WASHINGTON – For months, much of Louisiana fretted over how Republicans would revamp Medicaid. 

Various proposals had floated in the U.S. House that could have severely affected the state’s health care system, like ending hospital provider taxes or cutting the federal match funding for Medicaid. Those ideas did not make it into the Big Beautiful Bill Act that House Republicans passed by one vote last week.

“Louisiana is not going to suffer at first,” said Rep. Cleo Fields, D-Baton Rouge, who has 206,056 constituents on Medicaid. “The Louisiana Legislature is going to prepare its budget for the future and those changes are going to come in two years, no more than three.”

But Fields warns the consequences could be serious in the future as more Medicaid responsibility shifts to states. 

The policy revamp includes requiring able-bodied adult recipients without dependents up to age 64 to work, go to school or volunteer 80 hours a month — and prove it to state authorities starting Dec. 31, 2026. House Speaker Mike Johnson says about 4.8 million beneficiaries nationwide fall into that category. States would be required to check eligibility requirements every six months instead of every 12.

Fields and other Democrats argue those stricter rules will drive people out of the program, either because they aren’t eligible or because they will fail to keep up with the more stringent requirements. That’s particularly dangerous, they say, in a state that relies heavily on Medicaid to cover its residents.

“If this budget gets passed into law as it is currently written, Louisiana stands to lose more healthcare funding than any other state. Medicaid brings nearly $15 billion in federal funding to Louisiana, which is over 35% of the entire state budget,” Fields said.

It’s not clear exactly how many people could lose Medicaid coverage in Louisiana. Because the bill was pushed through so quickly, the nonpartisan Congressional Budget Office hasn’t finished its final analysis.

On May 20, before the final bill passed, the CBO estimated that 7.7 million nationwide could lose their coverage over the next decade. About 190,000 Louisiana beneficiaries would be knocked off Medicaid by 2033, according to a March 20 report by The Kaiser Family Foundation, or KFF, a San Francisco-based health care think tank.

Republicans argue that Medicaid has drifted off-mission since it was established in 1965 and has allowed people who don’t deserve coverage — specifically the able-bodied who refuse to work, immigrants who enter the country illegally, and people who make too much money. Resources spent on the undeserving drain funds from those who truly need the services, who Republicans define as low-income pregnant women, children, disabled and elderly.

“We have not cut Medicaid, and we have not cut SNAP (food stamps),” Johnson said Sunday on CBS’s “Face the Nation”. “What we’re doing is working on fraud, waste and abuse. Everyone in Louisiana and around the country understands that that’s a responsibility of Congress.”

Johnson, R-Benton, has 271,510 constituents, or about 36% of his district, on Medicaid.

The thousand-page bill that passed the House covers much of President Donald Trump’s domestic agenda, including tax breaks and increased border security, and is projected to add $3.8 trillion to the $36.2 trillion national debt. Those increases would be partially offset by reducing the cost of Medicaid, which pays health care services for about 80 million low-income Americans, 1.6 million of whom live in Louisiana.

Majority Leader Steve Scalise, R-Jefferson, argues that the legislation would jump-start the nation’s economy and that Democrats are employing scare tactics because they hate Trump.

“The Democratic Party up here in Washington is so consumed with hatred that they oppose rooting out waste, fraud, and abuse,” Scalise said.

His district has 186,787 people on Louisiana Medicaid programs, according to the Democratic members who make up the minority of the House Budget Committee and quote from government databases.

How the bill affects Medicaid

Some early proposals that provoked fear in Louisiana’s health industry ended up not making it into the House’s bill.

For example, the legislation doesn’t make specific changes to how much the federal government pays for healthcare services and how much the states must match.

The Federal Medical Assistance Percentage, or FMAP, sets the rate for the amount the federal government pays for services rendered. When the rates for different programs are averaged, Louisiana pays about 30% of the costs.

Governors and health care providers howled when conservative congressmen floated the idea of reducing the federal government’s FMAP contributions, thereby transferring those costs to state taxpayers.

Instead, Trump’s signature legislation would reduce the federal FMAP portion from 90% to 80% in the 14 states — wealthy and mostly led by Democrats — that use their own money to cover healthcare costs for immigrant adults, and their foreign-born children, who entered the country illegally. Those states argue their policies keep a vital segment of the labor force healthier.

The CBO estimates that about 1.7 million beneficiaries would lose their coverage. But Louisiana would not be affected.

Federal law forbids using federal money to provide Medicaid to illegal immigrants. 

Louisiana hospitals feared the bill would, at the urging of House conservatives, end the practice of states taxing health care providers — funds that are used to help pay the state’s matching FMAP portion and thus attract more federal dollars. The money also is used in Louisiana to help shore up rural clinics and hospitals whose patients are overwhelmingly on Medicaid and receive less reimbursement than private insurance pay.

The bill would freeze the provider tax and state-directed payments at their current levels.

“Thanks to our leadership, Speaker Johnson and Leader Scalise, we avoided the most devastating cliff that would have deeply cut Louisiana hospitals,” said Ryan Cross, vice president of Governmental Affairs and Advocacy at Franciscan Missionaries of Our Lady Health System, which operates facilities in Louisiana and Mississippi, including Our Lady of the Lake Regional Medical Center in Baton Rouge, the state’s largest.

Other health care changes

Another part of the bill, not part of Medicaid, would end automatic enrollment in private insurance available through the Affordable Care Act exchange for more affluent beneficiaries who receive subsidies to help pay for their insurance. The CBO predicts that an additional 3 million would end up uninsured by 2034.

The Democratic minority on the House Budget Committee calculated that the loss of the enhanced Affordable Care tax credits would cause premiums to skyrocket. They estimate that about 212,000 people in Louisiana hold those policies.

For instance, Rep. Clay Higgins, R-Lafayette, has about 36,000 constituents who would be affected and they would have to pay about $760 more — an 85% increase, the Democrats said.

Higgins has 265,604 constituents enrolled in Louisiana’s Medicaid programs.

Rep. Troy Carter, D-New Orleans, has the most constituents on Medicaid at 291,555, about 39%, with another 45,000 buying coverage through the Affordable Care Act, who would see a $690 or 62% annual increase in their premiums, according to the minority’s report.

The district represented by Julia Letlow, R-Start, has the state’s second-largest population on Medicaid, with 290,378 people, and another 35,000 whose Affordable Care Act policy prices would increase 79%, or $660.

The bill also would end coverage of transgender care through Medicaid and plans through the Affordable Care Act. This would include “gender transition procedures” for anyone under 18 years of age.

Also, payments would stop to Planned Parenthood, a national organization that provides healthcare, including abortions in many locations, for women.

The Senate now has the bill and a number of senators from both parties have announced their intention to rewrite portions.

Johnson asked senators to go lightly as he appeased warring House GOP factions with narrow compromises that he likened to crossing the Grand Canyon on dental floss. Johnson will have to rally his bickering Republican majority again once the Senate finishes.