> A Georgia Work Program Previews How Trump Could Reshape Medicaid

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A Georgia Work Program Previews How Trump Could Reshape Medicaid

Sunday, September 15, 2024 | September 15, 2024 WIB Last Updated 2024-09-15T07:17:15Z

 The nation’s only Medicaid work program is part of a broad Republican push to change how poor people qualify for health care. In a second Trump term, Medicaid could be a target for huge spending cuts.


Daphne Young, 61, was recovering from cervical cancer and managing a complex heart condition when she arrived late last month at an Atlanta job fair desperate to reclaim health coverage through Medicaid.

In July, Ms. Young, a journalist, had moved from California to Georgia, a state with strict Medicaid eligibility limits and one of just 10 that did not expand the program to adults under the Affordable Care Act. The monthly income she listed for herself and her son was too high for her to qualify, she said.

Instead, Ms. Young was guided to a table with a potential alternative: a new Medicaid program called Georgia Pathways to Coverage, which required enrollees with incomes up to 100 percent of the federal poverty level to work, study or do community service for at least 80 hours a month to secure coverage.

Pathways, which has drawn anemic enrollment ahead of its scheduled expiration next year, is the subject of an intense legal and philosophical battle over the future of Medicaid, a joint federal-state program that accounts for roughly 10 percent of the federal budget and covers around 75 million Americans, most of them .


The Biden administration quickly withdrew the Trump administration’s approvals of work requirements in state Medicaid programs and has sought to block Georgia from advancing Pathways. A federal judge allowed it to continue.


Health policy experts have said that Georgia has operated as a kind of conservative laboratory for Medicaid, previewing potentially dramatic changes that might occur if former President Donald J. Trump wins the White House in November.

Democrats have seized on the future of the program at a key moment in the campaign.

“Let’s finally expand Medicaid in Georgia so people can take their child to a doctor or go to an emergency room without going into medical debt,” Vice President Kamala Harris said in a recent campaign speech in Savannah, Ga.

Mr. Trump, who as president called for major cuts to Medicaid in his budget proposals, has said little about how he might reshape the safety net program. At the presidential debate this week, he suggested he had “concepts of a plan” to change the Affordable Care Act that he would soon share, which he could use to call for large reductions in Medicaid spending.

Edwin Park, a Medicaid expert at Georgetown University, said that a fight in Congress next year over expiring tax measures signed into law by Mr. Trump in 2017 could lead lawmakers to hunt for large cuts from federal health programs.

“And where would you go except for Medicaid?” Mr. Park said. “If we take former President Trump’s claims at face value about protecting Medicare and Social Security, Medicaid would be the largest source of savings.”





Republican lawmakers and policy experts, some of whom worked in the Trump administration, have been busy pressing the case on their own that Medicaid’s recent growth has put unsustainable pressure on federal and state budgets.

House Republican budget proposals, along with the Project 2025 initiative and conservative think tank papers, have argued that the program’s growth to cover more adults has diverted resources from other Medicaid recipients in need, such as children, pregnant women and disabled people.



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