Though the full ramifications of the “big, beautiful” tax and spending bill that narrowly passed the U.S. House this week are still murky — especially since the bill is likely to change as it makes its way through the Senate — the bill as currently written could jeopardize health insurance for tens of thousands of Utahns.
Plus, states including Utah would need to grapple with an estimated $625 billion in cumulative Medicaid cuts over 10 years from work requirements, stricter eligibility rules and a pause on provider taxes — changes that would likely lead millions of Americans losing Medicaid coverage.
On Friday, officials from the Utah Department of Health and Human Services told Utah News Dispatch they did not have state-specific estimates available detailing the potential impacts of the still-evolving federal budget reconciliation package on Utah’s Medicaid program because it’s still a “moving target.”
However, according to the health policy outlet KFF, the bill could result in an estimated $381 million loss in federal Medicaid dollars for Utah. The outlet used Congressional Budget Office (CBO) estimates to unpack the potential state-by-state impacts of a $625 billion federal cut to Medicaid in an analysis posted last week.
“Cuts of $625 billion will force states to make tough choices: maintain current spending on Medicaid by raising taxes or reducing spending on other programs; or cut Medicaid spending by covering fewer people, offering fewer benefits, or paying providers less,” KFF reported.
The vast majority of the cut would come from three sources: work requirements mandating that adults who are eligible for Medicaid expansion must meet work and reporting requirements (estimated to save $300.8 billion as people become ineligible), repealing the Biden administration’s rule simplifying eligibility and renewal process (estimated to save $162.7 billion) and setting a moratorium on new or increased provider taxes (estimated to save $86.8 billion), according to KFF.
It depends on what states decide to do to respond to the cuts, but in another analysis posted Tuesday based on CBO estimates, KFF estimated the changes to Medicaid and the Affordable Care Act Marketplaces could increase the number of people without health insurance across the nation by 8.6 million.
Additionally, when combined with the effect of the expected expiration of the Affordable Care Act’s enhanced premium tax credits, the CBO expects 13.7 million more people will be uninsured in 2034, according to KFF.
“Anticipating how states will respond to changes in Medicaid policy is a major source of uncertainty in CBO’s cost estimates. Instead of making state-by-state predictions about policy responses, CBO estimates the percentage of the affected population that lives in states with different types of policy responses,” KFF noted, adding that states may choose to implement work requirements that are easier or harder to comply with, which would impact enrollment.
So KFF’s analysis included a range of enrollment impacts varying by plus or minus 25% from a midpoint estimate.
Based on the budget reconciliation bill’s changes to Medicaid, Utah is projected to see its uninsured population increase by a mid-range estimate of roughly 65,000 — somewhere between 49,000 on the low end and up to 81,000 on the high end, according to the analysis.
When combined with the expected expiration of the Affordable Care Act’s enhanced premium tax credits, KFF estimated that Utah’s uninsured population could increase by even more — roughly 150,000, or a 4% increase. That estimate could vary between 110,000 on the low end or up to 190,000 on the high end, according to KFF.
Other states would see bigger impacts than Utah, where about 350,000 total Utahns enroll in Medicaid. About half of the 13.7 million more people who would be uninsured under both policy changes live in Florida (1.8 million), Texas, (1.6 million), California (1.5 million), New York (800,000), and Georgia (610,000).
Read the full report at UtahNewsDispatch.com.
