April 19, 2025
Thoughts on the letter 12 House Republicans recently sent to the House GOP leaders on the topic of preserving Medicaid in the coming budget reconciliation process:
Recently a group of more moderate House Republicans (including NY Reps. Garbarino, LaLota, and Malliotakis) sent a letter to House Majority leaders that drew some boundaries for what they would not support in terms of Medicaid cuts (see news story here, and the letter here.) (The NYS Council sent the letter and our initial analysis with all members last Friday). Apparently NY Representative Lawler (said to have missed the initial deadline to sign on to the letter) has apparently sent his own letter
and had an OpEd piece published on LoHud, the online news site for the Journal-News, a paper that covers the Lower Hudson region of Westchester, Putnam, and Rockland Counties.
Overall the letter is a positive step however many political analysts note that the language in the letter does not fundamentally challenge what House leaders want to do to the Medicaid Program. They go on to say the letter simply provides political cover for these Reps. to claim they are fighting for Medicaid.
Here’s the important part: The letter focuses on protecting Medicaid for ‘vulnerable’ Americans (i.e., the traditional Medicaid populations of seniors, disabled, children, pregnant women, etc. – about 4.6M in NY), but it says nothing about the millions of Americans like working poor people and their families, who are also dependent on Medicaid and specifically, the Medicaid expansion states around the country took advantage of under the Affordable Care Act (ACA). Here, the numbers are staggering with 20+ million nationally, and 2.4 million here in NY. The letter suggests instead that these people and families can and should use tax-advantaged “health savings accounts” to save up money to pay for health insurance and services, which presumes that they have money to spare and sock away. However, most of these Medicaid beneficiaries are poor and live paycheck-to-paycheck. Generally, they do not have any savings to spare and that’s how they qualify for Medicaid. Also, research shows that only wealthier people use HSAs because they itemize their tax deductions, and poor people don’t.
In addition, this bifurcation between ‘vulnerable’ Medicaid beneficiaries and ‘everyone else’ reflects a long-standing Republican paradigm that splits people on Medicaid into: a) those who are deemed “worthy”, and b) those who are viewed as less so and are often characterized as “freeloaders” who don’t work (even though the vast majority of working age people on Medicaid do already work, usually in low-wage jobs that also don’t provide job-based coverage.)
The letter also says NOTHING about protecting the ACA premium subsidies and out-of-pocket cost caps for lower-income working people and families who also live paycheck-to-paycheck (just like the ACA Medicaid expansion group.) In NY, this group includes those enrolled in our state’s special “Essential Plan” (1.6M), plus the generic ACA private plan enrollees (240K.) These two groupings (ACA Medicaid, and generic ACA) are two halves of a spectrum composed of lower and middle-income working people and families who don’t have access to job-based coverage and, turn to the ACA for it.
Taken together (ACA Medicaid + Essential Plan + generic ACA), 4.2M NYers are still at risk, about 21% of our population. This letter only protects the 4.5M (23%) of New Yorkers who rely on Medicaid and are deemed ‘vulnerable’. So at the end of the day the letter only goes half-way to protecting all Medicaid beneficiaries, current and future. While the letter is a positive step, most advocates agree it was probably put out in response to public pressure and to try to placate advocates, and to put a narrative out there that the lawmakers who signed on are fighting for Medicaid. While we can appreciate the letter (and thank the Reps. who signed it) for as far as it goes, there is still quite a way for these Republicans to go to fully protect Medicaid. We must continue to pressure all of the letter writers as well as their colleagues in the House and Senate who want to decimate Medicaid over the next 10 years. (Source: Healthcare for All -NY) —