Republicans are struggling to get the votes they need to pass Trump’s budget bill. They have a narrow majority in the House of Representatives, and they need almost every Republican vote to put the bill through. Much of the debate focuses on the fate of Medicaid.
Medicaid and Medicare are often confused. Medicare is health insurance for senior citizens, funded by their lifetime deductions from their income. Medicaid is health insurance for low-income persons.
Trump and most of the party want to cut Medicaid to pay for the Trump tax cuts, which are focused on high-income individuals and corporations. Even with deep cuts to Medicaid, the tax cuts will increase the deficits.
Lisa Desjardins of PBS assembled a fact sheet about Medicaid.
LET’S TALK ABOUT MEDICAID
By Lisa Desjardins, @LisaDNews
Correspondent
Hello from just outside the chambers of House Speaker Mike Johnson.
I am waiting with a handful of other reporters as a small group of House Republicans try to work out a compromise over the party’s “One, Big, Beautiful Bill.” (I am looking for a shorthand for the bill, perhaps OB3?)
Republicans do not have the votes for this — yet. But they could agree at any point in the next day or two. If not, they face a weekend standoff or the possibility of leaving for Memorial Day recess without the progress Johnson has promised.
There is much at stake here. We’d like to pull off one major piece and break down some highlights. Let’s talk about Medicaid.
The basics
- Medicaid is the federal health care program for low-income Americans.
- Close to 71.3 million Americans get their health care this way.
- CHIP is the Children’s Health Insurance Program, which, along with states, provides health care for kids whose families can’t afford health care but earn too much to qualify for Medicaid.
- Nearly 7.3 million American kids are enrolled in CHIP.
- Income thresholds: As this chart by the Kaiser Family Foundation shows, it varies by state and can vary on whether you have children or are pregnant.
- Medicaid expansion is a program in which the federal government pays 90 percent of the cost for any state that expands Medicaid to include those making up to 138 percent of poverty. In 2025, that is $21,597 a year for individuals or $44,367 for families of four.
- 40 states (plus Washington, D.C.)have Medicaid expansion.
The funding
We are about to get really nerdy.
The federal government and states share the costs of Medicaid. But the rate of federal sharing varies by state, based on a formula.
Something called FMAP, the Federal Matching Assistance Program, helps determine how much each state gets, based on the state’s average income level. These range from a 50 to 77 percent match in the states.
But that match rate is just one half of the formula. The other is how much states spend. Medicaid is often the largest single expenditure for any state. The largest portion of money comes from the state’s general fund or general budget.
But states also use something called a “provider tax,” which is a fee charged on health care providers. Think nursing homes or hospitals.
Here is the thing about the provider tax. It is a system whereby states can actually profit.
Think about it this way. States charge hospitals and nursing homes a fee. They spend that fee on Medicaid, upping the amount the federal government must match. (More state spending triggers more federal match.) And then those federal dollars go back to the state and to the providers, as people get care. So states and providers don’t lose money, in theory.
But they trigger more federal matching.
Why it matters
Fiscal conservative holdouts who oppose the current “One Big Beautiful Bill” want action on these provider taxes and potentially on the FMAP level.
But the latest draft instead reforms Medicaid primarily by setting up new work requirements for “able-bodied” people, or those without disabilities, in the program. That requirement is currently set to phase in over the next two years.
Per the Congressional Budget Office, this Republican Medicaid plan would lead to 8.6 million Americans losing their health insurance over the next decade.
(Changes to the Affordable Care Act would lead to millions more losing coverage, per CBO.)
Republicans argue that these are programs the United States cannot afford.
And all of it revolves around precisely how Medicaid works, and how states pay for it.
Diane Ravitch's blog 
THE PROBLEM IS that most people who have Medicaid-funded health insurance DON’T EVEN KNOW that they have Medicaid insurance because each state has different names for their Medicaid-funded insurance — So, if you want people to become angry about Medicaid cuts, YOU NEED TO SHOW THEM that their health insurance is Medicaid-funded.
Democrats need to tell their constituents the name that Medicaid-funded insurance goes by in their state so that they are aware of — and angry about and can protest to Congress about — the looming cuts to Medicaid.
If voters don’t know that their state-provided health insurance is funded by Medicaid, then they don’t care about cuts to Medicaid, and Democrats are just wasting their breath blathering on about cuts to Medicaid.
Here’s a state-by-state list of Medicaid-funded insurance plans:
ALABAMA — Alabama Medicaid
ALASKA — DenaliCare, Alaska Comprehensive Health Insurance
ARIZONA — Freedom to Work, Arizona Health Care Cost Containment
ARKANSAS — ARKids B, ARHOME, TEFRA, Provider-Led Arkansas Shared Savings
CALIFORNIA — Medi-Cal
COLORADO — Health First Colorado
CONNECTICUT — HUSKY B, C, and D; MED-Connect
DELAWARE — Diamond State Health Plan
DISTRICT OF COLUMBIA — DC Healthy Families
FLORIDA — Statewide Medicaid Managed Care
GEORGIA — Georgia Families, Georgia Families 360, Georgia Medical Assistance, Right from the Start Medical Assistance Group (RSM), Georgia Pathways to Coverage, TEFRA, Katie Beckett
HAWAII — Med-QUEST
IDAHO — Idaho Health Plan, IMPlus, Medicare Medicaid Coordinated Plan, Healthy Connections
ILLINOIS — All Kids Assist, Mom & Babies, Family Assist, FamilyCare
INDIANA — Hoosier Healthwise, Healthy Indiana Plan (HIP), Hoosier Care Connect
IOWA — Medicaid Fee For Service, IA Health Link
KANSAS — KanCare
KENTUCKY — Kentucky Medicaid, Humana Healthy Horizons, Anthem Medicaid Transition, Wellcare, Kentucky Children’s Health Insurance Program (KCHIP)
LOUISIANA — LaMOMS, Healthy Louisiana, LaHIPP, Medicaid Purchase Plan, LaCHIP Affordable Plan, Family Opportunity Act Medicaid
MAINE — MaineCare
MARYLAND — HealthChoice
MASSACHUSETTS — MassHealth
MICHIGAN — Healthy Michigan Plan
MINNESOTA — Medical Assistance
MISSISSIPPI — Mississippi Medicaid
MISSOURI — MO HealthNet
MONTANA — HELP, Healthy Montana Kids Plus Plan
NEBRASKA — Heritage Health Adult
NEW HAMPSHIRE — AmeriHealth Caritas New Hampshire, NH Healthy Families, Well Sense Health Plan
NEW JERSEY — NJ FamilyCare
NEW MEXICO — Centennial Care
NORTH CAROLINA — NC Medicaid Direct, NC Medicaid Managed Care
OHIO — Healthy Families, Healthy Start
OKLAHOMA — SoonerCare
OREGON — Oregon Health Plan
PENNSYLVANIA — HealthChoices, Medical Assistance
RHODE ISLAND — Rhody Health Partners, Rhody Health Expansion, RIte Care, Rite Share
SOUTH CAROLINA — Healthy Connections
TENNESSEE — TennCare
TEXAS — State of Texas Access Reform (STAR), Star+Plus, Star Kids, Star Health
VERMONT — FAMIS Plus, Commonwealth Coordinated Care Plus (CCC+), Cardinal Care, Medallion 4.0
WASHINGTON — Washington Apple Health
WEST VIRGINIA — WV Mountain Health Promise, Mountain Health Trust
WISCONSIN — Medicaid Purchase Plan (MAPP), Family Care, PACE/Partnership, IRIS (Include, Respect, I Self-Direct), Katie Beckett Medicaid, Children’s Long-Term Support (CLTS), Wisconsin Well Woman Medicaid, BadgerCare Plus
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Just so we all understand, these policies will lead to a dramatically higher abortion rate, brought to you by the who accuse their opponents of killing innocent babies. The republicans are also standing firm behind Netanyahu, whose genocide policy has now become the rival of Nineteenth Century American treatment of the Northern Cheyenne and Souix.
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The 19th century abuse of indigenous people in the US, who had lived here for more than 15,000 before European colonial powers invaded, was far more than the Northern Cheyenne and Sioux tribes.
It’s impossible to provide an exact number of Native American tribes abused by US government policies in the 19th century, as the impact varied widely and affected numerous tribes across the country.
However, it’s accurate to say that virtually all Native American tribes experienced some form of abuse or negative impact due to US government policies during that era.
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We would have less need for Medicaid and CHIP if we paid workers a living wage. Many companies that make tremendous profits do not offer healthcare coverage for employees or they only hire part-timers in order to avoid paying for employee benefits. Then, they pass those healthcare costs to taxpayers. McDonald’s and Walmart are notorious for this practice. Our federal minimum wage remains at $7.25 per hour.
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The USA should have universal health care like all the other wealthy industrialized nations. People don’t go bankrupt from medical costs in those other countries as can too easily happen to folks the USA.
Medicare for All, it’s about time but the GOP and Trump will scream COMMUNISM, SOCIALISM, COMMUNISM, BLAH, BLAH and nothing ever gets done.
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Per capita healthcare cost in the U.S. is TWICE as high as the average of the OECD. Because ours is a much, much more expensive system. And here’s the kicker: Our system has WORSE outcomes.
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This. Bill. Is. Evil.
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As a result of this bill, with its cuts in Medicaid and in SNAP, kids will die and suffer brain damage and other irreversible but avoidable tragic consequences.
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Add those US child deaths to many others who will die due to Trump’s fascist regime ending food and health care aid for children living in poverty around the world.
That death count may run into the hundreds of millions.
But that will be nothing to what may happen if the January 6, 2021, traitor become the dictator he wants to be, which may lead to a nuclear World War III, killing billions and ending civilization and life throughout most of the world as we know it.
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Exactly, Lloyd. There are kids staving in refugee camps right now because of the cuts in USAID, and kids and adults dying of AIDS for the same reason.
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I said “cuts.” That’s a misnomer. They eliminated 90 percent of the funding. Almost all of it.
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Putin has amassed troops on the borders of Finland and Norway.
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Every member who votes for this bill is taking an action that will kill and deform babies and children. It’s utterly evil.
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How can they live with themselves? Utterly morally bankrupt.
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Sociopaths, psychopaths and narcissists have no problem sleeping, no matter how much suffering and deaths their actions or lack of action cause.
They do not have a conscience. No guilt.
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Bizarre that the same people should call themselves Christians
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