Medicaid

With the House Republican budget bill having made it past its second significant hurdle last night (the House Budget Committee vote), it's time tot ake a cold, hard look at just what the impact of the bill will be in pure partisan terms.

The logic Congressional Republicans (or at least Donald Trump, who pretty much has complete control over the Congressional Republican hivemind) seem to be going with is that targeting the Medicaid expansion population is good politics for them because:

UPDATED 5/22/25: Welp. House Republicans did indeed follow through with passing their horrific (and disgustingly-titled) "One Big Beautiful Bill" Act which will effectively repeal the bulk of the ACA without officially repealing it, and that's just for starters.

The final vote was 215 - 214, with every Republican except a handful voting for it (and the two who voted against it openly admitted to the NY Times that they would have voted for it if their votes had been needed), and every Democrat voting against it. There were 2 Republican "no" votes...but both of those were only because they wanted the final bill to be even more draconian.

The Congressional Budget Office projected the bill, if enacted, will result in at least 13.7 million more Americans losing healthcare coverage (and that was based on a prior version of the bill; the new version is considered even more extreme).

Last week I wrote about the latest state of play regarding House Republicans so-called "big beautiful bill" to gut Medicaid in order to give fat tax cuts to billionaires. Yesterday the first official version of the legislative text was released, and it's pretty much as ugly as you might expect.

Here's some basics, via Nathaniel Weixel & Joseph Choi of The Hill:

...The plan caters more to the moderate wing of the Republican party by omitting two of the biggest and most politically controversial proposals discussed: a per-capita cap on people who get coverage from Medicaid expansion, and a direct lowering of the federal matching rate.

There's two new stories out about where things stand with Congressional Republicans obsessive desire to gut Medicaid & kick millions of people off their healthcare coverage in order to give massive tax cuts to billionaires. The first, from Jessie Hellmann, Sandhya Raman and Olivia M. Bridges at Roll Call, has some pretty positive-sounding news:

...Johnson, R-La., said leadership had ruled out two Medicaid policies that could go a long way toward meeting the Energy and Commerce Committee’s $880 billion, 10-year savings target but faced strong pushback from blue-state GOP centrists.

First, Johnson said the emerging package wouldn’t touch the Federal Medical Assistance Percentage, or FMAP, rate — the portion of state Medicaid costs borne by the federal government — for the Medicaid expansion population, which is currently 90 percent.

Johnson also poured cold water over a provision that would implement per capita caps on Medicaid benefits for enrollees in expansion states, though he wasn’t quite as definitive on that front.

via the State of Michigan (email, no link yet):

Gov. Whitmer Releases Top Lines of Alarming Report on Federal Medicaid Cuts, Finding Cuts Would Terminate Health Care for 700,000 Michiganders

MDHHS report also shows federal cuts to Medicaid will increase costs for hospitals and small businesses, and significantly strain state budget

LANSING, Mich. -- Today, Governor Gretchen Whitmer released toplines of an alarming report from the Michigan Department of Health and Human Services (MDHHS) on the impact of federal proposals to cut Medicaid. According to the new report, these proposed cuts would result in a loss of health care coverage for hundreds of thousands of Michiganders, reduce access to providers for all residents, increase financial burdens on hospitals and small businesses, and significantly strain the state’s budget.

With Congressional Republicans having clearly decided to target the ACA's Medicaid expansion population for gutting (potentially kicking up to 21 million Americans off their healthcare coverage), they're heavily pushing talking points claiming that they're Deeply Concerned® about preserving Medicaid for those they deem to be "deserving" of coverage:

The Musk/Trump Regime has published an update to the official Medicaid/CHIP enrollment data:

November 2024 Key Findings

Medicaid and CHIP Enrollment

• In December 2024, 78.8 million individuals were enrolled in Medicaid and CHIP.
  • 71.5 million individuals were enrolled in Medicaid, and 7.3 million individuals were enrolled in CHIP.
  • 41.4 million adults were enrolled in Medicaid, and there were 37.4 million Medicaid child and CHIP enrollees.

Medicaid and CHIP Applications Received

• In December 2024, Medicaid, CHIP, Human Services agencies, and State-based Marketplaces received 3.0 million applications, or 11 percent more applications, as compared to November 2024.
• The number of applications received has increased by 30 percent since December 2023 and increased by 84 percent since December 2022.

Total Medicaid/CHIP enrollment in December 2024 dropped slightly from November, by 171,000 people or 0.2%.

As regular readers know, I've been a bit obsessed over the past month or so with generating pie charts which break out the total healthcare program enrollment for the entire population of all 435 U.S. Congressional Districts as well as all 50 states +DC.

As you can imagine, this has been a monumental task; not only did I have to crunch a lot of data to break out the statewide numbers into House district-level estimates, I also had to convert that data into nearly 480 easy-to-read graphics...and then I doubled my workload by going one step further and adding high-res PDF versions for folks to print out in large format for town halls, rallies and #HandsOff protests nationally.

Now that I've finally completed this project, it's time to turn back to the main reason for it in the first place: The imminent threat to healthcare coverage for literally tens of millions of Americans being posed by the budget resolution recently passed by House Republicans, which (fortunately) still has a number of points where it can potentially be stopped.

After a concerning 2-month delay, the Centers for Medicare & Medicaid Services (CMS) has finally published an update to the official Medicaid/CHIP enrollment data:

November 2024 Key Findings

Medicaid and CHIP Enrollment

• In November 2024, 79.0 million individuals were enrolled in Medicaid and CHIP.
  • 71.8 million individuals were enrolled in Medicaid, and 7.3 million individuals were enrolled in CHIP.
  • 41.5 million adults were enrolled in Medicaid, and there were 37.5 million Medicaid child and CHIP enrollees.

Medicaid and CHIP Applications Received

Over the past couple of months I've compiled a master spreadsheet breaking out enrollment in ACA plans (Qualified Health Plans & Basic Health Plans), Medicaid/CHIP coverage (both traditional & via ACA expansion) and Medicare (both Fee-for-Services & Advantage) at the Congressional District levels.

With the pending dire threat to several of these programs (primarily Medicaid & the ACA) from the House Republican Budget Proposal which recently passed, I'm going a step further and am generating pie charts which visualize just how much of every Congressional District's total population is at risk of losing healthcare coverage.

USE THE DROP-DOWN MENU ABOVE TO FIND YOUR STATE & DISTRICT.