Senate Health Care Bill Slashes Medicaid Spending for All Populations

Senate Health Care Bill Slashes Medicaid Spending for All Populations

The Senate’s recently released bill, the Better Care Reconciliation Act (BCRA) would drastically cut and fundamentally change our country’s Medicaid program. Under this bill, instead of Medicaid being an “open system” where federal and state spending is based on medical needs, the federal government would limit spending by only giving states a per capita amount per enrollee, regardless of whether that would cover a person’s needs or care. In addition, while under the House bill, the per capita amount would increase at the pace of the consumer price index (CPI) for medical care — plus another percentage point, under the Senate bill the per capita amount would be significantly less over time. This is because the Senate bill proposes using the CPI for medical care only until 2025, when it would shift to the CPI for all goods, a formula that would leave the amount much lower than the CPI just for medical care.


While numerous studies have examined the impact of Medicaid spending cuts in the Congress’ healthcare bills over a 10 year period (for example, see reports from the Congressional Budget Office for the House bill and Senate bill and the Centers for Medicare and Medicaid Services), none of them examine the impacts over a longer time frame. The AARP Public Policy Institute’s new analysis of the recent Senate bill helps fill this gap through their model that looks out an additional decade to capture impacts on Medicaid spending between 2027 and 2036. This analysis shows that Medicaid cuts as a result of BCRA’s proposed limits on per capita spending, not including the expansion repeal, could be as much as 41% in 2036 across all populations, and 35% for older adults that year.


Such large cuts to the Medicaid program will have negative impacts on older adults, adults with disabilities, and individuals and families who rely on Medicaid to meet their health care and long-term services and supports needs.


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Karen Fletcher
Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.