The Word Games That Enable Medicaid Cuts -- Thom Walsh

[erronis]

https://prospect.org/politics/2025-06-23-word-games-enable-medicaid-cuts/
via The American Prospect

We don’t call it Medicaid in many states, and we use euphemisms for what are in reality cuts. That endangers the system, a health care regulator writes.

The following is a guest post for the “Trump’s Beautiful Disaster” newsletter by Thom Walsh, a member of the Green Mountain Care Board, Vermont’s regulatory system for health care. Sign up for the newsletter to get it in your in-box.

Medicaid Cuts That Aren’t Called Medicaid Cuts

Earlier this month, the Vermont Association of Hospitals and Health Systems warned that the Senate’s budget bill could cost Vermont hospitals more than $1.7 billion over five years. That’s in a state where many hospitals are already operating at a loss. The threat isn’t just to patients. It’s to jobs, local economies, and community anchors.

Vermont isn’t alone, and neither is Congress in savaging the health care system. In Missouri, over 30,000 children lost Medicaid coverage in 2023—many due to paperwork problems or system delays. In Mississippi, lawmakers advanced a bill to overhaul Medicaid eligibility systems, despite the state’s limited administrative capacity. Across the country, these changes are pitched as efficiency or modernization. But their effects are cumulative—and massive.

What’s happening to Medicaid isn’t overt. It’s incremental and strategic. The Senate’s latest proposal, far from softening the blow from the House’s version, includes a cap on provider taxes, reinstatement of co-pays, and expansion of work requirements for parents. These measures aren’t labeled as Medicaid cuts, but their purpose and effect are exactly that. And because they’re framed in the language of efficiency and fiscal discipline, they often escape public notice. That’s by design.

Rebranded, Reframed, and Reduced

The reality is that many people don’t know they’re on Medicaid. Over the years, many states have rebranded the program to distance it from national politics. Oklahoma calls it SoonerCare. Arkansas uses ARHOME. Connecticut’s program is HUSKY Health. Tennessee has TennCare. These names make Medicaid more palatable locally—but also more vulnerable. When coverage is lost or eligibility is tightened, beneficiaries often don’t realize what they’re losing. The branding creates political insulation.

. . .

In Arkansas’s short-lived 2018 Medicaid work requirement pilot, more than 18,000 people lost coverage. Most were working. They just couldn’t keep up with confusing reporting requirements, poor internet access, or inconsistent job schedules. In many cases, they didn’t even know their coverage was at risk. The system wasn’t built to promote work. It was built to reduce enrollment.

We’ve seen through the years that administrative “friction” is a powerful policy lever. Churn replaces continuity. Preventive care is delayed. Diagnoses are missed. Parents lose access, and children follow. Hospitals, schools, and public-health departments are left to pick up the pieces.

. . .

[Diamond_Dog]

1. Bingo ....

“The system wasn’t built to promote work. It was built to reduce enrollment.”