WHAT'S HAPPENING

BIDEN PROMISES TO FIGHT GOP ON 'GUTTING' MEDICAID. BUDGET TALKS SEEM LIKE ANOTHER STORY

BY MICHAEL MCAULIFF

Most lawmakers – Republicans and Democrats alike – have declared the marquee safety-net programs of Medicare and Social Security offlimits for cuts as a divided Washington heads for a showdown over the national debt and government spending. Health programs for lower-income Americans, though, have gotten no such bipartisan assurances.

More than 20 million people gained Medicaid coverage in the past three years after Congress expanded access to the entitlement program during the covid-19 pandemic, swelling Medicaid’s population by about 30%. But enrollment will fall starting in April, when the pandemic-era changes end and states begin cutting coverage for Americans who are no longer eligible.

On Tuesday, President Joe Biden pressured Republicans to release the party's plans to cut government spending, which are expected to call for deeper cuts to Medicaid – and could offer Americans a preview of Republicans' wish list should the party gain full power in the 2024 election.

If far-right Republicans "try to take away people's health care by gutting Medicaid and the Affordable Care Act, I will stop them," Biden said.

Biden and other Democratic leaders have said they want to expand Medicaid, a goal likely to be reflected in the president's budget proposal out next week. But while top Democrats say they will not negotiate government spending with Republicans when the GOP is refusing to raise the debt ceiling, they have left open the possibility of talks over Medicaid spending at a later date.

Rep. Hakeem Jeffries of New York, the new House Democratic leader, said in January that Democrats are open to "a conversation" with Republicans separate from the debt ceiling debate.

"There is a budget process, and there's an appropriations process," Jeffries said when asked by KHN why Medicaid did not get the same red-line defense as Medicare and Social Security during Biden's State of the Union address. "We are willing to have a conversation with the other side of the aisle about how to invest in

making life better for everyday Americans, how to invest in the middle class, how to invest in all those Americans who aspire to be part of the middle class."

Some Republicans hope to extract concessions with Democrats to cut the program by limiting benefits, such as by allowing more states to impose work requirements on Medicaid beneficiaries – a plan pushed by the Trump administration but largely struck down by the courts. Republicans could also target Medicaid provider taxes, meaning taxes placed on things like inpatient hospital services or nursing facility beds.

SHOWDOWN: While a majority of voters support raising the debt ceiling, they are split on how lawmakers should address the nation's debt.

Progressive Democrats have SHOWDOWN: While a majority of voters support raising the debt ceiling, they are split on how lawmakers should address the nation's debt. drawn a hard line and hope the program's growth makes cutting Medicaid a riskier political idea than it once was. More than 1 in 4 Americans are currently covered through Medicaid or the Children's Health Insurance Program, including children, pregnant people, people with disabilities, and people living on a lower income.

“To my mind, Medicaid must be off the table,” Sen. Bernie Sanders (I-Vt.), chair of the Health, Education, Labor, and Pension Committee, told KHN. “The idea of coming down heavy on people who are of low income would be outrageous, and I feel very much that’s what Republicans have in mind.”

The Biden administration is expected to send its annual budget blueprint to Congress on March 9, outlining the president's spending priorities for federal programs, including for Medicaid.

During his Feb. 28 speech, Biden pointed to recent Republican proposals to cut Medicaid and repeal the Affordable Care Act. And he listed the possible consequences of those proposals – such as the loss of mental health care for millions of children under Medicaid's guarantee of comprehensive health coverage – and urged Americans to compare the still-unknown cuts that Republicans want with his budget proposal.

Biden is likely to start any negotiations by arguing for more spending. He has called out conservative states that have resisted expanding Medicaid coverage, traveling to Florida after his State of the Union address to chastise nearly a dozen states that have not yet expanded the program under the ACA. He pushed to expand ACA subsidies during the pandemic and, more recently, to make them permanent.

House Republicans say they want to balance the federal budget in 10 years without raising taxes and without cuts to Medicare, Social Security, or military spending – a feat some analysts have