Revoke of vaccines
The announcement that Robert F. Kennedy Jr. would take the top job at the HSS under incoming president Donald Trump sent ripples through the biopharmaceutical industry. The markets responded almost immediately to his strong anti-vaccine stance. Shares of vaccine makers fell. More shockwaves erupted after Kennedy’s lawyer asked the government to revoke its approval of 13 vaccines, including the polio vaccine.
Other, equally profound changes are expected to occur in the health sphere, though the conversations around them are not as loud.
Medicaid cuts
As Donald Trump and his cabinet prepare to take office and Republicans take control of the U.S. Congress in 2025, several federal health programs may face budget cuts, the biggest of which are likely to target Medicaid.
“Those would be very severe,” said Joan Alker, executive director of the Center for Children and Families and professor at Georgetown University’s McCourt School of Public Policy, while speaking at a Dec. 6 Ethnic Media Services briefing.
Medicaid is one of the four government-sponsored health insurance programs in the U.S. and it provides health insurance to low-income individuals and households. Though it is primarily managed by the state governments, it is partially funded by them. The federal government is its primary payer.
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ACA expanded benefits
The program was established in 1965, but it was expanded by the Affordable Care Act (ACA), which was passed in 2010. In most states, any member of a household with income up to 138 percent of the federal poverty level is eligible for Medicaid under the ACA. As of 2022, Medicaid provides free health insurance to 85 million low-income individuals and households. In 2019, the program paid for half of all U.S. births. It also plugs some gaps in Medicare, also a federal program, which provides health insurance to mostly those above the age of 65.
A little over 55 percent of all the federal money that is flowing to states is coming in the form of Medicaid, Alker said. “So, if we do see big cuts to Medicaid, it will affect all areas of a state’s budget, not just their health budget. It would be near impossible for even a well-meaning state to make up for these cuts.”
3.7 million low-income people at risk
Though the changes to Medicaid may not come into effect immediately, there is one that will.
When adopting the Affordable Care Act—which has enabled states to widen the eligibility for health insurance coverage—nine states had a proviso built into it that if the extra federal funding for Medicaid dropped, ”trigger laws” would come into effect, swiftly ending the expanded Medicaid coverage. The outcome would be that about 3.7 million low-income people in these states—Arizona, Arkansas, Illinois, Indiana, Montana, New Hampshire, North Carolina, Utah, and Virginia—would be at immediate risk of losing their health insurance coverage.
Even states that don’t have trigger laws will still have to grapple with other challenges, if federal payments were to drop. At the present, “the match rate is very generous, said Alker. “For every 10 cents that the state puts up, the federal government contributes 90 cents.” If that were to revert to the regular rate, for California, it would fall to 50 percent. The difference would be “a huge amount of money for California to make up,” she added.
Red tape hurdles
How could the changes in Washington D.C. translate into the ground? Red tape could be added, which would make it harder for people to get through the process. There could be a reduction in the benefits. Healthcare providers who see a lot of low-wage workers and those in rural communities could very likely face cuts in their reimbursement. “And that will be very hard for them to absorb,” Alker explained.
These factors, taken together, would lead to a decline in enrollment.
What could be even more momentous is that the requirements for Medicaid eligibility could change. The Trump government could require enrollees to either work, volunteer, undergo job training as well as report it to continue to get health coverage.
People of color hit the hardest
As of late 2024, Georgia is the only state in the country that has a Medicaid work requirement. This program is available to adults under the age of 65, with household income below the poverty level, but only if they’re working at least 80 hours per month and reporting their work to the state. By mid-2024, a year after the program began, only some 4,000 people had enrolled in it. This low enrollment is due to the work requirement and accompanying paperwork.
Should these changes come to pass, people of color would be hit the hardest. 34 percent of LatinX, 39 percent of Blacks, and 35 percent of Native Hawaiians and Pacific Islanders, are covered by Medicaid. “So it’s one-third or more of many of these groups,” said Alker.
Impact on SNAP
And it’s not just everyone’s health that will be impacted directly, but indirectly as well, through changes to the Supplemental Nutrition Assistance Program (SNAP), better known as food stamps.
SNAP is a federal program that helps low-income people purchase food so that they are adequately fed. It provides more than 40 million people with the money they need to put food on the table every month.
It’s not just adults who could be impacted. Kids too, will be, said Mayra Alvarez, president of the Children’s Partnership, a nonprofit that works to ensure that all children have the resources they need to thrive.
The number of children in the U.S. reached 74 million in 2021, making up 22 percent of the U.S. population. California is home to nine million children, of which more than five million children live with one undocumented parent. Three out of four of California’s children are children of color and 4.5 million children in California have one immigrant parent.
“Children need health care, but they also need food, Alvarez said. “One huge area of concern is the access to nutrition support through SNAP.” If that changes, scores could go hungry.
Impact on energy assistance
Additionally, the new White House could seek to end the Low-Income Home Energy Assistance Program (LIHEAP) that helps families afford heating and cooling.
All in all, changes to these core programs could shake up the country in the most fundamental of ways.
Image by Ratna Fitry from Pixabay
