Defenders of the bill proposed by Senate Republicans last week spent some time on television over the weekend arguing that the effect of the bill, titled the Better Care Reconciliation Act, was not to cut Medicaid spending. Sen. Patrick J. Toomey (R-Pa.) went on CBS to argue that the expansion of Medicaid under the Affordable Care Act was preserved; White House counselor to the president Kellyanne Conway told ABC’s George Stephanopoulos that the Senate bill was not a cut to Medicaid.
On Monday, the Congressional Budget Office released its nonpartisan analysis of the Senate proposal. Not only does that analysis make clear that the Senate proposal includes significant cuts to Medicaid spending, it also demonstrates that the Senate bill is more reliant on Medicaid cuts than even the House bill that President Trump called “mean.”
“The largest savings” in the federal budget, the CBO report says, “would come from reductions in outlays for Medicaid — spending on the program would decline in 2026 by 26 percent in comparison with what CBO projects under current law — and from changes to the Affordable Care Act’s (ACA’s) subsidies for nongroup health insurance.”
What does that first part look like? It looks like this.
That’s a decrease of over $770 billion on Medicaid over the next 10 years. (We broke down that decrease earlier on Monday, if you’re curious.) By 2026, the federal government would cut 1 of every 4 dollars it spends on Medicaid.
How significant is this? Overall, the CBO estimates that the Senate bill will result in fewer people being uninsured by 2026 than the House health care bill (titled “The American Health Care Act”). Measured against the baseline number of uninsured that would be expected under the Affordable Care Act, the Senate bill would see 22 million more people uninsured, compared with the House’s 23 million.
But looking just at the expected decreases in Medicaid coverage, the Senate bill is actually worse over the long run. The reduction in the number of people with Medicaid coverage is slower out of the gates, but, by 2026, fewer people will have Medicaid coverage under the Senate plan than under the House plan.
In 10 years, 14 million fewer people would have Medicaid coverage if the House bill were enacted. If the Senate bill were enacted, that number would be 15 million. The number of people who lose coverage from their employers would be lower under the Senate bill, which reinforces the core trade-off being made: Shifting the negative effects from wealthier Americans to less wealthy ones.
But the CBO report makes one thing very clear: There’s simply no way to look at the Senate bill as not being a cut to Medicaid.