More than 750,000 Hoosiers would automatically lose health coverage if federal funding for Medicaid dips below a certain threshold.
The federal government funds 90% of Medicaid expansion programs — like the Healthy Indiana Plan, or HIP. When some states wrote their programs into law, they included what’s known as a “trigger law” in case federal funding was reduced.
Adam Searing, a research professor at Georgetown University’s Center for Children and Families, said these trigger laws can require states to end their expansion programs if there are changes to federal funding.
“States like Indiana, it's pretty automatic,” Searing said. “There's some limited review. But the expansion—if the legislature doesn't do anything, the expansion just goes away.”
While three states wrote that a reduction or loss of federal funding triggers a review of their programs, Indiana is one of nine states where Medicaid funding automatically ends.
Searing said these states are significant because it wouldn’t take any action by the state legislature for the trigger law to go into effect.
“[State lawmakers] wanted to have a process already in place that would eliminate very quickly that program,” Searing said.
Searing offered two reasons states may have written trigger laws into their programs.
The first is because Medicaid is an expensive program. Searing said the state may have gone into the development of those programs worried about what would happen if they were required to take on that cost by themselves.
The second reason Searing said was lawmakers in these states might have also realized how “politically difficult” it would be to remove this health coverage.
“You were worried about the fiscal health of the state, but also you also didn't want to be on the hook for having to act as a legislature to take away people's health coverage,” Searing said.
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However, cuts to federal Medicaid funding might impact more than just those states.
“In many, many other states, there will be very difficult conversations in the legislature,” Searing said.
Searing said this isn’t just a theoretical possibility. The incoming Trump administration has already shown interest in reducing federal Medicaid funding.
“Some of these groups that have come up with plans about what they think the incoming administration and congressional leadership should do, have these exact cuts in Medicaid and have targeted expansion as being a particular cut and reducing that federal matching percentage,” Searing said.
While those conversations are happening at a federal level, Searing said Medicaid expansion has bipartisan support in many states.
“When I see all the Republicans talking about how important it is at the state level, I think there will be a lot of discussion about it,” Searing said. “It's not going to be that easy because it's a popular program.”
Searing said Medicaid expansion is one of the most studied public health topics in history. Searing said that means there’s a lot of information about if it has worked for improving health.
“There are literally hundreds and hundreds of studies showing the benefits of expansion and health coverage for families from better financial security to getting treatment earlier to being healthier just in general, too,” Searing said.
Nationally, these trigger laws would affect more than 3 million people. Searing said this means these people likely couldn’t afford to see their doctors or seek care.
Searing said that while he is not an advocate, he hopes legislative leaders will listen to their constituents when they offer stories about the effects of losing health coverage.
Abigail is our health reporter. Contact them at aruhman@wboi.org.
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