with disabilities in Texas. It is the largest funder for nursing homes, long-term care for the disabled and elderly, and nearly half of all births in the state.
Michael Morgan, a 75-year-old retired nurse in Fort Worth, worries that if Trump limits federal spending on Medicaid, Texas could make it even harder for his daughter Hannah to get coverage. She has Down syndrome, schizencephaly, and other severe disabilities. Morgan is using his savings to cover her health care expenses after she lost Medicaid coverage at 19. State officials denied her new application in November, arguing that Morgan missed the deadline for submitting necessary paperwork, even though he received the form the day before it was due.
“I don’t know how much more they can cut it,” he said of Medicaid in Texas.
During his first term, Trump attempted to repeal the Affordable Care Act, which provides health coverage to 45 million Americans. His administration also backed Medicaid spending caps, including block grants that would give states a fixed amount of federal funding regardless of need. Currently, Medicaid covers all eligible individuals, no matter the cost.
While these efforts did not gain traction in Trump’s first term, with Republicans holding majorities in both the House and Senate in January, they are expected to push for Medicaid cuts. Some conservatives, like U.S. Sen. John Cornyn and U.S. Rep. Jodey Arrington, have supported these measures. GOP policy recommendations, including those from the Heritage Foundation and the Republican Study Committee, also call for cutting Medicaid.
Arrington, who has pushed for work requirements and reductions in federal Medicaid spending, has suggested capping Medicaid funding by $1.9 trillion. He has also advocated for requirements that most adults on Medicaid hold jobs. However, research on work requirements in Arkansas found that many Medicaid recipients were already working or qualified for exemptions, but the mandate still caused thousands to lose coverage.
Cornyn, while opposing cuts to Medicare or Social Security, has indicated he may support cuts to Medicaid, suggesting that block grants would make sense.
William T. Smith, a 65-year-old retired construction worker in Brownsville, said he voted for Trump because he supports cutting unnecessary programs. However, he believes Medicaid should not be a target for cuts. Smith, who has chronic obstructive pulmonary disease, bipolar disorder, and other health conditions, is still trying to obtain Medicaid coverage and thinks the federal government should find savings elsewhere to expand care.
“I don’t think they’re going to yank health care away from people,” he said. “If they do, I’d be really angry.”
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