With Trump’s return to the White House, some fear Medicaid cuts

With Donald Trump headed back to the White House in January, there are growing concerns about the prospects of funding cuts or other restrictions on Medicaid.

Some healthcare advocates are worried about the potential of Medicaid cuts in President Trump's second term.

Some healthcare leaders have expressed hopes that the next Trump administration will understand the importance of Medicaid. Some fear that the Trump White House will reduce funding and states may impose other restrictions, including imposing work requirements for eligibility for Medicaid.

Georges C. Benjamin, MD, executive director of the American Public Health Association, told Chief Healthcare Executive® that he’s concerned about Medicaid.

“We know that there's been at least some verbalization on the campaign about reducing support for Medicaid, because their perspective of the Medicaid program is very different than my perspective of the Medicaid program, which is a comprehensive insurance program for people,” Benjamin said. “They see it as a program that needs to be limited in this cost. It actually saves taxpayers money.”

• Read more: What a second Trump term could mean for public health

Annie Andrews, MD, who ran for Congress on the Democratic ticket in South Carolina in 2022, said she’s worried that the possibility of cuts to Medicaid isn’t getting sufficient attention.

“We always hear about threats to Medicare and Social Security, but we don't hear people talk about threats to Medicaid,” Andrews told Chief Healthcare Executive®. “And I think that's because of a branding issue with the Medicaid program. People think it's welfare. People think it's just healthcare for poor people, and so many people just don't care about that.”

‘Deeply worried’

Medicaid, with the Children’s Health Insurance Program, provides health coverage for about 4 in 10 of America’s children under the age of 18, according to data from KFF.

Andrews, a pediatrician, worries that millions of kids could lose coverage.

“The majority of pediatric care in this country is those well-child checks, where children receive routine immunizations and counseling on how to avoid injury and illness,” Andrews said. “That is the bedrock of the practice of pediatrics, and if we pull that rug out from under children, then again, we're going to have more children with acute diseases, chronic diseases, preventable injuries and illnesses, and it's going to drive up the cost of the healthcare system. So I'm deeply worried about cuts to Medicaid.”

Bruce Siegel, MD, president and CEO of America’s Essential Hospitals, a trade group representing safety net hospitals, stressed the importance of Medicaid in a statement after the presidential race was called for Trump.

“We stand ready to work with the new administration and Congress to strengthen health care for all people by protecting Medicaid and other programs that help working families and others stay well and productive,” Siegel said in his statement.

Medicaid enrollment rose during the COVID-19 pandemic, rising from 71 million people in February 2020 to 94 million in April 2023, according to the Associated Press. But the federal government allowed states to review eligibility last year, and states have pared the number of people receiving Medicaid coverage.

As of July 2024, 72.4 million Americans were enrolled in Medicaid, and 7.1 million young people were enrolled in the Children’s Health Insurance Program, according to KFF.

• Read more: Hospitals and doctors pledge to work with Trump, and spell out some priorities

Impact on hospitals

Hospitals and health systems face higher costs as more people have lost Medicaid coverage, according to the American Hospital Association’s “Cost of Caring” report this year. Health systems say they saw an uptick in uncompensated care in 2023, and the association expected that trend to continue.

While Andrews would prefer to sell the importance of Medicaid in protecting vulnerable adults, kids, and individuals with diabetes, she said hospitals may want to focus on explaining the financial damage they’ll suffer if Medicaid is cut. She said that could be a more effective avenue with the Trump administration and their representatives in Congress.

Plus, Medicaid offers vital funding to rural hospitals, which are based in districts represented by Republicans. And many rural hospitals are struggling financially and can’t afford more headwinds.

“The other side of it is an economic argument,” Andrews said. “Hospitals in South Carolina will not survive if they lose their Medicaid funding.”

Hospitals are required by federal law to treat patients in emergencies, and she said more people without Medicaid coverage will show up in the emergency departments of hospitals, she said.

“When you cut a Medicaid program in a state like South Carolina, people still get sick and they still get hurt, and they show up in the emergency department and they still receive care,” Andrews said. “They can't afford that care. Someone has to pay for that care. So what happens is insurance premiums for privately insured patients go up, and the cost for privately insured patients go up.”

Seema Verma, who served as administrator of the Centers for Medicare & Medicaid Services during the Trump administration, talked about Medicaid in a panel discussion two weeks before the election at the HLTH Conference.

Verma said in a second Trump administration, he would look at how Medicaid dollars are spent and ensure the aid is going directly to recipients in need. Trump would definitely give more deference to the states regarding Medicare, so states could have more latitude to make changes as they see fit, she said.

Work requirements

Andrews and others are worried about the prospect of states imposing work requirements for individuals seeking Medicaid coverage. She said selling requirements for recipients to have a job could be “a relatively easy thing for them to sell,” and she said that would be a bad mistake.

“That just ignores the reality of people who require support from a program like Medicaid,” Andrews said. “I truly believe that if more Americans could spend a few days a year in a children's hospital or in a public school, and see what real Americans are dealing with, they would not be so quick to demonize people who rely on programs like Medicaid. But yeah, I think anything is possible.”

Andrews said if fewer people are covered by Medicaid, hospitals will likely see more patients in their emergency departments. And those patients will be sicker.

“They're not going to have access to preventative primary care, or they're going to delay going to the hospital,” Andrews said. “So revoking access to insurance for more Americans is only going to drive already exorbitant healthcare costs up, and we're all going to feel that. And this is an unfortunate way to have to learn that lesson.”

Much attention has been focused on the Affordable Care Act with Trump returning to the White House. He tried to abolish the law in his first term, but during his campaign for a return to the Oval Office, he said he wouldn’t get rid of the law but wanted to make it better. When pressed on how he would improve the law during his debate with Vice President Kamala Harris, Trump said he had “concepts of a plan.”

Andrews said she’s worried about the Affordable Care Act, but notes its popularity with the American public may preserve the law enacted by President Barack Obama. More than 6 in 10 Americans (62%) view the Affordable Care Act favorably, according to KFF polling.

“I certainly believe Trump wants to dismantle the Affordable Care Act,” Andrews said. “But I think when the rubber meets the road, many of these lawmakers know that their constituents depend on the Affordable Care Act, and maybe it will hold, because it is actually a deeply popular program.”