May 16, 2025

First things first.  See below from the Drug Policy Alliance and take action by sending a message to Washington (*see yellow highlighted info in the notification) that is specific to the topic of preserving Medicaid for Americans caught in the tornado of the addiction and mental health crisis in this country:

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FEDERAL BUDGET RECONCILIATION:  THE LATEST 

More details summarized from reporting from sources including Crian’s NY, Politico, and The Hill):
A surprise holdout by ultraconservative members of the House Budget Committee Thursday is forcing House Speaker Mike Johnson to entertain significant changes to the GOP sweeping domestic policy bill, endangering his Memorial Day timeline for House passage and a planned Friday (TODAY) vote in the House Budget Committee to advance the GOP megabill.  
Here’s the math problem for Republicans: Budget is split 21-16 in favor of Republicans, and Democrats are expecting full attendance. That means Republicans can lose only two votes if they want to move forward with the megabill later today. Not only do they have at least three members threatening to vote no, but GOP Rep. Brandon Gill is on parental leave and is expected to miss tomorrow’s markup.  The Budget meeting was supposed to be a formality for GOP leaders — their only job is to package up pieces of the bill from different committees and glue them together for consideration on the floor.
So the House Budget Committee is looking like a serious bottleneck for Speaker Mike Johnson — and a serious threat to his Memorial Day megabill deadline.  The panel needs to package up various pieces of the bill advanced by other committees and send it to the floor, a perfunctory but necessary step toward passage that is now threatened by the holdouts who are demanding three key changes:  speeding up the phase-out of clean energy tax credits enacted under former President Joe Biden; immediately removing immigrants in the country illegally from any Medicaid access, rather than allowing states several years to comply; and moving up the Medicaid work requirement start date from 2029 (as drafted in the bill) to 2027.  Note:  House Majority Whip Steve Scalise has promised that the bill that ultimately comes before the house will move up the implementation of work requirements – ultra conservatives are calling for them to begin in the fall of 2026.  Scalise did not offer an alternative date.  Needless to say, the Republican plan to push this agenda through without the votes of any Democrat is not expected to be easy.  Hard-liners appear to have gotten a bone here, with GOP leadership signaling they are seriously considering moving up the implementation of new work requirements in the program from 2029 to 2027. That could lead to tens of billions of dollars in savings, but would also lead to more coverage losses ahead of the 2028 election.
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(Crain’s Health Pulse, 5/16) 

New York could be on the hook for $2.8 billion under a federal budget plan that eliminates funding for the state to provide health insurance to immigrants awaiting a more permanent resident status.

The budget proposal, part of President Donald Trump’s “one, big beautiful bill” to cut $900 billion in spending, includes a provision that cuts federal dollars to states that offer health coverage to certain immigrant populations under the Affordable Care Act. New York insures more than 500,000 lawfully present immigrants under the Essential Plan, a publicly-funded health plan, using federal dollars available through the ACA.

The proposal, passed Wednesday by the House ways and means committee, seeks to limit eligibility for ACA premium tax credits for undocumented immigrants who reside in the U.S. legally but are not eligible for federal Medicaid dollars, including those who are within five years of receiving their green card or people seeking asylum. Though it would effectively eliminate federal contributions to the Essential Plan for those individuals, New York still has to cover the costs. A 2001 court case, Aliessa vs. Novello, mandates that the state use its own Medicaid money to provide health coverage to lawfully present immigrants.

“It’s cruel,” said Elisabeth Benjamin, senior vice president of health initiatives at the Community Service Society and the attorney who litigated the case. “But beyond being cruel, it just doesn’t make sense for the health care system.”

The proposal adds to a separate plan to fine New York for providing coverage to undocumented immigrants within the House energy and commerce legislation, which also passed on Wednesday. Congressional Republicans included a plan to penalize states that use their own Medicaid dollars to provide health insurance to undocumented immigrants 65 and older – a program that New York launched just last year.

Danielle De Souza, a spokeswoman for the Department of Health, said the agency is monitoring the federal budget and is “deeply concerned” about proposals to limit health care access for people living in New York with legal immigration status.

“If enacted, the provision could jeopardize coverage for hundreds of thousands of residents and strain the state’s safety net,” De Souza said. She did not answer a question about how much money the state stands to lose, but said the Department of Health “remains committed to protecting access to essential health care services and ensuring the well-being of all residents across the state.”

The hospital industry sounded the alarm about the federal government’s move to slash insurance subsidies for immigrants. Ken Raske, president of the Greater New York Hospital Association, said in a Wednesday memo to members that the bill in the ways and means committee included “several troubling health provisions that directly harm New York state,” adding that the loss of health insurance for immigrants will require hospitals to provide more uncompensated care.

“Congress has painted a giant bullseye on New York,” Benjamin said. “I don’t understand how any member of Congress from New York who voted to pass this plan could be serving their constituents.”

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