Trump's Trials - As Congress debates Medicaid cuts, a look at the potential impacts

Episode Date: May 20, 2025

Health economist Lindsay Allen, assistant professor at Northwestern University's Feinberg School of Medicine, speaks to NPR's A Martinez about the impact of proposed cuts to Medicaid being debated in Congress. Support NPR and hear every episode of Trump's Terms sponsor-free with NPR+. Sign up at plus.npr.org.Learn more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

You're listening to Trump's Terms from NPR. I'm Scott Detrick. We're going to be doing all sorts of things nobody ever thought was even possible. President Trump has brought back strength to the White House. We can't just ignore the president's desires. This will be an entirely different country in a short period of time. Every episode of Trump's Terms, we bring you NPR's latest coverage of the 47th president, with a focus on actions and policies he is pursuing on his own terms and in the process, taking the presidency into uncharted territory.

Today's story starts right after this. I'm Tonya Mosley, co-host of Fresh Air. At a time of sound bites and short attention spans, our show is all about the deep dive. We do long-form interviews with people behind the best in film, books, TV, music, and journalism. Here our guests open up about their process and their lives in ways you've never heard before. Listen to the Fresh Air podcast from NPR and WHYY. Know that fizzy feeling you get

when you read something really good, watch the movie everyone's been talking about, or catch the show that the internet can't get over. At the Pop Culture Happy Hour podcast, we chase that feeling four times a week. We'll serve you recommendations and commentary on the buzziest movies, TV, music and more. From low brow to high brow to the stuff in between, catch the Pop Culture Happy Hour podcast from NPR. I'm Stephen Skeep in Washington, D.C. One of the most contentious parts of the budget bill in Congress is cuts to Medicaid. That's the public health insurance program for Americans who are disabled or have limited

income. To understand the numbers and what they mean, A. Martina spoke with health economist Lindsay Allen at Northwestern University's Feinberg School of Medicine. So Lindsay, the Congressional Budget Office estimates a savings of about 625 billion dollars to the national deficit. The office also thinks that up to 10.3 million people could lose coverage over a decade. Is this gamble even worthwhile? I don't know that I can say the gamble is worthwhile because the CBO estimates actually rely on some pretty big assumptions. One of them is assuming that the states are going to somehow replace the lost federal funding. And that's something that many of the states

just can't or won't do. So in practice, the cost burden is just shifting to states and local governments and hospitals and families. And we suspect that more people are gonna lose coverage than the CDO estimated. So ultimately you're saying someone has to pay. Absolutely. It just shifts the burden of paying for

that care to someone else. Yeah. So, let's take a step back for a second. Uh Bradley, what does it mean to Medicaid recipients to lose coverage? What's the impact on their health and also maybe their their wallet? Yeah, absolutely. So, Medicaid is a health and economic engine and so, when you receive Medicaid, you end up being able to get care for conditions that need treating.

So if you lose Medicaid, you don't end up actually having that need for care go away. Yeah, okay, so let's dig into some of the specific proposals here. One is to require able-bodied adults without dependents to prove they're working or training for a job as a condition to secure Medicaid coverage. If this requirement, Lindsay, goes through, how could that impact coverage?

Well, that sounds wonderful in theory, but something like 91% of the individuals that this bill would be targeting with work requirements are caring for family, they're in school, or they're dealing with health issues that aren't always visible or formally diagnosed. So the policy is not really changing behavior, it's just stripping coverage from people who are already contributing in ways that the system just doesn't recognize. I happened to be in Georgia at the time when Governor Brian Kemp was really, really pushing work requirement for Medicaid coverage, 80 hours of work or volunteer activities. I know that Arkansas was the first state to do it back in 2018. How has that turned out for these states?

What we've seen, so especially in Arkansas and now more recently Georgia, is that the coverage loss is happening not because people aren't eligible but because they get stuck in paperwork. So the red tape is dense and confusing especially for people who are juggling multiple jobs or they're caregiving or they're dealing with their health issues. So what would be some other ways to streamline Medicaid and maybe better serve its most vulnerable beneficiaries without drastically reducing access to health care? Sure. So if we want to cut Medicaid costs without hurting people, the data point us

toward things like reducing prescription drug prices or cracking down on high cost, low value care or investing in preventive services that are what actually lower long-term costs, unlike policies that just cut people off. That's health economist Lindsay Allen. She's an assistant professor at Northwestern University's Feinberg School of Medicine. Lindsay, thank you. Thank you, A. And before we wrap up, a thank you to our NPR Plus supporters who hear each show without

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