As Congress continues working toward a budget agreement, voters across Utah and the country are closely following discussions around Medicaid. While there is plenty to appreciate in the Republican plan, such as extending tax relief and funding border security, lawmakers need to slow down and consider the potentially enormous impacts that would follow any major cuts or structural changes to Medicaid.
Medicaid is a core program that provides coverage for our country’s most vulnerable citizens — including lower-income families, seniors and people with disabilities. Here in Utah, more than 1 in 10 residents are insured through Medicaid, and children account for half of enrollees. These individuals and families generally have few other coverage options. Many cannot afford private plans.
In 2023, when a temporary expansion of Medicaid during COVID-19 “unwound” back to pre-pandemic levels, about 1 in 3 of the Utahns who were dropped did not pick up coverage from another source. They simply remained uninsured. This underscores that households that count on Medicaid often have nowhere else to turn. Sure enough, a 2023 survey found that more than half of uninsured Utahns say high insurance costs are their primary reason for forgoing coverage. Cuts to Medicaid’s enrollment rolls or Medicaid benefits would put more of our citizens in this position.
Having worked as a pediatric orthopedic nurse at Shriner’s Children Hospital, I have seen the value of Medicaid firsthand. It helps ensure hard-working individuals and families can proactively manage their health and receive high-quality medical care when and where they need it. Adults with Medicaid coverage are four times more likely to seek preventative care than people without insurance, and five times more likely to have a regular source of care.
Lawmakers should pay particular attention to how Medicaid changes could affect Utah children, who make up the largest participation in our program. Nationally, about 4 million children lack health insurance, and Utah has one of the highest rates of uninsured children — more than 8%, about 82,000 young people, in 2020.
Health care coverage is one of the biggest factors that affects a child’s long-term health. Children who are insured are more likely to stay healthy and live healthier lives as they grow up. They are twice as likely to receive wellness checkups and preventative care, like routine doctor visits and vaccinations. They have better hospitalization outcomes on average, often because their families seek medical care earlier when symptoms present. And they even have longer life expectancies, since healthy lifestyles and habits they develop as young people stay with them as adults.
One in six Utah children depends on Medicaid for their health care coverage. Among children with special needs, that rises to more than 1 in 4. Rates are even higher in rural parts of our state, where over 20% of kids are insured through Medicaid.
While Utahns appreciate Congress’ focus on reining in wasteful spending, cuts to Medicaid would simply shift costs onto individuals, families and local hospitals — many of whom cannot afford it. Our most vulnerable residents could face high out-of-pocket expenses. Utah’s uninsured rate would likely rise, putting greater pressure on our hospitals, whose patients already are disproportionately uninsured.
With between 30% and 40% of rural Utah hospitals currently at risk of closing because of financial stress, the question soon becomes, how much more can they take? About 15% of Utah hospitals’ revenue is paid by Medicaid. Paring back this pivotal funding source could cause many to eliminate services, while others could be forced to close their doors for good. Of course, ordinary Utahns, who rely on our hospitals for care, would be hurt the most in those scenarios.
Thankfully, President Donald Trump and House Speaker Mike Johnson have ruled out changes to Medicaid that would cut benefits. The president has pledged not to touch the program except to eliminate fraud and abuse. The speaker said per capita caps are “off the table.” Those are welcome promises to Utah families.
However, lawmakers have not closed the door entirely to a block grant structure — which would simply entail major benefit cuts under another name. Congress is simply moving too fast at the moment, approaching their lawmaking responsibilities without regard to consequences or realities on the ground. I hope Trump, who understands how important Medicaid coverage is, and Utah’s congressional delegation will remain consistent, hold the line and take block grant Medicaid cuts off the table.
Utah is fortunate to have leaders who understand the importance of health care access and affordability. I hope Republicans will continue to champion the working class by opposing any structural changes to Medicaid. Individuals, families and children across our state are counting on them to do the right thing.