The clearest legislative priority of the Trump administration and the Republican-led Congress is to keep taxes low for the richest households and corporations. Last week, House Republicans submitted a budget resolution that calls for $880 billion in cuts to Medicaid—the program that provides health insurance for low-income Americans—to help pay for extending the 2017 Tax Cuts and Jobs Act (TCJA), which primarily benefits the highest earners. President Trump endorsed the House plan earlier this morning, despite vowing yesterday to not cut Medicaid.
Besides being unfair, the cost of this overall tax cut would be large enough to put huge stress on other parts of the economy, no matter how it is paid for. But the costliest way to pay for this would be to enact large cuts in spending programs like Medicaid that provide benefits to economically vulnerable families. These cuts would equal almost 11% of all Medicaid spending over the proposed time period.
In a forthcoming report, we highlight just how damaging these Medicaid cuts would be for typical families. Health coverage is expensive in the U.S., and the value of Medicaid’s coverage is equal to a huge share of the total income of poorer families. In fact, a family health insurance plan in private markets can cost more than what the bottom 20% of families earns in an entire year.
Figure 1 below shows the House budget resolution’s average cut to Medicaid benefits for the bottom 40% of the income distribution, expressed as a share of average income. It also shows how much extending the TCJA’s expiring provisions would boost incomes for these groups and the top 1%. The upshot is that the bottom 40% would be unequivocally worse off: Proposed cuts to Medicaid would reduce incomes for the bottom 40% more than extending the TCJA would boost them—and the lowest-income households would fare the worst. Strikingly, this is true even as the full $880 billion in Medicaid cuts would only pay for about 20% of the total cost of the TCJA—other cuts and economic damage falling on non-rich families stemming from tax cuts for the rich would still be forthcoming. Meanwhile, the TCJA boosts the incomes of the top 1% significantly, while these households do not rely in any way on Medicaid.
A table from our forthcoming report is reproduced below—it shows the cuts to Medicaid expressed as a share of total money income for the bottom 40% of the income distribution for each state. States with more generous Medicaid coverage will see larger cuts, while states that have been stingier to date with Medicaid will see smaller cuts. But in every single state, the proposed cuts are a disaster for the incomes of the bottom 40%. This policy trade-off of thousands of dollars in cuts for the bottom 40% in exchange for tens or even hundreds of thousands of dollars in tax cuts for rich families crystallizes the Republican priorities.
