We explained earlier this week that delaying the end of the Affordable Care Act (ACA)’s higher funding for Medicaid expansion wouldn’t change the long-run effects of the House health bill: states would still have to end their expanded Medicaid programs because of the large cost shift from losing federal funds, and the poor and near-poor adults losing Medicaid wouldn’t be able to afford private coverage.
Now, Senate Republicans are reportedly coalescing around what may be an even worse Medicaid “compromise.” Senators Dean Heller, Rob Portman, Shelley Moore Capito, and others are supporting a phasedown of Medicaid expansion funding, with funding cuts still beginning in 2020.
That approach would not preserve anyone’s coverage in the long run. It also would do next to nothing to preserve Medicaid expansion in the short run. First, at least eight Medicaid expansion states — Arkansas, Illinois, Indiana, Michigan, Montana, New Hampshire, New Mexico, and Washington — have expansion “trigger laws” under which their Medicaid expansions automatically end if the federal matching rate for expansion enrollees falls at all. Under the reported proposal, these state triggers would go off in 2020 — just like under the House health bill.
Second, even non-trigger states would see their costs for new expansion enrollees rise significantly starting in 2020. Few state legislatures will choose to come up with extra funding to keep their expansions going when they know that the federal funding cuts — and required state funding increase — will just keep rising each year. More likely, even non-trigger states would freeze enrollment starting in 2020. If so, their expansions would be more than two-thirds gone by the end of 2021 and virtually eliminated by the end of 2024.
Just last week, new polling found that the Medicaid expansion is extremely popular, with its popularity crossing party lines. Eight-four percent of the public, including 71 percent of Republicans, support continuing current federal funding for the expansion.
The expansion’s overwhelming popularity may be part of the reason that a number of Senate Republicans say they want to find a way to maintain the gains from expansion in their states. But the deal some Senators appear ready to accept would not only reverse those gains over the longer run, it wouldn’t even maintain them in the near term.
Help us Prepare for Trump’s Day One
Trump is busy getting ready for Day One of his presidency – but so is Truthout.
Trump has made it no secret that he is planning a demolition-style attack on both specific communities and democracy as a whole, beginning on his first day in office. With over 25 executive orders and directives queued up for January 20, he’s promised to “launch the largest deportation program in American history,” roll back anti-discrimination protections for transgender students, and implement a “drill, drill, drill” approach to ramp up oil and gas extraction.
Organizations like Truthout are also being threatened by legislation like HR 9495, the “nonprofit killer bill” that would allow the Treasury Secretary to declare any nonprofit a “terrorist-supporting organization” and strip its tax-exempt status without due process. Progressive media like Truthout that has courageously focused on reporting on Israel’s genocide in Gaza are in the bill’s crosshairs.
As journalists, we have a responsibility to look at hard realities and communicate them to you. We hope that you, like us, can use this information to prepare for what’s to come.
And if you feel uncertain about what to do in the face of a second Trump administration, we invite you to be an indispensable part of Truthout’s preparations.
In addition to covering the widespread onslaught of draconian policy, we’re shoring up our resources for what might come next for progressive media: bad-faith lawsuits from far-right ghouls, legislation that seeks to strip us of our ability to receive tax-deductible donations, and further throttling of our reach on social media platforms owned by Trump’s sycophants.
We’re preparing right now for Trump’s Day One: building a brave coalition of movement media; reaching out to the activists, academics, and thinkers we trust to shine a light on the inner workings of authoritarianism; and planning to use journalism as a tool to equip movements to protect the people, lands, and principles most vulnerable to Trump’s destruction.
We urgently need your help to prepare. As you know, our December fundraiser is our most important of the year and will determine the scale of work we’ll be able to do in 2025. We’ve set two goals: to raise $140,000 in one-time donations and to add 1469 new monthly donors by midnight on December 31.
Today, we’re asking all of our readers to start a monthly donation or make a one-time donation – as a commitment to stand with us on day one of Trump’s presidency, and every day after that, as we produce journalism that combats authoritarianism, censorship, injustice, and misinformation. You’re an essential part of our future – please join the movement by making a tax-deductible donation today.
If you have the means to make a substantial gift, please dig deep during this critical time!
With gratitude and resolve,
Maya, Negin, Saima, and Ziggy