Medicaid cuts could leave millions uninsured

By Christian M. Wade

» Statehouse Reporter

BOSTON — Massachusetts stands to lose billions of dollars in Medicaid funding under a cost-cutting proposal being considered by the GOP-controlled Congress to pay for extending tax cuts, which experts say will force the state to make painful cuts in the taxpayer-funded program.

The House Republ ican’s budget resolution, which was approved Tuesday by 217-215 largely party line vote, calls for extending expiring tax cuts from President Donald Trump’s first term, which would cost an estimated $4.5 trillion. To pay for it, the plan calls for up to $2 trillion in cuts over the next decade, including $880 billion from Medicaid. Republicans say the savings will come from reining in “unsustainable spending” in the program that provides coverage for low-income people. Members of the Massachusetts’ congressional delegation were among House Democrats who uniformly opposed the GOP spending plan. They argue it’s a ‘giveaway’ to billionaires at the expense of health insurance and food support for tens of millions of low-income Americans.

“The American people can forgive a lot — but they will not forgive this betrayal,” House Minority Whip Katherine Clark, a Revere Democrat, said in remarks Tuesday ahead of a vote on the resolution.

House Speaker Mike Johnson, a Louisiana Republican, has brushed off claims that the plan will force vulnerable people off Medicaid, saying the spending would be reduced by “rooting out fraud, waste and abuse,” and making “sure that illegal aliens who do not qualify are not on the rolls.”

Gov. Maura Healey told a gathering of business leaders this week her administration estimates more than 2 million people in Massachusetts could lose their healthcare coverage as a result of the House budget proposal.

“So these kinds of cuts are immense,” Healey, a Democrat, said in remarks to the Greater Boston Chamber of Commerce on Tuesday. “They’re going to

See MEDICAID, Page A2

Medicaid provides health insurance and long-term care to roughly one in every five people living in the U.S and accounts for nearly $1 out of every $5 spent on health care, according to federal data.

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cause unnecessary suffering. Who do you think’s going to pay for that?”

Medicaid provides health insurance and long-term care to roughly one in every five people living in the U.S and accounts for nearly $1 out of every $5 spent on health care, according to federal data. The program is jointly funded by states and the federal government.

Healey’s preliminary fiscal 2026 budget projected more than $16 billion in federal revenue, with the bulk of the funding tied to Medicaid reimbursements.

A report by KFF, a nonprofit independent organization focused on health policy, said restricting federal Medicaid spending could leave Massachusetts and other states with tough choices about how to offset reductions with state funding, limit Medicaid utilization or benefits, or reduce coverage.

The group estimates Massachusetts could lose anywhere between $11.6 billion and $23.2 billion in Medicaid funds over the next decade under various scenarios being considered for cutting spending, including per-capita caps on funding.

Suzanne Curry, director of policy and government relations for the advocacy group Health Care for All, said while it’s not yet clear where the cuts in Medicaid will come from, reductions in federal funding would force the state to make “difficult decisions” about how it spends health care dollars.

Those decisions could include adjusting eligibility levels to reduce the number of people who qualify for Medicaid coverage, reducing benefits or services for existing members, or potentially reducing provider rates paid to hospitals and nursing homes.

“Those are some of the tough decisions that the state would have to make if significant cuts go through on a federal level,” Curry said.

Keeping MassHealth viable would require a substantial infusion of state funds, she said, which could mean deep cuts to other areas of the budget.

“It would be detrimental not to Medicaid itself, but other health care programs that rely on Medicaid as a revenue source,” Curry said.

Others argue that Massachusetts could benefit from reducing the enrollment of its Medicaid programs, which have been expanded to include more people over the years, adding to the state’s financial burden.

Health care coverage is one of the state’s biggest expenses. The cost of Mass-Health — the state’s Medicaid program which serves more than 2 million or roughly one in every three people — has doubled in the past decade and now accounts for nearly 40% of overall spending.

Josh Archambault , a senior fellow on health care policy at the Pioneer Institute, said he thinks changes to MassHealth are “long overdue” and said if the federal government “resets the financial picture” on Medicaid spending it would provide an opportunity for reforms.

He said federal cuts would prompt “hard but necessary” discussions on Beacon Hill about how to spend limited health care dollars to focus on the state’s most neediest residents.

“ For decades we haven’t had that conversation, because it’s been about maximizing federal reimbursements and supplemental payments,” Archambault said. “The amount of money that has flowed through these programs is astronomical, and the problem is that people aren’t getting any healthier.”

Christian M. Wade covers the Massachusetts Statehouse for North of Boston Media Group’s newspapers and websites. Email him at cwade@cnhinews.com.