For Medicaid cuts, national work requirements being considered, says Idaho's U.S. Rep. Fulcher

U.S. Rep. Russ Fulcher, R-Idaho, speaks with Republican supporters at the Idaho GOP election night watch party at the Grove Hotel in Boise, Idaho, on Nov. 8, 2022. (Otto Kitsinger for Idaho Capital Sun)
U.S. Rep. Russ Fulcher, R-Idaho, sits on the House committee tasked with finding $880 billion in spending cuts over the next decade.
While he stressed that the House Committee on Energy and Commerce is early into searching for cuts, he offered a preview for what's on the table in an interview with the Idaho Capital Sun on Monday.
'The big takeaway is, number one, our objective is to save it,' Fulcher said of Medicaid. '… And I think we're going to get there. Number two: our objective is to keep the benefits intact for everybody it was intended for. And I think we're going to get there.'
Asked what he meant by Medicaid's intended population, Fulcher described what Medicaid enrollment looked like before the Affordable Care Act prompted all but 10 states to expand Medicaid.
'Disabled people, elderly people who truly need the health care, and they don't have any other channel to get it. And that's what Medicaid was designed for. And we're trying to make sure that that remains intact,' he said.
But Fulcher pushed back on what he called misinformation about congressional Medicaid spending cut plans, naming U.S. Sen. Bernie Sanders, an Independent from Vermont, and U.S. Rep. Alexandria Ocasio-Cortez, D-New York, who recently visited Idaho for a rally.
'I know exactly where they're coming from, and they would like to see a universal health care system. And there was a big push to make Medicaid that vehicle — and it was just never designed for that,' Fulcher said.
'If you're working-age, able-bodied, I think that there's a reasonable chance that that's going to change. But at the same time, I would say there's some fairness in there too, because that was really never what was envisioned with the program. It's just the expansion population included everybody, and there was never any discussion for a funding mechanism,' Fulcher said. 'So shame on all of us for letting that happen.'
But not all of the House's planned cuts need to come from Medicaid, he said. One of the first places the committee will look is to end mandates for electric vehicles and green energy, which he said could combine to well over $100 billion alone.
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For Medicaid, several savings options are on the table, Fulcher said, like:
Medicaid work requirements for 'working-age, able-bodied people.' That could also come with a range of exceptions, Fulcher said, like for people with disabilities or who are medically frail, Native American tribe members, people under the age of 19, people over the age of 64, and people in school or training. There might also be hardship waivers, he said, targeted to counties with higher unemployment rates.
'If we simply employ that — which, frankly, I think is warranted, because it was never intended for the working age, able-bodied, ever — then you might get the rest of the way,' Fulcher told the Sun. 'We very well may get the rest of the way of the savings target we're trying to hit.'
Rule changes for noncitizens and people enrolled in Medicaid in several states at the same time. (In Idaho, noncitizens do not qualify for Medicaid generally. But they can qualify for emergency services paid by Medicaid.)
Cutting states' higher matching rate for Medicaid expansion hasn't been discussed — yet, Fulcher said.
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'I'm not saying it's not going to be. But that's not discussed yet. And I think part of the reason why is we want to know how much savings we think we can get' in other ways, Fulcher said.
But any federal cuts to Medicaid expansion match rates could have ripple effects that could force states into tough decisions about whether to continue Medicaid expansion. Here's how:
If the feds cut their Medicaid expansion match rate, Medicaid expansion in nine states would automatically be repealed, based on trigger laws in those states, according to Georgetown University's Center for Children and Families.
In Idaho, cutting the federal match rate for Medicaid expansion would either: Trigger a review by the Idaho Legislature when it is in session based on one law, or allow the Idaho Department of Health and Welfare director to use broad program cut powers recently given to him by a new state law.
Here's how the federal match rate works: The federal government covers 90% of a state's Medicaid expansion costs, through the Affordable Care Act passed in 2010. That's significantly higher than the typical Medicaid federal matching rate, which is adjusted each year based on states' economic performance. Idaho usually gets 70% of its non-expansion Medicaid costs covered by the federal government.
Provider taxes are a complex process states use to get additional federal Medicaid funds, Fulcher explained. Typically hospitals are taxed some amount that states claim as a Medicaid expense to get additional federal funds. In Idaho, it's called the hospital assessment tax. Across the nation, Fulcher said provider taxes account for about $600 billion.
'That was never intended for that to be the process. And so this provider tax issue has really turned into kind of a milking of the federal system. And we don't know how much of that is really going for care, and just how much that is going to other expenses for hospitals,' Fulcher said. 'We just don't know. It might all be legitimate.'
A long way out: Fulcher stressed the U.S. House's process to find spending cuts is just starting, and that Congress is likely months away from passing bills for cuts.
The U.S. House and Senate have passed competing budget cut plans, and both need to reconcile their differences for policies to pass both chambers.
'The current budget resolution goes through the end of September. And frankly, I think we're going to chew up all that time. Because what's likely to happen is our committee is going to come up with something, and it will pass the House. And then the Senate is — their committees are going to come up with something else. It's going to pass the Senate. And then we're going to grind it up between the two,' Fulcher said. 'So this is a long long way, I think, from fruition.'
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