The U.S. House of Representatives is barreling forward to meet its self-imposed deadline of voting this week on legislation that would enact the largest cuts to Medicaid and SNAP in the history of the programs. The cuts would strip health coverage and food assistance away from tens of thousands of Missourians.
The House budget reconciliation plan includes:
– At least $625 billion in Medicaid cuts, including new red tape and administrative burdens on both the state and those enrolling in Medicaid, and restrictions on how states can finance their share of Medicaid
– Nearly $300 billion in cuts to food assistance, including massive cost shifts to states and the expansion of work requirements to parents of children over the age of 6 and adults aged 55 to 64
Cuts to the health care and food assistance Missourians need are being made to pay for a larger tax package that will increase the deficit to give a lopsided tax cut to the nation’s top earners. Simply put, when cuts to federal programs are accounted for, the package takes resources from the poorest Americans and gives them to the richest.
House Cuts to Medicaid Would Force Drastic Cuts to Health Coverage and Benefits,
Increase Costs for Missouri Families
Medicaid helps keep Missourians and their families healthy so they can work, succeed in school and contribute to their communities. But if enacted, the House reconciliation package would result in unprecedented cuts to health services.
These proposed cuts to Medicaid would add new barriers and red tape, increase the cost of care, and force cuts to benefits – causing Missourians to lose coverage and undermining the existing quality of care.
The House budget reconciliation bill would:
Impose harsh work requirements on Medicaid expansion applicants and current enrollees.
While some exemptions would be allowed, other states that have implemented work requirements have experienced large coverage losses that included enrollees who met meeting work requirements or were eligible for exemptions.
State after state has shown that work requirements don’t increase employment, and eligible people lose health care because of administrative errors and steep barriers caused by reporting requirements.
Over 91,000 thousand Missourians are expected to lose health coverage, even though around 90% are already working or qualify for an exemption due to disability, caregiving, or enrollment as a student. While the bill does allow for exemptions in high unemployment areas, only a few Missouri counties might qualify for those waivers.
Restrict the use of provider taxes, an important funding stream for Medicaid in Missouri.
States would be prevented from increasing provider tax rates and from implementing new provider taxes. Missouri’s provider tax (also known as the Federal Reimbursement Allowance or FRA) must be periodically renewed by lawmakers and currently expires in 2029. This renewal could be flagged as a “new provider tax” under the proposed legislation, meaning Missouri is at risk of losing $4.3 billion in funding for Medicaid ($1.5 billion in provider taxes and an additional $2.8 billion in federal matching dollars).
Impose new administrative barriers and red tape causing people to lose health coverage.
Current proposals would require Medicaid expansion enrollees to renew their eligibility every six months as opposed to annually. Doubling the frequency of these renewals would increase administrative costs, require additional staffing and further strain Missouri’s already struggling enrollment systems. In addition, proposals would delay implementation of streamlined application and enrollment rules for children and older adults, including measures intended to help low-income Medicare beneficiaries gain access to Medicaid coverage of Medicare premiums.
Increase the cost of health care for Missouri families. Co-pays of up to $35 per service would be required for Medicaid expansion enrollees between 100-138% of the federal poverty level (FPL) (for one adult, that would be between $15,650 and $21,597 in 2025). Other provisions would reduce access to the ACA marketplace by narrowing eligibility, increasing costs & premiums, reducing benefits and implementing new barriers to access such as shorter open and special enrollment periods. Moreover, the House bill would disqualify those who lose Medicaid coverage because of work requirements from accessing subsidized plans through the marketplace.
Increase the number of uninsured Missourians, further raising health care costs and medical debt. Roughly 110,000 Missourians would become uninsured as result of the provisions outlined above.
However, despite the House bill’s many tax provisions, the legislation fails to renew premium tax credits, which enabled many Americans to afford coverage in the ACA marketplace. Combined, the expiration of premium tax credits and other health provisions would result in an estimated 190,000 Missourians losing their health insurance coverage.
When people lose their health insurance, they delay preventive care, are unable to control chronic conditions, and are more likely to seek more expensive emergency care. As a result, they are more likely to experience medical debt, and any uncompensated medical care increases costs for everyone.
Cuts to Nutrition Assistance Will Shift Massive Cost to States,
Take Food Away from Missouri Families
The House proposal cuts the Supplemental Nutrition Assistance Program (SNAP) by more than twenty percent. Among other provisions, it would shift massive costs to states and put 150,000 Missourians’ food assistance at risk.
The proposal breaks the United States’ commitment to ensure households have access to an adequate diet no matter where they live. If enacted, states would face an unpredictable cost share requirement for SNAP, ranging from 5 to 25 percent of benefit costs, as well as increased administrative costs.
Under the proposal, Missouri would be expected to pay an additional $405 million to maintain its current level of SNAP food assistance for Missourians. The potential impact on the state budget, along with other proposed program changes means Missourians of all ages are at risk of losing food assistance.
Moreover, the proposal would take food assistance away from families that include parents with children over the age of 6 and adults ages 55 to 64 who don’t meet arbitrary work requirements. SNAP’s existing work requirements don’t raise employment, and expansion of the requirements don’t address the extra challenges faced by parents of school-aged children in the workforce or employment discrimination against older adults.
150,000 Missourians would be at risk of losing a portion of their families’ nutrition benefits.
Changes to Health Care and Food Assistance Will Have Ripple Effects on Missouri Communities, Particularly in Rural Areas
Federal cuts to Medicaid and SNAP will be devastating to those who lose health care and nutrition assistance, but the consequences to the health and economic wellbeing of Missouri’s communities will be widespread.
By increasing the purchasing power of families with low ages, SNAP creates a ripple effect within Missouri’s economy. Every SNAP dollar spent in local communities generates an estimated $1.57 in economic growth. SNAP spending supports retailers, agriculture, and jobs across the state and provides an especially critical boost to Missouri’s rural communities, accounting for over 4% of total Gross Domestic Product in some areas.
Similarly, Medicaid plays an important role in ensuring health care access in rural areas. Not only are rural Missourians more likely to be covered by Medicaid than Missourians living in urban areas, but Medicaid also helps rural health care providers stay afloat so they can serve everyone in their communities. Twenty-six rural Missouri hospitals are at risk of closing, with nine considered to be at immediate risk. Decreased Medicaid funding would be disastrous to the health care infrastructure of those communities.
Medicaid and SNAP help families directly and also play an integral role in Missouri’s state and local economies. Medicaid funding flows to medical and mental health providers, and SNAP benefits are spent directly in local communities. These federal funds in turn support additional jobs and create economic activity throughout the Show-Me State.
Missourians Deserve Better
The House budget reconciliation proposal will raise costs on families and make it harder for Missourians – including children, older adults, Missourians with serious health conditions and disabilities, veterans, and workers with low-paying jobs – to meet their basic needs.
Instead of pursuing this reckless proposal, Congress should protect America’s social safety net, which provides stability to individuals and enables our economy to function and grow.
