Heed GOP legislators on harmful Medicaid cuts

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First elected to the Minnesota House in 1998 and now serving in the state Senate, Anoka County Republican Jim Abeler is a veteran rider of the state budget roller coaster and has been on the front lines when economic downturns require belt-tightening.

As a legislator who’s spent a career focused on health and human services, he understands that spending cuts in these areas are particularly painful. When they’ve been required, they’ve come with a personal toll: anguish and months of lost sleep.

“Done badly, true harm can happen,” Abeler said in an interview Tuesday. ”Done carefully, we can try to manage through it.”

I’ve known Abeler a long time and watched him wrestle with these decisions over the past quarter-century. So it wasn’t a surprise to hear that he spearheaded a thoughtful and necessary letter to the state’s Republican congressional delegation — one that urgently sounds the alarm about reckless potential federal funding cuts to Medicaid.

Medicaid provides medical coverage to the needy, elderly and disabled. It’s jointly financed by the federal and state governments. In Minnesota, it’s generally referred to as Medical Assistance.

A quick look at a state fact sheet from KFF, a nonpartisan policy organization, shows the vital role Medicaid has in providing access to health care here. In Minnesota, Medicaid covers one in six adults aged 19 to 64, three in 10 children, one in three people with disabilities and five in nine nursing home residents.

The bulk of expenditures, 57%, is for the elderly and individuals with disabilities. That’s an important point to understand with the House Republican budget resolution passed last week setting a savings target of $880 billion (spread over 10 years) for the committee overseeing Medicaid. For background, the program’s yearly national spending in fiscal 2023 came to $872 billion.

The newly passed House budget framework doesn’t specify Medicaid cuts. But it does set a massive spending reduction target to help offset the cost of President Donald Trump’s tax cuts. The target leaves the House committee overseeing the program with little option but to take aim at this safety-net program.

Even if the committee cuts everything that’s not health care under its jurisdiction to $0, “it will still be more than $600 billion short,” the New York Times reported on Tuesday.

A reduction this sudden and of this scope to Medicaid will make it challenging to shield seniors and those with disabilities from downstream consequences. That’s the impetus for the Feb. 20 letter, which was signed by more than a dozen Republican legislators.

The missive is commendably blunt about the federal cuts' potential impact. It needs to be. Too often Medicaid critics don’t realize the program’s vital role in serving the elderly in nursing homes and those with disabilities. The letter makes this reality abundantly clear.

“Given some of the large numbers coming out of Washington, we are concerned that there is no practical way to accommodate some of the proposed massive reductions and still provide the kind of care these vulnerable people require,” the letter states.

“There are no other sources to make up the lost federal share beyond severely impacting the seniors and those with disabilities who we serve. This is contrary to how we Republicans respect the aged and the vulnerable.”

Signatories include Abeler and two GOP legislators who lead key health care committees: Sen. Paul Utke, R-Park Rapids, and Rep. Jeff Backer, R-Browns Valley.

While it would have been easy to add dozens more signatures from DFL legislators, Abeler was smart to keep signers limited to Republicans. In this age of deep political divisions, the Republican majorities in the U.S. House might too easily dismiss concerns from the state’s DFLers.

It’s harder to do that when the objections are coming from within your own political party.

The legislative letter also had a limited distribution. It was only addressed to President Trump and the state’s four Republican U.S. House representatives, another logical move.

The GOP controls the U.S. House, the Senate and the White House. The party’s leadership determined the $880 billion savings target. In addition, the state’s Republican U.S. House members wield serious clout.

Rep. Tom Emmer serves as the House majority whip. Rep. Pete Stauber, who represents northeast Minnesota, is also increasingly influential. Support from either could make a critical difference in shielding the Medicaid program.

“The message is to please be thoughtful and continue being our partners for the people you’ve asked us to serve,” Abeler said, adding that he hopes this Republican-to-Republican letter will break through.

It certainly was worth a try, even if Emmer, Stauber and the state’s two other Republican U.S. House representatives voted for the budget framework this week. As the U.S. House committee tasked with finding the $880 billion in cuts gets to work, there’s time for House leadership to heed the concerns outlined in the Minnesota legislators' letter.

Abeler noted that Gov. Tim Walz has proposed substantially reducing projected state spending on Medicaid programs serving 70,000 low-income Minnesotans with disabilities. If all the reductions go through at state and federal levels, “We are going to be in a hard way,” Abeler said, adding that Minnesota would be hard-pressed to make up for the federal cuts by relying on state revenue.

Total Medicaid spending in Minnesota came to $18.5 billion in fiscal 2024. Generally, the feds’ contribution to state Medicaid costs comes to about 51%, though it’s a higher percentage for some populations. You don’t have to be a budget wonk to understand that a 10% cut in federal aid, which is what the House savings target could result in, translates to significant shortfalls for the state to make up.

It’s to Abeler’s credit that he loses “months” of sleep when cuts are proposed to state programs serving the elderly and disabled. Members of Congress should be tossing and turning as well with potentially life-threatening Medicaid cuts bearing the brunt of paying for another round of Trump tax cuts.