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"In short, recent proposals for a per capita cap or block grant would cause people to lose health coverage and benefits, shift costs and risks to states, and destabilize healthcare providers."
Republican proposals to impose a per person cap on federal Medicaid funding or turn the government health insurance program for lower-income Americans into a block grant would leave millions of people without coverage or care, according to an analysis published Tuesday.
The Center on Budget and Policy Priorities (CBPP), a progressive think tank, examined GOP policy proposals including the per capita funding cap and making Medicaid a block grant and found that such policies "would dramatically change Medicaid's funding structure, deeply cut federal funding, and shift costs and financial risks to states."
"Faced with large and growing reductions in federal funding, states would cut eligibility and benefits, leaving millions of people without health coverage and access to needed care," CBPP added.
Policymakers should protect #Medicaid’s federal-state funding to avoid harming millions of people. Caps or block grants would force deep cuts, shift costs to states, destabilize providers, and threaten access to care. www.cbpp.org/research/hea...
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— Center on Budget and Policy Priorities (@centeronbudget.bsky.social) January 7, 2025 at 9:41 AM
According to the analysis:
Many of those losing Medicaid coverage would be left unable to afford lifesaving medications, treatment to manage chronic conditions like cardiovascular disease and liver disease, and care for acute illnesses. People with cancer would be diagnosed at later stages and face a higher likelihood of death, and families would have more medical debt and less financial security. A large body of research shows that Medicaid improves health outcomes, prevents premature deaths, and reduces medical debt and the likelihood of catastrophic medical costs.
"Before resurrecting harmful per capita cap proposals, policymakers should consider how similar past proposals would have impacted states' budgets and thus their ability to support Medicaid enrollees," CBPP advised.
The analysis comes as Republicans—who control both houses of Congress and, starting on January 20, the White House as President-elect Donald Trump takes office—pursue a massive tax cut that would be funded in part by cutting social programs including Medicaid. GOP lawmakers are also considering work requirements for Medicaid recipients in order to help pay for the tax cut, which critics argue would primarily benefit rich people and corporations.
According to a 2024 report by the National Association of State Budget Offices, Medicaid—which, along with the related Children's Health Insurance Program, serves nearly 80 million U.S. adults and minors with limited income and resources—makes up more than half of all federal funding for states.
Total Medicaid spending was approximately $860 billion for fiscal year 2023, with the federal government contributing around 70% of the funds. The CBPP analysis notes that "under a per capita cap, states would get additional funding as the number of enrollees increased, but if the caps were set at an insufficient level, the state's funding shortfall would grow as more people enrolled."
The report also says that "the design of per capita caps can expose states to cuts even if spending falls below caps for some eligibility groups, and even if spending growth falls below the cap on average over time. And as the caps would be permanent, the size of the cuts and the number of states affected would continue growing over time. These losses in federal support would impose significant strain on states and put millions of people at risk of losing benefits and coverage."
Under a block grant, "the funding shortfall would be even worse since federal funding wouldn't change in response to enrollment increases," the analysis states.
"In short, recent proposals for a per capita cap or block grant would cause people to lose health coverage and benefits, shift costs and risks to states, and destabilize healthcare providers," the publication concludes. "The federal funding cuts to states would be large and unpredictable. Restructuring Medicaid's financing would also make the program highly vulnerable to future cuts, as it would impose a funding formula that could be easily ratcheted down further—for example, by setting the cap or its growth rate even lower. Policymakers should reject proposals for per capita caps and block grants and instead retain the current federal-state financial partnership."
"Increased homelessness is the tragic, yet predictable, consequence of underinvesting in the resources and protections that help people find and maintain safe, affordable housing," said one advocate.
The controversial federal system for tracking homelessness in the United States recorded an 18% increase from 2023, breaking the record previously set last year, according to a report released Friday.
The U.S. Department of Housing and Urban Development's (HUD) process—which advocates and experts have long argued is flawed and results in inaccurate data that understates the homelessness crisis—provides a snapshot of how many people are unhoused for a single night each January.
This year, the HUD report states, "a total of 771,480 people—or about 23 of every 10,000 people in the United States—experienced homelessness in an emergency shelter, safe haven, transitional housing program, or in unsheltered locations across the country."
"Homelessness among people in families with children, individuals, individuals with chronic patterns of homelessness, people staying in unsheltered locations, people staying in sheltered locations, and unaccompanied youth all reached the highest recorded numbers in 2024," the report notes. "Veterans were the only population to report continued declines in homelessness."
The publication for the agency's 2024 Point-in-Time (PIT) Count adds that "people who identify as Black, African American, or African continue to be overrepresented among the population experiencing homelessness."
In a HUD statement about the document, the outgoing Biden administration highlighted that "this report reflects data collected a year ago and likely does not represent current circumstances, given changed policies and conditions."
Alongside the report, the Biden administration on Friday announced measures to address the crisis, which include "updating regulations that streamline the repurposing of surplus federal properties for affordable housing and homelessness services, making resources available to a select number of states under the second cohort of the Housing and Services Partnership Accelerator with the Department of Health and Human Services (HHS), and awarding approximately $39.8 million to support veterans through the HUD-Veterans Affairs Supportive Housing (HUD-VASH) program."
The data came just weeks away from President-elect Donald Trump's return to the White House—and, as Peggy Bailey, an executive vice president at the progressive think tank Center on Budget and Policy Priorities, warned on social media Friday, the incoming Republican administration "is poised to make matters worse."
"Trump's record and Republican proposals raise SERIOUS concerns that the incoming [administration] and Congress will abandon evidence-based approaches and pursue funding cuts and policies that further increase homelessness and deepen inequities," she said, pointing to the president-elect picking former Texas state Rep. Scott Turner (R-33)—who has a history of opposing efforts to help the poor—to run HUD.
While sounding the alarm about the potential impact of Republicans controlling the White House and both chambers of Congress next year, Bailey also called out current policymakers for not doing enough to reduce homelessness, saying: "This is a policy choice. Housing is a basic human need. In the wealthiest nation in the world, solutions are in reach."
"The research is clear: Rental assistance promotes housing stability and is key to solving homelessness. Reducing homelessness will require *expanding* rental assistance, not cutting it or taking it away from people who need it to make ends meet," she explained. "Under the status quo, deep racial and other inequities in homelessness and housing insecurity persist, due to income and wealth inequities stemming from generations of discrimination in housing, education, and employment."
"Policymakers' choices left many communities [without] the resources to respond as need increased, like after natural disasters, surges in market rents, or when some people who recently came to the U.S. seeking asylum or work opportunities had nowhere to live," Bailey added. "Homelessness is unacceptable—and solvable—regardless of who experiences it."
According to HUD's statement:
Migration had a particularly notable impact on family homelessness, which rose 39% from 2023-24. In the 13 communities that reported being affected by migration, family homelessness more than doubled. Whereas in the remaining 373 communities, the rise in families experiencing homelessness was less than 8%. Rents have also stabilized significantly since January 2024. Since then, HUD has added 435,000 new rental units in the first three quarters of 2024; that's more than 120,000 new units each quarter. The PIT Count was conducted at the tail of significant increases in rental costs, as a result of the pandemic and nearly decades of under-building of housing. Rents are flat or even down in many cities since January.
The Maui fire, in addition to other natural disasters, had an impact on the increase in homelessness. In Hawaii, more than 5,200 people were sleeping in disaster emergency shelters on the night of the PIT count due to the Maui fire. HUD continues to work diligently with the state of Hawaii and Maui County through funding and technical assistance to support long-term recovery from the fire. Over the last year, since the PIT Count was conducted, rental costs have stabilized, with rents down in some cities.
Like Bailey, leaders at advocacy groups called on policymakers—at all levels—to do far more to help unhoused people.
"The answer to ending homelessness is ensuring everyone has access to safe, stable, and affordable housing," Ann Oliva, CEO of the National Alliance to End Homelessness, said in a Friday statement responding to the new data.
"Our leaders must immediately expand the resources to rehouse people without homes and assist the rapidly growing number of people who cannot afford skyrocketing rents," Oliva continued. "This record-setting increase in homelessness should sound the alarm for federal, state, and local lawmakers to advance evidence-based solutions to this crisis."
Renee Willis, incoming interim CEO of the National Low Income Housing Coalition, similarly stressed that "increased homelessness is the tragic, yet predictable, consequence of underinvesting in the resources and protections that help people find and maintain safe, affordable housing."
"As advocates, researchers, and people with lived experience have warned, the number of people experiencing homelessness continues to increase as more people struggle to afford sky-high housing costs," she said.
"These data confirm what we already know: that too many of our friends, neighbors, and family members are experiencing the crisis of not having a place to call home," Willis added. "Without significant and sustained federal investments to make housing affordable for people with the lowest incomes, the affordable housing and homelessness crisis in this country will only continue to worsen."
Some progressive U.S. lawmakers weighed in on social media Friday. Congressman Maxwell Alejandro Frost (D-Fla.) emphasized that "as housing prices increase, homelessness increases. Homelessness is a housing problem."
Sen. Bernie Sanders (I-Vt.) said that "this is the richest country on Earth. 770,000 Americans should not be homeless, and 20 million more should not be spending over half their incomes on rent or a mortgage."
"We need to invest in affordable housing," Sanders added, "not Trump's massive tax breaks for billionaires."
This post has been updated with comment from U.S. Rep. Maxwell Alejandro Frost (D-Fla.) and Sen. Bernie Sanders (I-Vt.).
"Behind these eye-popping budget numbers are millions of real people who will see health coverage, food assistance, and other forms of support taken away," said the Center on Budget and Policy Priorities.
Taken together, budget proposals released by House Republicans and the far-right agenda outlined by the Trump-aligned Project 2025 initiative would "create a harsher country with higher poverty and less opportunity" while simultaneously delivering more tax cuts to the wealthiest people in the United States.
That's according to a
detailed analysis published Tuesday by the Center on Budget and Policy Priorities (CBPP), which examines the House Republican Study Committee's (RSC) budget blueprint, the GOP House Budget Committee's (HBC) proposed budget, and the Project 2025 agenda crafted by dozens of right-wing organizations and former Trump administration officials.
Analyzing the three proposals in tandem "brings the implications of influential conservative policymakers' and a think tank's broader fiscal policy agenda into sharper focus," CBPP said Tuesday, explaining how—if enacted—the plans would slash critical social programs such as Medicaid and federal nutrition assistance, disinvest from public infrastructure and medical research, attack immigrants, and double down on "skewed, expensive, and ineffective tax cuts" for the rich.
The liberal think tank estimates that the three right-wing proposals would strip Medicaid coverage from tens of millions of people in the U.S., take early learning services from roughly 800,000 children, curb cash assistance for millions of seniors, and cut nutrition assistance for tens of millions of low-income families. Such proposed cuts are consistent with the budgets Republican nominee Donald Trump put forth during his first term in the White House.
"The RSC budget calls for cutting average Supplemental Nutrition Assistance Program (SNAP) benefits by about 22%," CBPP's new analysis observes. "This cut would affect 41 million people participating in SNAP."
"And Project 2025 calls for gutting summer food assistance programs that children in families with low incomes rely on when school is out, which could include the new Summer EBT program that is expected to provide grocery benefits to more than 21 million children this summer," CBPP added.
The think tank emphasized that "behind these eye-popping budget numbers are millions of real people who will see health coverage, food assistance, and other forms of support taken away."
"This will make it even harder for them to afford the basics, leading to serious hardships such as homelessness or overcrowded living, food insecurity, hunger, and untreated health conditions," the CBPP said.
While proposing funding cuts that would strip food aid, healthcare, and other programs from working-class people across the U.S., the three proposals align behind a tax agenda that would disproportionately benefit the wealthiest Americans, according to CBPP.
"For example, each agenda would double down on the 2017 tax cuts, whose core provisions are tilted heavily toward high-income households," the think tank said Tuesday. "The RSC budget calls for the continuation of all of the 2017 law’s individual income tax cuts and adds substantial tax cuts for corporations, wealthy shareholders, and large estates on top."
"Project 2025 goes further," CBPP added, "calling for a set of extreme near-term tax policies that would raise taxes on middle- and low-income households while cutting them for wealthy households, shareholders, and corporations."
Additionally, each of the three right-wing policy proposals calls for the elimination of an Internal Revenue Service (IRS) funding boost approved by congressional Democrats and President Joe Biden as part of the Inflation Reduction Act. The funding increase has allowed the IRS to collect over $1 billion in past-due taxes from the wealthy in the U.S., according to the agency.
CBPP's new analysis lends weight to Democrats' warnings that House Republicans have injected elements of the deeply unpopular Project 2025 agenda into key government funding fights in the lead-up to the November elections, in which control of the White House and Congress are at stake.
"It is also notable what is missing from these agendas," CBPP said Tuesday. "Despite rhetoric from some Republicans about the need to support families—and children in particular—these sweeping agendas do not call for new or increased investments to help families afford childcare or rent, to expand the Child Tax Credit, or to bolster the [Earned Income Tax Credit] for workers without children."
"And they do nothing," the analysis adds, "to ensure that all workers have access to paid family and medical leave so they can take time off to welcome a new child, attend to a health issue, or care for a family member who needs them."