House-passed budget bill projected to cause Medicaid and SNAP cuts, job losses in WV

Reps. Carol Miller and Riley Moore, both R-W.Va., voted for the measure, touting its tax cut provisions that the University of Pennsylvania’s Penn Wharton Budget Model projected would drive a $3.2 trillion increase in the national deficit over 10 years.

Deep cuts to Medicaid and the Supplemental Nutrition Assistance Program to pay for the tax cuts favoring the wealthy are expected to hit low-income West Virginians hard.

Under a version of the legislation advanced by the House Energy and Commerce Committee last week, Medicaid enrollment loss in West Virginia would total between 57,000 and 94,000 people, according to an analysis by the Kaiser Family Foundation, a nonpartisan health policy research group.

The midpoint of that enrollment loss range, 75,000, is 15% of West Virginia’s total Medicaid and Children’s Health Insurance Program as of June 2024, per KFF data.

“If the bill passed by the House gets enacted, it would represent the biggest rollback in federal support for health care ever,â€� KFF executive vice president for health policy Larry Levitt said in a X post °Õ³ó³Ü°ù²õ»å²¹²â.Ìý

West Virginia health advocates fear the package’s Medicaid rollbacks would trigger an avalanche of job losses, rural hospital closures and state budget shrinkage.

"I see the looks on my patients' faces when they fear losing their health care," Dr. Ron Stollings, a former Democratic state senator from Boone County who practices internal and geriatric medicine there, said during a virtual media conference held Thursday by Protect Our Care West Virginia, a health care advocacy group, to rally opposition to the bill. " ...We're getting ready to pull the rug out from under them.�

Under the package, states would have to condition Medicaid eligibility for people aged 19-64 applying for coverage or enrolled through the Affordable Care Act expansion group on working or participating in qualifying activities for at least 80 hours every month.

West Virginia would suffer losses of $15.9-22.5 million in state and local tax revenue, $232.8-329.2 million in gross domestic product and $234.3-331.6 million in federal funding under Medicaid work requirements, per an analysis this month from the Commonwealth Fund, a health care advocacy group.Ìý

During a session that began just after 1 a.m. Wednesday and lasted roughly 22 hours, the House Rules Committee tightened Medicaid work requirements in the measure, moving up their start date from Jan. 1, 2029, to Dec. 31, 2026.

Households most affected by the cuts to Medicaid and SNAP — those in the bottom fifth of income brackets, would experience the largest losses under the bill, averaging $28,000 lifetime for the working-age population, according to a Penn Wharton Budget Model analysis published Monday. In contrast, working-age households in the top fifth of income brackets would benefit from lower taxes, gaining $30,000 on average, per the analysis.

“As a country, we will have placed the wants of the wealthiest over the actual needs of the most vulnerable,� Laura Jones, executive director of Milan Puskar Health Right, a clinic that provides health and dental care to the uninsured and underinsured at no cost, said during the Protect Our Care West Virginia teleconference. “It's unconscionable.�

'This will be devastating'

The budget reconciliation package would require states to verify that individuals applying for coverage meet requirements for at least one month before the month of Medicaid application.

“Really, the only point of these bureaucratic hurdles is to create cracks for people to fall through,� Seth DiStefano, policy outreach director at the West Virginia Center on Budget and Policy, a progressive think tank, said during the Protect Our Care West Virginia teleconference.

The package would narrow the window for retroactive Medicaid coverage for qualified medical expenses incurred from 90 days to one month before the date of application for coverage.

Stollings views the budget reconciliation package as a threat to hospitals, health centers and emergency medical service providers.

“This will be devastating,� Stollings said.

Fewer jobs, more government bureaucracy predicted  

The budget reconciliation package follows what has been an uptick in health care jobs in West Virginia.

Health care and social assistance employment increased 2.3% from 2022 to 2023, more than double that span’s 1.1% total non-farm employment increase, according to WorkForce West Virginia data.

West Virginia would lose 1,100 to 1,600 direct health jobs and 2,100 to 3,000 total jobs under Medicaid work requirements like those advanced through reconciliation, according to the Commonwealth Fund’s analysis.

“One bright spot has been health care. We've been steadily getting health care jobs,� West Virginia Center on Budget and Policy executive director Kelly Allen said during a virtual briefing on the reconciliation package Tuesday.

Nearly two-thirds of 26.1 million Medicaid-covered adults already were working full-time or part-time in 2023, according to a KFF analysis of U.S. Census Bureau data. Another 29% were not working due to caregiving, illness or disability, or school attendance.

Allen predicted the reconciliation package would increase paperwork and complicate treatment compliance.

“If you're someone who wants to see less government red tape, less government bureaucracy. this is a lot more of it,� Allen said.

Tens of thousands of SNAP cuts in West Virginia projected 

The independent, nonpartisan Congressional Budget Office has estimated 8.6 million fewer people would have health insurance with changes to Medicaid and the Affordable Care Act under the budget reconciliation package prior to its advancement out of the House Rules Committee. The CBO also said 3 million fewer people each month would have SNAP benefits.

The reconciliation package is projected to slash spending on SNAP by more than $290 billion over 10 years, including shifting much of SNAP benefit costs to states with a new cost-sharing formula tied to payment error rates.

Roughly 84,000 West Virginians would be at risk of losing some SNAP aid under expanded work requirements in the package, according to an analysis by the Center on Budget and Policy Priorities, a progressive think tank, prior to the more stringent version passed by the House.Ìý

Allen estimated that, under the reconciliation package prior to its House Rules Committee approval, West Virginia’s share of SNAP costs could exceed state spending on three categories combined:

• The Promise Scholarship, a merit-based financial aid program for state high school graduates planning to attend one of the state’s public or independent two- or four-year institutions
• West Virginia Child Protective Services workers
• Child care assistance

“Kids will go hungry. People won't have health coverage, and they will forego life-saving treatment,� Sharon Parrott, president of Center on Budget and Policy Priorities, predicted during a Tuesday media briefing.

Support from W.Va.'s congressional delegation

Miller and Moore argued the bill would benefit families despite a Penn Wharton Budget Model analysis finding that working-age households in the middle of income distribution would see an average lifetime reduction of $3,000 from the package, as they face a chance of needing spending programs that would be reduced.

“This legislation will undoubtedly make life for the average American better,� Miller said in a House floor speech prior to the body’s vote on the bill.

Moore said in a statement Thursday the package would result in “our economy enter[ing] a new Golden Age� and extolled provisions that would cut off Medicaid and Affordable Care Act funding for gender-affirming care for transgender people and repeal support for green energy, which he called the “Green New Scam.�

West Virginia’s senators have signaled support for the package.

Sen. Shelley Moore Capito, R-W.Va., expressed support for Medicaid work requirements in a call with reporters Thursday.

“I think there are a lot of reasons to work besides [working] for a benefit and you're getting money. But also, it's a self-esteem thing,� Capito said. “You're contributing to your community. You're getting up and going out.�

Capito dismissed fears the bill would disproportionately benefit the wealthy at the expense of low-income people, suggesting small businesses and families throughout income brackets would see tax relief.

“I want to see Medicaid be there for the people that it's designed for, and that means that people that are ineligible should not be getting benefits and should be removed,� Capito said.

Medicaid fraud control units reported 1,143 convictions in fiscal year 2023, according to a U.S. Department of Health and Human Services Office of Inspector General report.Ìý

“We just can’t have everybody on Medicaid just for the sake, yay, yay, yay,� Sen. Jim Justice, R-W.Va., said in a Fox Business Network appearance last week. �I mean, if you’re not deserving, you shouldn’t be there.�

In a speech Thursday, House Speaker Mike Johnson, R-La., set a goal of getting the package to Trump for him to sign into law by July 4.

Protect Our Care West Virginia director Lynette Maselli called on Capito and Justice Thursday to reject any federal budget cuts to Medicaid.

“If Republicans get their way, the costs are going to go up,� Maselli said. “Hard-working families will lose their coverage, and our entire health care system will be thrown into chaos.�