STARKVILLE — Since the U.S. House of Representatives passed a budget resolution that calls for a $2.3 trillion cut to mandatory spending over the next decade. Republican lawmakers are working to make $880 billion of those cuts in the Medicaid program.

The Congressional Budget Office has established that cuts of that size would necessitate Medicaid program cuts, despite repeated promises from President Trump that he and his cabinet would not cut the program. Trump did say he intends to cut “fraud” and waste from the program.

House Democrats believe that a Medicaid cut of $2.3 trillion, or about a third of projected Medicaid spending. Medicaid is a joint federal-state program that covers medical costs for the poor, the blind, people with disabilities, the elderly, and children. House Republicans say their counterparts across the aisle are engaging fear fear-mongering and political grandstanding as the word “Medicaid” is not mentioned in the budget resolution.

Democrats claim Medicaid in Mississippi covers more than 640,000 Mississippians, or over 25% of the state’s total population. Further, they claim a congressional cut of one-third of federal Medicaid funding across all segments could result in 120,000 rural residents and 110,000 children losing their health coverage, as part of a total of over 200,000 people who would be left without Medicaid coverage. As many as 1-in-4 senior citizens could lose their nursing home care.

Mississippi remains one of 10 states that have not adopted some form of Medicaid expansion or so-called “Obamacare” to draw down additional federal funds to pay for health care for the working poor.

The 10 non-expansion states include Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming. The failed 2024 Mississippi Medicaid expansion effort would have expanded Medicaid coverage to about 200,000 people who earned up to 138% of the federal poverty level, or $20,120 annually for one person.

The decision not to expand Medicaid has left an estimated 166,600 uninsured non-elderly adults in the state ineligible for Medicaid coverage under the Affordable Care Act standard.

Like the two major parties in Congress, advocacy groups are likewise split on the issue depending on their political or policy leanings. The liberal Brookings Institution holds that Medicaid cuts are dictated by the GOP-backed proposal. “Estimates suggest that achieving the dramatic spending reductions Congress is aiming for in reconciliation will require cuts to Medicaid, which serves lower-income adults and children through a combination of state and federal funding.

“Two types of potential cuts — lowering the federal matching rate for the Affordable Care Act Medicaid Expansion and implementing work requirements — would be especially harmful to 50-64-year-olds, who are less likely to be able to work and more likely to have existing or emerging health issues. Evidence from the states and other programs suggests that work requirements would significantly reduce insurance enrollment without boosting employment, and these impacts are likely to be larger for this population,” Brookings concluded.

The conservative Heritage Foundation saw it from a different perspective: “During the COVID-19 pandemic, Medicaid had a significant surge in enrollment. Due to restrictions on the states preventing them from verifying eligibility during the pandemic, total enrollment jumped from 70 million in February 2020 to a high of 94 million in April 2023.

“Allow work requirements as a condition of receiving benefits. Like in other welfare programs, certain able-bodied Medicaid enrollees should be required to work or look for work as a condition of receiving benefits. The first Trump Administration approved several state proposals to put in place a work requirement. The Biden Administration rescinded those agreements. The second Trump Administration should revive those efforts, and Congress should follow with additional statutory changes and guidance.”

While disagreements between the state House and Senate are present, it’s unlikely the Mississippi Legislature will make any significant changes to the existing Medicaid program until President Trump brings more clarity to his stance on Medicaid and until Congress acts on the legislation.

In a relatively poor state like Mississippi, Medicaid remains too volatile a program for missteps by state leaders.

Sid Salter is a syndicated columnist. Contact him at [email protected].

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