May 15,2023

Wyden Statement on Senate Floor on Republican Proposed Cuts to Medicaid

As Prepared for Delivery

The Senate has just heard compelling arguments from the Senators from Massachusetts and Pennsylvania about the importance of Medicaid. Now I’m going to lay out three key arguments about the House Republican proposal to cut the program.

Most Americans with health coverage through Medicaid are already working if they are able to.

The House Republican plan to cut Medicaid will put millions of Americans at risk, including seniors in nursing homes.

The track record shows work reporting requirements are a bureaucratic nightmare for Americans. It’s hard to figure out how the so-called “small government Republicans” have become so fond of bureaucracy.

Here’s why House Republicans want to slash Medicaid by billions. They say it’s about work.  But really, it’s all about securing an ideological trophy on the evidence-free proposition that Americans near the poverty line are actively choosing to stay there instead of working. So what this work reporting requirement is really about is ripping away health care coverage from Americans who Republicans have judged to be unworthy.

Don’t take it from me: an analysis from the Kaiser Family Foundation paints a clear picture of who will be at risk of losing their coverage. As of 2021, there are 25 million adults aged 19-64 enrolled in Medicaid. 43 percent are working full time, and 18 percent are working part time. I will stop right there and note that is equal to the national labor force participation rate at 61 percent.

Now who are the remainder with Medicaid coverage who aren’t actively working: 13 percent are caregiving for a child or relative. 11 percent are unable to work due to an illness or disability. 6 percent are attending school. The remaining 9 percent, about 2 million Americans, aren’t working because they are retired or unable to find work.

Here’s the catch: under the House Republican scheme, the majority of these Americans will be forced to report to their states whether they are working and how much each and every month, under the threat of losing their health insurance. My Republican colleagues are fond of sharing their “small government bona fides” but to me that sounds like an awful lot of bureaucratic government paperwork. What’s worse, the Congressional Budget Office found in an analysis just last year that work requirements do not increase employment.

I am now going to explain how this ill-conceived proposal is going to hurt more Americans than those who are subject to work reporting requirements. The House Republican bill cuts Medicaid by over $100 billion. That cut comes from one source: Americans getting kicked off their Medicaid coverage. The only way for Americans to retain Medicaid coverage will be for states to pick up the whole tab. And that’s simply shifting the federal share of Medicaid onto the states that don’t want to saddle their health programs with bureaucratic red tape that has never been shown to increase employment.

Shifting Medicaid costs to states has real consequences; it is not an abstract exercise. When the federal government pares back how much it contributes to a states’ Medicaid program, the state is left holding the bag to make up the difference. That means states face tough choices about which Americans will have health coverage and whether hospitals and nursing homes will face funding cuts that threaten their ability to stay open.

Doctors could see their pay cut. State options like a full year of postpartum care, which Congress created on a bipartisan basis just last year, would be subject to cancellation. These cuts will jeopardize your parents’ or your spouses’ access to Medicaid’s nursing home benefit, or cut resources for home care, which allows people with disabilities and the elderly to receive care in their homes instead of moving into an institution.

Unfortunately, there are some real world examples to illustrate what happens when a state implements work reporting requirements. During the Trump Administration, federal health agencies allowed Arkansas to conduct this work reporting experiment. Within the first year, 18,000 lost their Medicaid coverage, about quarter of those subject to work reporting. A year later, nearly 90 percent of those who lost coverage had not re-enrolled.

Those who were enrolled in “Arkansas Works” painted a bleak picture. Reporting their work was nothing but red tape. The website was down nights and weekends supposedly for maintenance. It was plagued with errors and difficult to access on mobile devices. Calling the help line resulted in an endless parade of robotic questions and dead ends. Those are just a couple of examples of the hoops these work reporting requirements are designed to create in order to deprive Americans of health coverage. Keep in mind that these are families walking an economic tightrope. Many do not have reliable access to the internet or a cell phone - especially those in rural areas.

It’s no secret that affordable health coverage is critical to staying healthy and financially stable. If you need medical treatment but you can’t afford it, getting and keeping work is going to be that much harder. That’s why this policy is upside down and particularly cruel - it slams the door and throws away the key on Americans trying to get back on their feet. The reality is that having Medicaid health coverage supports Americans’ ability to join the workforce – it doesn’t deter them.

And it’s not just Medicaid that House Republicans want to come after. Their scheme would also smother food assistance like SNAP and anti-poverty programs like TANF with the same bureaucratic red tape.

Even in the early months of this Congress, it’s clear that there is a lot of room for bipartisan agreement on health care. I’m working closely with my partner on the Finance Committee, Senator Crapo, to take on drug middlemen known as pharmacy benefit managers. And I am confident there are other areas where Republicans and Democrats can come together and make positive change for American families.

Here’s my bottom line: cutting Medicaid and creating an entire new layer of bureaucracy and paperwork just to take away health coverage from more Americans is not a proposition that Democrats in the Senate support. I will fight policies that come after Medicaid every step of the way.