As the largest health insurance program in the country, providing health care to more than 70 million people, Medicaid is an essential pillar of our health care system.

The Affordable Care Act expanded Medicaid to cover more working Americans who do not make enough to afford private coverage. Now, 40 states, both red and blue, have expanded it, saving lives, keeping hospitals open, saving states money and improving the well-being of countless Americans. 

Medicaid is jointly funded by the federal government and the states, and it is supported by 76% of Americans. It covers one in five Americans, including kids, moms, seniors, people of color, rural Americans and people with disabilities.

Every family knows someone who relies on Medicaid.

In West Virginia, 516,500 of our friends, family members and neighbors are covered by Medicaid — that includes:

• 49,000 seniors
• 196,000 children
• 86,000 people with disabilities

So, why are Republicans in Congress planning to slash trillions from Medicaid to hand out $4.6 trillion in tax breaks to the wealthy?

Republicans in Congress are submitting three proposals that would dramatically reduce federal funding for Medicaid: block grants, per capita caps and reducing Medicaid matching rates. Currently, the federal government pays between 50% and 77% of enrollees’ Medicaid costs, and more for certain high-value services. 

These proposals would blow at least a $235 million hole in West Virginia’s state budget and leave tens of thousands of people uninsured.

Medicaid also helps fund rural hospitals by ensuring more patients can pay for their care. Rural hospitals in Medicaid expansion states, like West Virginia, are 62% less likely to close. In 2023, over 600 rural hospitals were at risk of closing, almost all of which were within non-expansion states. If Congress cuts Medicaid expansion, more rural hospitals will be forced to close their doors.

Medicaid is the single largest payer for long-term care, maternity care and mental health services. Nearly a third of adults have received maternity care, home health care, or nursing home care through Medicaid. Nearly one in five adults nationwide struggling with mental illness have access to care through Medicaid. If Congress has its way, millions of Americans will lose access to essential care.

Congress is also considering imposing so-called work requirements; however, research shows that work reporting requirements cost states money and do not improve people’s ability to find work.

A large majority of adult Medicaid beneficiaries who can work already do. According to a 2024 analysis, over 80% of working-age adults on Medicaid were working, acting as family caregivers or attending school. 

Proposals that require individuals to regularly document and report hours worked or in school cause eligible people to fall through the cracks. Arkansas, the only state to implement Medicaid work reporting requirements on Medicaid beneficiaries, saw one in four of those subjected to the reporting requirement lose health coverage within six months.

Researchers found that this loss of coverage was generally not because people were unable to comply with the work requirement, but that they found the reporting process itself — the bureaucratic red tape — to be confusing and difficult to comply with, or they were unaware of the requirements altogether. Of those who lost their health coverage due to the work reporting requirements in Arkansas, half reported serious problems paying medical bills, 56% delayed addressing health care needs due to cost, and 64% delayed receiving needed medications.

So, what does all this mean? Fewer dollars mean fewer resources for low-income families, people with disabilities, pregnant women and others who rely on Medicaid for health coverage. The state’s going to lose funding for all those people who lose coverage. Even though these poorer states spend less per resident on Medicaid, their federal reimbursement rate is relatively high, and so the impact of federal cuts is large. 

Gutting Medicaid will take health care away from hardworking families across West Virginia, instead of helping them — they deserve better, and it is within our power to do so.