And further to that....
Project 2025 contains several proposed changes to Medicare and Medicaid, framing the programs as being largely responsible for the United States’ annual budget deficit, which currently stands at $1.27 trillion for 2024.
“In essence, our deficit problem is a Medicare and Medicaid problem,” the Project 2025 proposal states.
What Project 2025 says about Medicaid
Medicaid is a free or low-cost national public health insurance program designed to provide coverage to eligible low-income adults, pregnant women, children, older adults and people with disabilities. As of March 2024, more than 82 million Americans were enrolled in Medicaid.
Project 2025 calls for Medicaid’s federal funding to be converted from its current model — the federal government paying a fixed percentage of states’ Medicare costs — to a model in which the federal government pays a block grant (or fixed amount) to each state, regardless of their specific costs.
Block grants have been floated several times over the years. Such proposals are typically “designed to fail to keep pace with expected enrollment and/or health care cost growth in order to deeply cut federal Medicaid spending over time, relative to current law,” according to a report on Project 2025 from Georgetown University’s McCourt School of Public Policy.
In 2017, a Medicaid block grant plan proposed by Republicans would have slashed Medicaid’s federal funding by more than 25% over 10 years and 30% over 20 years, according to a Congressional Budget Office projection.
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Project 2025 also proposes adding a work requirement, “similar to what is required in other welfare programs,” as well as raising premiums for higher-income beneficiaries. Eligibility should be redesigned, too, the plan reads, “to serve the most vulnerable and truly needy and eliminate middle-income to upper-income Medicaid recipients."
One recent attempt to impose a Medicaid work requirement led to thousands of beneficiaries losing coverage.