Lost to many in the flood of controversial directives and proposals emanating from Washington in recent days is the serious discussion on the political right of plans to slash the nation’s Medicaid health insurance program.
As Dr. Aaron E. Carroll, president of the health policy organization AcademyHealth, explained in an essay in the February 2 edition of the New York Times, Republican lawmakers are seriously discussing a plan to pay for the Trump administration’s pledge to renew 2017 tax cuts (total cost: $4 trillion over the next decade) via big Medicaid cuts:
“How do they square the math? It appears they are prepared to do so at the expense of the poor and middle class, by yanking health care coverage from children, new mothers, people with disabilities and seniors. Republican leaders in Congress have suggested that one option they are considering to bankroll their tax breaks would be to cut hundreds of billions from Medicaid; another proposal would roll back subsidies that have helped middle-class families pay Affordable Care Act premiums. They have made it clear they want to finalize legislation in the first 100 days of Mr. Trump’s presidency.”
Dr. Carroll goes on to detail his belief that such cuts would be “catastrophic” for the nation — noting that “children, seniors and people with disabilities — groups that make up more than 75 percent of the program’s spending….”
A recent report from the Center on Budget and Policy Priorities echoes Carroll’s concern. It reports that one prominent budget-cutting tactic under consideration — mandating work requirements for Medicaid recipients — would have an enormously negative impact. It explains that while nearly two-thirds of Medicaid recipients currently work full or part-time and that only 2% are unemployed merely because they could not find work, 36 million people nationally — including between 17-32% of enrollees in North Carolina — could be at-risk of losing coverage under various work requirement schemes.
One thing Dr. Carroll’s essay doesn’t have the space to do is to spell out precisely what massive cuts to such a vital program would mean as a practical matter in states like North Carolina. On the front, however, a recent fact sheet distributed by the nonpartisan Commonwealth Fund entitled “What Medicaid brings to North Carolina” does precisely that.
The following is a by-the-numbers look at some of the highlights:
2.8 million – number of children and adults in North Carolina insured by Medicaid or the Children’s Health Insurance Program (CHIP) as of September 2024
1,407,870 – number of children enrolled in Medicaid or CHIP
480,836 – adults enrolled because of Medicaid expansion under the Affordable Care Act as of June 2024 (more recent numbers from NC DHHS place the total at over 609,000)
350,271 – number of people dually eligible for Medicare and Medicaid as of September 2024
41 – percentage of children ages 0-18 in North Carolina who were covered by Medicaid in 2023
12 – percentage of adults ages 19-64 in North Carolina who were covered by Medicaid in 2023
$14 billion – amount of federal dollars that flowed to North Carolina’s Medicaid program in 2023
73 – percentage of North Carolina’s Medicaid spending that came from the federal government in 2023 (Note for Medicaid expansion enrollees, the figure is 90%)
21 – percentage of North Carolina adults ages 19-64 enrolled in Medicaid who reported having medical debt in 2024
29 – percentage of people with medical debt enrolled in Medicare
29 – percentage of people with medical debt enrolled in employer-provided health insurance
32 – percentage of people with medical debt enrolled in individual and Marketplace programs
(Note these debt numbers were compiled prior to the implementation of the Cooper administration’s groundbreaking medical debt relief program that took effect during the second half of 2024.)
40 – percentage of children ages 0-18 living in metro areas covered by Medicaid or CHIP in 2023
49 – percentage of children living in rural areas
12 – percentage of adults ages 19-64 living in metro areas covered by Medicaid or CHIP in 2023
16 – percentage of adults living in rural areas
60 – percentage of youth ages 12-17 with a mental health condition with public insurance whose mental health services were always covered in 2022
46 – percentage of youth ages 12-17 with a mental health condition with private insurance whose mental health services were always covered in 2022
27 – percentage with public insurance whose services were usually covered
30 – percentage with private insurance whose services were usually covered
13 – percentage with public insurance whose services were sometimes or never covered
24 – percentage with private insurance whose services were sometimes or never covered
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