In the nearly seven months since Speaker of the House Mike Johnson first uttered the term “one big, beautiful bill” during a Republican meeting, reporters, journalists, podcasters, pundits, and just about everyone has been poring over the details of the bill as it has come together, dissecting it line by line to discern not just what President Donald Trump and his Republican Party sought to accomplish, but more importantly what the very real consequences would be if and when the bill came to fruition.
And “when” has become “now.”
There are many details of concern in the bill, now signed into law, but we asked David Dayen, Executive Editor at The American Prospect, to join us during last Saturday’s broadcast and help us take a closer look at how programs like Medicaid and SNAP will be affected in particular, starting off with a breakdown of what changes have been made that relate to the overall massive cuts.
“There is one [change] that is true across both of these programs, and that is the addition of ‘Work Requirements,’” said Dayen, referring to an extra step in the process that requires applicants to be actively working and provide proof of employment. Dayen went on to explain that Arkansas had once tried implementing Work Requirements in their Medicaid program for a couple of years before it was eventually removed, and what analysis of the trial period revealed was that the vast majority of applicants were employed and actively working, and so including the Work Requirements did not have the affect of increasing the workforce, which has been one of the go-to defenses for the requirement by Republicans. Therefore, Dayen believes this is not actually Republicans’ real goal and motive behind adding the extra step.
“The goal is to trip people up and get people off the program,” he stated bluntly. “The whole point here is to create a new bureaucracy that people have to comply with, on a regular basis, and make it so that it’s hard to not just sign up for Medicaid, but to maintain your coverage and to stay enrolled.”
Dayen went on to explain that this is exactly what the Congressional Budget Office (CBO) and other analysts have been projecting, that the changes the law makes will ultimately prevent people from being able to stay in the program or prevent enrollment altogether. And of course what is the ultimate result of people being tripped up and dropping off of Medicaid or SNAP? Bam. The government has “saved money.”
“When you’re talking about ‘cuts,’ that’s what we’re talking about.”
Other changes which will have painful consequences for people on Medicaid include the introduction of a new “cost-sharing” setup which effectively shifts certain financial burdens, like copays, from the government to the individual, as well as a change to the Provider Tax that initially doesn’t seem like a major deal but which Dayen believes will ultimately hurt states’ abilities to adequately fund their Medicaid programs.
“[Provider Tax] is a way that states had used to get more resources, federal resources, into their Medicaid programs,” Dayen explained. “What they would do is they would tax healthcare providers, hospitals, clinics, things like that, but then they would increase the reimbursement rate for those providers, so the providers would pay money in but also get more money back and they would essentially break even; but the people paying the money back are a combination of the state and the federal government, so the federal government pays some of that share, and the state ends up getting more money to administer Medicaid.”
“That has been frozen and actually curtailed in this bill. And it’s a little gimmicky if you just sort of explain what it is, but in the context of this bill it just means states are going to get less money for their Medicaid programs. And states don’t have more money just sitting around to devote to Medicaid, so the result is going to be cutbacks in the Medicaid program.”
As Dayen noted multiple times during the discussion, and as we have reiterated on our broadcasts since this bill began gaining ground, the ultimate goal is clear: this is a way for the Republicans to finally gut these critical programs that help working people. They have had them in their sights for a very long time but weren’t able to do it outright before, and so they have managed to accomplish it in such a way that it’s a slash that will bleed out over time.
Watch our full discussion with David Dayen: