Medicaid is in Republicans’ sights. Here’s what you need to know.

More than 72 million Americans receive free or low-cost health insurance coverage through Medicaid, including many lower-income families and people with disabilities.

Republican majorities in Congress reportedly are considering cuts of as much as $2.3 trillion over a decade to the program. This would leave it up to state governments to either make up the difference, reduce the number of people insured by the program, or scale back what health care is covered.

What is Medicaid?

In 1965, President Lyndon Johnson signed legislation creating the Medicaid and Medicare programs. Medicare, a federally run health insurance program, offers coverage to 68 million Americans, almost all age 65 or older. Medicaid provides at least half of the funding for each state to operate its own health insurance program for individuals and families who cannot afford coverage. 

The program works like other temporary health insurance plans, covering medical care, prescription drugs, dental care for kids, and other medical expenses. States can decide whether to include additional benefits, such as adult dental care and vision, and whether to require a co-payment.

The Affordable Care Act, passed by Democratic majorities in Congress and signed into law by President Barack Obama in 2010, offered more funding to states that opted to expand Medicaid eligibility to households with incomes that are slightly above the federal poverty level. Forty-one states have chosen to participate in that expansion, but Republicans in the Wisconsin Legislature have repeatedly blocked efforts by Gov. Tony Evers and other Democrats to do so. Wisconsin’s Department of Health Services estimates that expanding Medicaid would allow 89,700 more residents to access health insurance and save the state $1.6 billion over two years in health care costs.

Who uses Medicaid?

About 19% of Americans with health insurance in 2023 received coverage through their state’s Medicaid program, according to a September 2024 report by the U.S. Census Bureau. 

In Wisconsin, 1.1 million individuals were enrolled in Medicaid as of October 2024. 

The program provides care to a significant number of pregnant women, infants, and children. According to March of Dimes data, 34.7% of all births in Wisconsin in 2023 were covered by Medicaid.

As of 2015, 63% of Wisconsin’s nursing facility residents were covered by Medicaid, according to KFF data.

What do Republicans want to cut?

“We don’t know exactly what’s going to happen,” Andrea Ducas, the vice president for health policy at the progressive nonprofit Center for American Progress, said in a phone interview. “But we can say, without question, that one of the prime targets that Republicans are looking to, and House Budget [Committee] Republicans in particular are looking to, to help pay for the tax cuts that they’re trying to put together is the Medicaid program.”

Ducas noted that on Jan. 10, Politico published a list of potential spending cuts being considered by House Budget Committee Chair Jodey Arrington (R-TX). According to a KFF analysis, about $2.3 trillion of the $5.5 trillion in possible cuts over 10 years would be made to Medicaid spending. Similar Medicaid cuts were also included in a 50-page list of ideas being considered by the House Ways and Means Committee published by the New York Times on Jan. 23. 

The proposed cuts would partially offset the costs of Trump’s plans, which include mass deportation of migrants, changes to border security, and permanent tax cuts for the wealthiest Americans. 

A Navigator Research/Global Strategy Group poll released Jan. 23 found 81% of registered voters oppose Medicaid cuts.

The cuts being considered, Ducas said, include limits to how much the federal government reimburses the states for each individual’s health care, limits to the how much money each state receives in total, and new restrictions on eligibility and work requirements for beneficiaries. 

What would the impact of those cuts be?

“Generally, this really feels like we’re in a moment of existential threat to that program,” Ducas said. “If the federal government share of that tab [for Medicaid coverage] goes down, then states have to make up the difference,” Ducas explained.

“To compensate for the severe federal funding cuts,” wrote professor Edwin Park of the Georgetown University McCourt School of Public Policy Center for Children and Families in November, “states will either have to dramatically raise taxes and drastically cut other parts of their budget including K-12 education or, as is far more likely, institute deep, damaging cuts to Medicaid eligibility, benefits and provider and plan payment rates,”

Ducas predicted that fewer people having insurance coverage would put everyone else’s health at risk, especially during future pandemics or natural disasters.

With fewer patients, rural providers in particular would struggle to stay in operation, said Maddie Twomey, the communications director for the health care advocacy group Protect Our Care: “It would be a total crisis. We’re already in a position where a lot of rural hospitals have closed. I think these communities can’t afford any more closures. We see areas that don’t have any maternity wards in 50 miles.” With more closures, Twomey predicted, people in rural parts of the state will be unable to access prenatal care, and those with life-threatening issues might not make it to an emergency room in time.