As a second Trump administration promises major reforms across the federal government, advocates for Medicaid access are concerned what trillions in cuts could mean for many American families.
A new study released by Georgetown University indicates families in rural areas are more likely to rely on Medicaid health insurance coverage, compared to urban residents in the same state.
Joan Alker, executive director of the Center for Children and Families and research professor at Georgetown’s McCourt School of Public Policy, said the study highlights what $2.3 trillion in cuts to the program could mean for rural families.
“Medicaid does a very good job of protecting families from medical debt, particularly at these times that families are most vulnerable, like when you're pregnant and having a baby or on the other end of the life spectrum as folks age into needing long-term care," Alker said.
"Medicaid is also the number one payer for nursing home residents and long-term care services.”
In Beltrami County, nearly 40% of children have Medicaid as their insurance as do 22% of non-elderly adults and 15% of seniors.
Alker said the proposed cuts, recently released by U.S. House Republicans, pose access barriers to Medicaid that will negatively impact families.
"States will have no good choices if these kinds of cuts are made," Alker said. "There's no way they could make up the difference."
Alker explained this could include additional red tape or cutting rates paid to providers.
Around Northern Minnesota, health care providers like hospitals and ambulance services cite low federal reimbursements as the primary reason for operating shortfalls, causing units and wards to shut down and otherwise putting a strain on an already fragile system.
"If Medicaid gets cut, then reimbursement will go even lower," Alker said. "We have a problem in our health care system; costs are too high, but that's not a Medicaid problem. Medicaid is actually the lowest payer."
Alker said Congress should look to savings elsewhere, encouraging people to contact their representatives with a reminder that Medicaid is serving "the most vulnerable people in the most vulnerable communities."
In Mahnomen County, which has the highest poverty rate of any county in Minnesota, more than 45% of children have Medicaid insurance as do 30% of non-elderly adults.
Alker discussed the data indicating Medicaid access as a critical source of health care coverage for people living on or near tribal lands.
"This is one of the things that I found most shocking about the data... in a number of counties, for example, South Dakota in Indian Country... 40% to 2/3 of seniors on these tribal lands are being covered by Medicaid."
While many seniors qualify for health insurance coverage through the legacy program Medicare, Alker noted Medicaid assists low-income seniors who don't qualify for Medicare.
"This would be devastating for these Native populations,” Alker said.
University of Minnesota School of Public Health Professor Katy Backes Kozhimannil contributed to the findings, and her research into rural maternity care also highlighted Medicaid’s important role in Native American health.
“Importantly, Indian Health Service and other components of the federal system for Native health are woefully underfunded, and payments from Medicaid are an important source of revenue," she said in an online webinar.
Kozhimannil said her team's recent research showed about 75% of Native people experiencing childbirth did not have access to IHS services around the time of birth between 2016 and 2020.
"The vast majority of American Indian and Alaskan Native birthing people, with and without access to the Indian Health Service, have Medicaid as a primary payer during pregnancy and childbirth," she said.
Kozhimaanil also highlighted research into how mental health and substance abuse treatment, already more difficult to access in rural Minnesota than in the metro, would be negatively impacted by the scale of the proposed cuts to Medicaid.