WASHINGTON – Proposed cuts to Medicaid, the public health insurance program for Americans with disabilities or limited incomes, are generating significant debate in Congress. A recent discussion featured health economist Lindsay Allen from Northwestern University’s Feinberg School of medicine, offering insights into the potential consequences of thes cuts.

A Martínez spoke with Lindsay Allen about the Congressional Budget office (CBO) estimates, which project a deficit reduction of approximately $625 billion but also suggest that up to 10.3 million people could lose coverage over the next decade. Martínez questioned whether this “gamble” is worthwhile.

ALLEN responded, “I don’t know that I can say the gamble is worthwhile because the CBO estimates actually rely on some pretty big assumptions.One of them is assuming that the states are going to somehow replace the lost federal funding, and that’s something that manny of the states just can’t or won’t do. So in practice, the cost burden is just shifting to states and local governments and hospitals and families, and we suspect that more people are going to lose coverage than the CBO estimated.”

MARTÍNEZ followed up, “So ultimately, you’re saying someone has to pay.”

ALLEN affirmed, “Absolutely. It just shifts the burden of paying for that care to someone else.”

The Ripple Effect of Coverage Loss

ALLEN elaborated on the broader implications for Medicaid recipients who might lose coverage,emphasizing the impact on both their health and financial stability. “Medicaid is a health and economic engine. And so when you receive Medicaid, you end up being able to get care for conditions that need treating. So if you lose Medicaid,you don’t end up actually having that need for care go away,” she explained.

“It just shifts the burden of paying for that care to someone else.”

Work Requirements and Red Tape

One specific proposal involves requiring able-bodied adults without dependents to demonstrate they are working or training for a job to maintain Medicaid coverage.MARTÍNEZ asked how this requirement could affect coverage.

ALLEN responded, “Well, that sounds splendid, in theory. But something like 91% of the individuals that this bill would be targeting with work requirements are caring for family, they’re in school, or they’re dealing with health issues that aren’t always visible or formally diagnosed. So the policy is not really changing behavior. It’s just stripping coverage from people who are already contributing in ways that the system just doesn’t recognize.”

MARTÍNEZ cited Georgia’s push for work requirements under Governor brian Kemp and Arkansas’s implementation in 2018, questioning the outcomes in those states.

ALLEN noted, “What we’ve seen, so especially in Arkansas and now, more recently, Georgia, is that the coverage loss is happening not because people aren’t eligible, but because they get stuck in paperwork. So the red tape is dense and confusing, especially for people who are juggling multiple jobs, or they’re caregiving, or they’re dealing with their health issues.”

Choice Solutions for Streamlining Medicaid

MARTÍNEZ inquired about alternative strategies to streamline Medicaid and better serve vulnerable beneficiaries without significantly reducing access to care.

ALLEN suggested, “Sure. So if we want to cut Medicaid costs without hurting people, the data point us toward things like reducing prescription drug prices or cracking down on high-cost, low-value care, or investing in preventive services that are what actually lower long-term costs – unlike policies that just cut people off.”