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President Trump's massive tax bill - the one he calls the Big, Beautiful Bill - could cut more than $700 million from Medicaid. Millions of older Americans with low incomes rely on Medicaid to take care of home health expenses their Medicare coverage does not. Alex Olgin explains what's at stake.
ALEX OLGIN: Alene Shaheed looks forward to 9 a.m. every morning. That's when her home health aide comes to her Jacksonville, Florida, apartment.
ALENE SHAHEED: Everything revolves around having the home health aide. She is the lifeline to my independence.
OLGIN: Shaheed is 79 years old and in a wheelchair. Since her only family member - her son - lives in Georgia, the aide is the only one that helps her bathe and dress, as well as go to doctor's appointments, shopping and to church.
SHAHEED: Going out, interacting, socializing - those are the things I enjoy doing. I have always done them.
OLGIN: She's 1 of 12 million low-income older Americans who has Medicaid. It helps pay for her monthly Medicare premiums, doctor visits, drugs and home health aides. Republicans, including House Speaker Mike Johnson, have publicly said that the One Big, Beautiful Bill, which ties Medicaid to work, will only hurt healthy working-age people without jobs.
Brian Blase agrees. He's president of the conservative health care think tank the Paragon Health Institute. He says stricter eligibility requirements shouldn't impact kids, seniors and disabled people that rely on Medicaid.
BRIAN BLASE: I think policy right now is so out of whack that we have magnitudes more ineligible people on the program.
OLGIN: However, the legislation would make it more complicated to keep or apply for Medicaid. States may more frequently ask for multiple bank statements, life insurance policies or for proof of the exact value of someone's assets.
BLASE: I do not think we have a problem with people who are eligible for the program, want to be enrolled and have difficulty getting coverage.
OLGIN: Evidence suggests that the opposite is true. Only about half of low-income seniors who qualify for Medicaid to help pay for their Medicare are actually signed up. This is according to a 2017 analysis by congressional staff. The Biden administration had just made applying more simple. Amber Christ, with Justice in Aging, a group that advocates for low-income seniors, is worried these changes will make it hard for seniors to stay in the program.
AMBER CHRIST: These cuts are so extensive that no group relying on Medicaid, including older adults and disabled people, will be spared from the harms.
OLGIN: The Congressional Budget Office, which analyzes impacts of legislation, finds that as many as a tenth of low-income older Americans who are on both Medicare and Medicaid - like Alene Shaheed - could lose coverage over the next decade. Christ is concerned about choices seniors could be forced to make if they lose this help.
CHRIST: I think people will reduce their - seeking out care because they can't afford it. Another scenario, they'll go to the emergency room and then they won't be able to pay the deductibles and coinsurance.
OLGIN: If 79-year-old Alene Shaheed got caught up in this Medicaid mix up and lost her home health aide, it would mean doing something she really dreads.
SHAHEED: Without the home health aide, my only other option would be a nursing home. I don't want to lose that control over my life.
OLGIN: As the bill moves through the Senate, some Republicans are opposing these Medicaid cuts, like Josh Hawley of Missouri, who is worried about the millions who could lose coverage, though he says he could support work requirements. Others, though, continue to insist big spending cuts are needed to reduce the federal deficit.
For NPR News, I'm Alex Olgin. Transcript provided by NPR, Copyright NPR.
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