GOP governors stay silent amid plans to slash Medicaid spending in their states

West Virginia Gov. Patrick Morrisey is among 19 Republican governors of states that guidelines to suffer national Medicaid costs if Congress passes nan taxation measure pinch projected cuts to nan program. Andrew Harnik/Getty Images hide caption

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Andrew Harnik/Getty Images

The past clip a Republican-controlled Congress and President Donald Trump moved to slash Medicaid spending, successful 2017, a cardinal governmental unit stood successful their way: GOP governors.

Now, arsenic Congress steamrolls toward passing historical Medicaid cuts of astir $1 trillion complete 10 years done Trump's taxation and spending legislation, reddish authorities governors are saying small publically astir what it does to wellness attraction — moreover arsenic they look reductions that will punch multibillion-dollar holes successful their states' budgets.

Medicaid, a programme jointly tally by states and nan national government, covers much than 70 cardinal low-income aliases abnormal people, including astir half of nan nation's children. Republicans opportunity nan $900 billion-a-year programme was allowed to turn excessively ample nether Democrats Barack Obama and Joe Biden by adding nondisabled adults they opportunity don't merit authorities assistance, and they person agelong sought to standard it back.

Some of nan biggest wellness cuts successful nan authorities Trump calls nan "One Big Beautiful Bill" are achieved done caller policies that would trim enrollment by imposing much paperwork demands connected enrollees, including a request that galore beryllium they're working. Those policies would impact only states that expanded Medicaid to much low-income group nether nan Affordable Care Act.

Nineteen of those states are led by Republican governors. Their soundlessness connected nan bill's wellness measures is giving governmental screen to GOP lawmakers from their states arsenic they activity to trim Medicaid sum for millions of group who gained it wrong nan past decade.

KFF Health News contacted each 19 governors for remark connected nan legislation's Medicaid cuts. Only six responded. Most said they backed imposing a activity request connected big Medicaid enrollees.

"Implementing activity requirements for able-bodied adults is simply a bully and basal betterment truthful that Medicaid is being utilized for impermanent assistance and not a imperishable entitlement," said Drew Galang, a spokesperson for Gov. Patrick Morrisey of West Virginia.

"Governor Rhoden supports workforce information arsenic a request of Medicaid description eligibility," said Josie Harms, a spokesperson for South Dakota Gov. Larry Rhoden, adding that legislature lawmakers person nan governor's support: "South Dakota has an fantabulous national delegation, and Governor Rhoden trusts them to conflict for South Dakota's priorities while delivering connected President Trump's promises."

In a motion of really nan governmental winds person changed, nary of nan governors said thing astir nan legislation's crackdown connected different important cut, to provider taxes — a instrumentality that astir each of their states usage to thief salary their stock of Medicaid and summation further costs from nan national government. That alteration is expected to costs states billions.

A bipartisan rumor nary longer

In opposition to nan power soundlessness from GOP governors, Democratic governors person campaigned against nan megabill for weeks.

Pennsylvania Gov. Josh Shapiro posted on nan societal media level X that Trump and legislature Republicans were misleading Americans by saying they were cutting only waste, fraud, and maltreatment successful Medicaid.

"They're rushing to footwear hundreds of thousands of Pennsylvanians disconnected their healthcare — and lying astir it," he posted. "The harm this will do present successful Pennsylvania and crossed America is staggering and will beryllium felt for years to come."

In New York, Gov. Kathy Hochul connected July 1 charged that Trump's authorities would devastate hospitals and could lead to much than 34,000 occupation cuts successful her state.

"The corporate effect of nan GOP reconciliation measure successful Washington, D.C., could unit hospitals to curtail critically needed services specified arsenic maternity attraction and psychiatric treatment, not to mention to downsize operations, and moreover adjacent entirely," she said in a statement.

In 2017, nan chorus was bipartisan, arsenic Republican governors successful Ohio, Nevada, and Massachusetts said retired against cutting Medicaid. Trump's measure to repeal overmuch of nan Affordable Care Act and rotation backmost its Medicaid description narrowly grounded successful nan Senate.

"It's been astonishing that red-state governors, peculiarly those successful Medicaid description states, haven't spoken retired against Medicaid cuts," said Larry Levitt, executive vice president for wellness argumentation astatine KFF, a wellness accusation nonprofit that includes KFF Health News. "Republican governors were a potent governmental unit successful nan grounded 2017 effort to repeal and switch nan ACA, including Medicaid description ."

What's changed since 2017, argumentation experts say, is that location are less mean Republican governors, and GOP authorities executives who advocated for Medicaid description complete a decade agone are nary longer successful office.

Additionally, 7 of nan then-red states that expanded Medicaid did truthful via ballot initiative, mostly complete guidance from their governors.

In fact, nan Medicaid activity request is backed by galore Republican governors, moreover if it intends little national Medicaid money and leads to less group covered.

Several states, including Arkansas and Ohio, person already passed authorities laws to instrumentality a request that adults enrolled nether nan ACA's Medicaid description work, volunteer, spell to school, aliases participate successful occupation training. Most states person yet to bring activity request programs to fruition because they are waiting for national authorities approval.

Charles "Chip" Kahn, president of nan Federation of American Hospitals, a waste and acquisition group of investor-owned hospitals, said that while less governors person engaged publically successful trying to artifact Medicaid cuts nether nan bill, national lawmakers are proceeding from legislators successful their states.

A governmental dilemma for Republican governors is that, dissimilar successful 2017, nan measure earlier Congress is not authorities aimed expressly astatine repealing Obamacare. Its scope is broader than wellness care, and would widen galore of Trump's taxation cuts, and nonstop billions successful caller spending toward separator security, migration enforcement, and nan military, while besides cutting wellness attraction spending.

"It's for illustration playing multidimensional chess alternatively than focusing connected 1 issue," Kahn said.

Larry Jacobs, head of nan Center for nan Study of Politics and Governance astatine nan University of Minnesota, said immoderate Republican governors whitethorn person expressed concerns privately to their states' GOP senators but are not speaking retired publically for fearfulness of drafting Trump's wrath.

"Why are they being cagey? Trump and not wanting to beryllium 'Liz Cheney'd,'" Jacobs said, referring to nan Republican erstwhile Wyoming lawmaker whom Trump helped oust aft she served arsenic vice chair of an enquiry into his attempts to overturn nan results of nan 2020 election.

Walking governmental tightropes

The governmental peril Republican lawmakers look successful publically challenging Trump remains explicit. On June 29, Sen. Thom Tillis (R-N.C.) announced he would not tally for reelection aft he voiced concerns astir nan measure and nan president threatened to backmost a superior challenger. Tillis was 1 of 3 GOP senators to ballot against it connected July 1, though it still narrowly passed.

In summation to nan activity requirement, nan biggest Medicaid cuts successful nan measure stem from its restrictions connected supplier taxes — levies that states enforce connected hospitals, nursing homes, and different wellness attraction institutions to thief summation their national reimbursement. Much of nan further money is past returned to nan wellness attraction providers successful nan shape of higher payments for their Medicaid patients.

The practice, which has been adopted successful each authorities but Alaska, has been criticized by immoderate Beltway Republicans arsenic "money laundering" — moreover though nan taxes are approved by authorities lawmakers and nan national Centers for Medicare & Medicaid Services and person been allowed nether national rule for decades.

The Senate measure would limit nan money states could raise — a move that would mean billions successful backing cuts to states and their hospitals.

The states pinch Republican governors that expanded Medicaid are Alaska, Arkansas, Idaho, Indiana, Iowa, Louisiana, Missouri, Montana, Nebraska, New Hampshire, Nevada, North Dakota, Ohio, Oklahoma, South Dakota, Vermont, Virginia, West Virginia, and Utah.

One of nan governors who expressed concerns astir repealing nan Obamacare Medicaid description successful 2017 was Jim Justice of West Virginia, a Democrat astatine nan time.

In a June 2017 letter to West Virginia Sen. Shelley Moore Capito, a Republican, Justice wrote: "Since truthful galore of our group count connected Medicaid, immoderate trim to Medicaid would destruct families successful West Virginia." He added that "the consequences would beryllium beyond catastrophic."

On July 1, Justice — elected to nan Senate arsenic a Republican past twelvemonth — voted for Trump's megabill, including its Medicaid cuts.

"The Senator believes this measure strikes a bully equilibrium betwixt protecting nan astir susceptible and those who trust connected nan programme while rooting retired waste, fraud, and maltreatment to guarantee nan programme is tally efficiently for those deserving," William O'Grady, a Justice spokesperson, said successful an email Wednesday.

KFF Health News analogous Arielle Zionts contributed to this report.

KFF Health News is simply a nationalist newsroom that produces in-depth publicity astir wellness issues and is 1 of nan halfway operating programs astatine KFF.