Medicaid Expansion

Political battles are usually won based on appealing to emotion, not to facts, policy or logic.

However, you should still have those facts at your disposal for two reasons: First, they still help you craft appeals to emotion. Second, they also help you craft the actual policy. Besides, I'm a data guy; my primary job is to help put facts & policy into easily-understandable context.

Over the past couple of months I've compiled a master spreadsheet breaking out enrollment in ACA plans (Qualified Health Plans & Basic Health Plans), Medicaid/CHIP coverage (both traditional & via ACA expansion) and Medicare (both Fee-for-Services & Advantage) at the Congressional District levels.

via NY State of Health:

  • Republican-Passed Bill Would Gut New York’s Healthcare System 
  • Estimated Loss of $13.5 Billion Every Year, Devastating Our Healthcare System 
  • 1.5 Million New Yorkers To Lose Healthcare Coverage and Become Uninsured; Over $3 Billion in Losses for New York’s Hospitals

Governor Kathy Hochul today was joined by the Democratic Leader of the U.S. House of Representatives Congressman Hakeem Jeffries and leaders in the health care and labor sectors to sound the alarm on the detrimental effects of several healthcare provisions already passed by the House of Representatives in the Republican budget reconciliation bill. These provisions collectively amount to an annual loss of nearly $13.5 billion for New Yorkers and our healthcare sector, jeopardizing healthcare access for millions of New Yorkers and threatening the state’s hospitals and healthcare providers. 

“Republicans in Washington have made it abundantly clear that they are determined to dismantle the social safety net that millions of New Yorkers rely on to secure their basic necessities,” Governor Hochul said. “They are specifically targeting essential and life-saving programs such as Medicaid and food stamps with the consequence that everyday Americans will bear the brunt of this attack. I am committed to utilizing litigation and other appropriate tools to safeguard and protect New Yorkers.” 

Over the past month or so, as Congressional Republicans have pulled out all the stops in their attempt to ram through their budget bill which would gut Medicaid and ACA exchange enrollment (along with SNAP and numerous other desperately-needed social aid programs), you may have noticed that they keep using an oddly specific talking point:

Mike Johnson: Medicaid Is Not for 29-Year-Old Males Sitting on Their Couches Playing Video Games

--CNN, February 27, 2025

Mike Johnson on Medicaid: "What we've talked about is returning work requirements ... you return the dignity of work to young men who need to be out working instead of playing video games all day. We have a lot of fraud, waste, and abuse in Medicaid."

Welp. House Republicans did indeed follow through with passing their horrific (and disgustingly-titled) "One Big Beautiful Bill" Act which will effectively repeal the bulk of the ACA without officially repealing it, and that's just for starters.

The final vote was 215 - 214, with every Republican except a handful voting for it (and the two who voted against it openly admitted to the NY Times that they would have voted for it if their votes had been needed), and every Democrat voting against it. There were 2 Republican "no" votes...but both of those were only because they wanted the final bill to be even more draconian.

The Congressional Budget Office projected the bill, if enacted, will result in at least 13.7 million more Americans losing healthcare coverage (and that was based on a prior version of the bill; the new version is even more extreme).

There's so many awful things included in the bill, many of which are of course healthcare-related, and it would take hundreds of blog entries to discuss them all...but I want to focus on one in particular.

 

Pennsylvania Democratic Representative Brendon Boyle, on MSNBC last night:

Rep. Boyle: The one thing I would point out, though, is this bill is actually significantly worse [than the GOP's ACA repeal attempt in 2017], because this piece of legislation will throw 13.5 million, almost 14 million Americans off their healthcare.

First, you're cutting people off Medicaid. But second, this does include very deep cuts to Obamacare as well. And finally, I have breaking news for you tonight, that literally just came out in the last few minutes as I've been sitting here: The nonpartisan Congressional Budget Office, the official authority on these figures, has now confirmed that this bill, in addition to Medicaid cuts, in addition to Obamacare cuts, includes $500 BILLION WORTH OF CUTS TO MEDICARE that is now in this bill as well.

via Covered California:

La versión en español de este Declaracion puede ser descargada en este enlace.

Covered California expresses deep concern regarding the proposed health provisions in the reconciliation bill moving through the House of Representatives.

If enacted, the legislation would have devastating consequences to the health, well-being and financial security of hundreds of thousands of Californians who would lose access to affordable health insurance. It would also lead to greater strain on the health care system and increased costs for individuals and businesses throughout the state.

via New York State of Health:

  • Estimated Nearly $13.5 Billion Loss Annually For New Yorkers and Our Healthcare Economy 
  • Nearly 1.5 Million New Yorkers Could Lose Essential Plan or Medicaid Coverage And Become Uninsured 
  • Governor Hochul Demands Republican Members of Congress Oppose These Cuts and Protect Their Constituents 

Governor Kathy Hochul today updated New Yorkers on the harmful effects of several healthcare provisions already passed from the House Ways & Means and Energy & Commerce committees for the Republican budget reconciliation bill. These provisions collectively amount to an annual loss of nearly $13.5 billion for New Yorkers and our healthcare sector, jeopardizing healthcare access for millions of New Yorkers while imperiling the state’s hospitals and other healthcare providers. 

So, the Congressional Budget Office has published updated estimates of the budgetary impact of the House Republican budget plan (officially called the "One Big Beautiful BIll Act" (seriously); more appropriately called the #MedicaidMassacre bill by certain individuals (ahem) were to pass & be implemented.

In addition to all the dollar amounts tossed around, however, the spreadsheet also includes some important footnotes, including the following (h/t Larry Levitt of KFF for the heads up):

Under the Title IV - Energy & Commerce tab is this:

UPDATED 5/22/25: Welp. House Republicans did indeed follow through with passing their horrific (and disgustingly-titled) "One Big Beautiful Bill" Act which will effectively repeal the bulk of the ACA without officially repealing it, and that's just for starters.

The final vote was 215 - 214, with every Republican except a handful voting for it (and the two who voted against it openly admitted to the NY Times that they would have voted for it if their votes had been needed), and every Democrat voting against it. There were 2 Republican "no" votes...but both of those were only because they wanted the final bill to be even more draconian.

The Congressional Budget Office projected the bill, if enacted, will result in at least 13.7 million more Americans losing healthcare coverage (and that was based on a prior version of the bill; the new version is considered even more extreme).

Last week I wrote about the latest state of play regarding House Republicans so-called "big beautiful bill" to gut Medicaid in order to give fat tax cuts to billionaires. Yesterday the first official version of the legislative text was released, and it's pretty much as ugly as you might expect.

Here's some basics, via Nathaniel Weixel & Joseph Choi of The Hill:

...The plan caters more to the moderate wing of the Republican party by omitting two of the biggest and most politically controversial proposals discussed: a per-capita cap on people who get coverage from Medicaid expansion, and a direct lowering of the federal matching rate.

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