By Juan Miguel Adams
This story was published in Sahan Journal on February 26, 2025.
The future of Medicaid is in jeopardy under the Trump administration. Threatened cuts to Medicaid—one of the largest public health programs utilized by one in five Americans—could leave millions of people without healthcare.
Medicaid, a public health insurance program for low-income individuals, provides coverage for over 80 million Americans, ensuring vulnerable people have access to medical care.
It is jointly funded by federal and state governments, with the federal government typically contributing 70% of the costs; however, it is contingent on how much each state allocates or their resident’s income levels. For states that expanded Medicaid under the Affordable Care Act (ACA), the federal contribution reaches as high as 90%.
Dr. Nathan Chomilo, Medical Director for the State of Minnesota’s Medicaid and MinnesotaCare programs, says the program touches all Minnesotans: “There’s someone in your life, whether it’s a family member, a friend, a friend of a family member, … [who] has had Medicaid step in and help them,” he said.
Medicaid is a lifeline for millions of Americans who can’t afford the care they need, including physician services, labs, and X-rays. In addition, providing medical services such as immunizations and screenings helps prevent more serious, costly health issues. Health insurance through Medicaid works to ensure Americans stay healthy, go to work, care for their families, and pay their bills.
Susan Pleasants, Senior Vice President of Optimal Care for M Health Fairview and a practicing physician, believes Medicaid is crucial for ensuring vulnerable communities have access to insurance.
“The people who are most impacted are communities like the disabled who have nothing going for them as far as services or benefits, so Medicaid is really their access for almost everything that supports their daily life,” Pleasants said.
Medicaid was relatively stable under both the Obama and Biden administrations. President Donald Trump’s recent endorsement of a House budget that would gut Medicaid, despite previously stating the program ‘isn’t going to be touched,’ has raised concerns about the future of the program. In his last term, his attempt to impose block grants or per capita caps alarmed advocates and users of the program. Now, many are watching as Trump’s conflicting plans for the future leave Americans unsure if he will pursue actions similar to his last term, potentially impacting millions who depend on vital healthcare resources.
Sarah Rahmoune, a freshman at the University of Minnesota, says using Medicaid has made healthcare affordable for her. “We would probably struggle paying for healthcare if it wasn’t for UCare or Medicaid. Just a doctor’s visit itself is pretty expensive … because of Medicaid, we don’t have to pay as much every time we get sick,” Rahmoune said.
In Trump’s previous term, his administration invited states to sign waivers that would change their Medicaid programs into a block grant, which caps federal funding, thus limiting coverage and benefits in an attempt to provide money for other ventures of growth such as education or infrastructure. These waivers, however, would likely reduce access to care for the residents in these states. Additionally, efforts to lower the poverty line, which would limit Medicaid eligibility, were part of the many changes Trump’s administration explored during his last term.
Adrian Uphoff, Health Policy Analyst at the Minnesota Medical Association, finds the Trump Administration oblivious to the impact of Medicaid. “The push for fiscal conservatism in health policy often overlooks the realities of how health care access and affordability are tied to basic human needs,” Uphoff said.
Uphoff believes the Trump Administration will likely face backlash from its bipartisan supporters if major changes are made.
“I think the administration may come to find that Republicans in Congress are going to be upset when their constituents come knocking on their door saying, ‘why can’t I get health care anymore?’” Uphoff said.
As voters in rural populations increasingly align with the Republican Party, cuts to Medicaid would disproportionately impact these regions, potentially leading to hospital closures and limiting access to healthcare for residents outside of the metropolitan areas, regardless of political affiliation.
Chomilo shares Uphoff’s concern about the possible impacts of these shifts, “If things like work requirements and per capita caps are implemented, I think we can expect to see more challenges for individuals who rely on Medicaid, increasing the strain on both the state and on vulnerable communities,” Chomilo said. “We’ve seen in other states like Arkansas and Georgia that work requirements didn’t lead to greater employment but did lead to an increase in medical debt and a decrease in access to care.”
The United States already has experience with cuts in Medicaid with the government contribution in some US territories. In Puerto Rico, the statutory cap from the government was set for 50% of the program cost in 1983, like many other states, but by 2010, it covered 18% of Puerto Rico’s Medicaid funding. Puerto Rico’s per capita caps have strained its healthcare system, and with tropical storms or hurricanes striking four times every year, disasters only worsen the crisis, leaving providers unable to provide care to patients affected by these natural disasters because the state has run out of money.
“Medicaid is really the backbone of so much of our healthcare system … so many children and families who have had some misfortune and might find themselves disabled at the moment are depending on Medicaid to be there for them to support them … I really do believe we all do better when we all do better, as late senator Wellstone once told,” Chomilo said.
Trump’s latest move to endorse Medicaid cuts has sparked fears about the program’s future. While the White House has stated its intent to protect Medicaid from ‘waste, fraud, and abuse,’ the lack of clarity has left many wondering what this will mean for beneficiaries. However, it’s important to note that States have the authority to accept or reject federal proposals such as block grants and the public’s pushback can influence lawmakers’ decisions. This means that while the administration may propose changes, the impact will depend heavily on local government choices and the actions of American citizens.
Juan Miguel Adams, a junior at Saint Paul Academy, produced this story through ThreeSixty Journalism’s Capitol Reporting Workshop sponsored by the Saint Paul & Minnesota Foundation. Juan Miguel worked with MPR Video Producer Anne Guttridge to complete his story.
