This week, Congress is marking up their long-awaited committee bills to achieve the $1.5 trillion in spending cuts outlined in April’s budget resolution to partially offset the cost of extending expiring tax cuts that primarily benefit the nation’s wealthiest households. Many of the provisions would disproportionately harm West Virginia, increasing grocery and health care costs for residents, shifting federal costs onto the state budget, and straining our health care and charitable food systems by increasing food and health insecurity. While the WVCBP is still analyzing the full impact of the proposals, here are a few things to know about what is in the committee bills.
The House Energy and Commerce Committee, which has jurisdiction over Medicaid, released a plan outlining significant and deep cuts to Medicaid, squarely threatening the Medicaid expansion which covers more than 160,000 West Virginians. Among the included provisions are harsh work reporting requirements for adults between the ages of 19 and 64, increased paperwork and red tape for all expansion enrollees, and increased cost sharing and co-pays for some adults.
The non-partisan Congressional Budget Office released an analysis estimating these new provisions would result in 8.6 million residents nationwide losing Medicaid and more than $700 billion in reduced federal health care funding. If passed, this would mark the largest cut to Medicaid in history.
The WVCBP estimates that approximately 40,000 West Virginians would lose their health care coverage as a result, including more than 23,000 residents in Congresswoman Carol Miller’s district and 17,000 in Congressman Riley Moore’s.
In addition, these coverage losses would result in the loss of hundreds of millions of dollars in federal funding that currently goes to hospitals and providers in West Virginia. As a result, thousands of jobs in the state would be lost and rural providers have warned that hospitals operating on the margins would be at risk of closure.
A wide body of research has made clear that work reporting requirements and other bureaucratic red tape like frequent redeterminations and cost-sharing, all included in this proposal, do nothing to help people “find” work, but they do succeed at reducing health coverage and access to care. That is because the vast majority of adults on Medicaid are already working or would be eligible for an exemption due to caregiving responsibilities, a disability, or other likely exemptions. One analysis found that had work reporting requirements been left in place in Arkansas’ Medicaid program, over time 97.7 percent of those required to report would have been noncompliant—not because they were not working or did not meet an exemption category, but because the paperwork is so cumbersome and automated processes are so error-prone. Work reporting requirements, cost sharing, and increased frequency of redeterminations do nothing to help the underlying barriers that West Virginians not working face– they do not help families access child care or home health care, improve public transportation, increase job training, or create jobs where there are none.
In West Virginia, more than 277,000 (one in six) residents rely on SNAP to help afford the cost of groceries. Since its inception, the Supplemental Nutrition Assistance Program (SNAP) has been 100 percent federally funded. The House Agriculture Committee seeks to end that commitment among their proposed changes to SNAP by enacting the largest cut to SNAP in program history and requiring, for the first time, state budgets to shoulder a significant portion of the cost of food assistance just as state budgets are tightening.
In the committee documents released this week, they estimate that under the new rules, West Virginia’s state lawmakers could be on the hook for 15 percent of SNAP costs annually. Based on 2024 SNAP benefits, that would add a new line item to the state budget of more than $84 million annually.
Shifting SNAP to a cost-sharing program between the federal and state government would mean that West Virginia state policymakers would need to raise new state revenue, cut funding for other state-funded priorities, or reduce and restrict program eligibility.
The SNAP provisions in the committee document released this week would also expand SNAP’s existing work reporting requirements on so-called “able-bodied adults without dependents” to apply to parents of children over the age of six and adults up to the age of 64 (from the current cap of 54 years old). This puts tens of thousands of older West Virginians at risk of losing their food assistance including veterans, retirees, and grandparents who may be informally caring for their grandchildren. At the same time, it reduces the flexibility for states to waive these work reporting requirements for residents who may need the benefits, taking away important state flexibility and oversight.
An analysis from the Center on Budget and Policy Priorities estimates that 18,000 West Virginians between 55-64 years old and 28,000 parents of young children would be at risk of losing their food assistance directly under this policy, with 66,000 West Virginians including children seeing lower food security in their household from living with someone whose benefit is decreased– because SNAP benefits come to the entire household, inevitably all members will be impacted when SNAP benefits are reduced.
More than 50,000 West Virginians get their health coverage through the Affordable Care Act’s health insurance marketplace, with over 95 percent receiving a tax credit subsidy to help make their monthly premiums more affordable. As part of the American Rescue Plan Act (ARPA) and then the Inflation Reduction Act (IRA), Congress increased the amount of financial assistance available to families who get their health coverage through the ACA marketplace. In West Virginia, this resulted in marketplace enrollment more than doubling. But if not extended, those subsidies that help nearly 50,000 West Virginians afford the cost of health care will expire at the end of this year.
In the committee legislation released so far, it appears that Congressional leaders in the House do not plan to extend those subsidies. An analysis from the non-partisan Congressional Budget Office estimates that 2.2 million residents will no longer be able to afford their health coverage if these provisions expire and 1.9 million will become uninsured entirely.
West Virginia residents saw the most benefit from the increased ACA subsidies, as our state has the highest health care costs in the country. If allowed to expire, the 50,000 residents who get their health coverage through the Marketplace would see their monthly premiums increase by 140 percent.
Overall, the components of the budget reconciliation package would be deeply harmful to West Virginians. Cutting Medicaid and food assistance in the specific ways these proposals do goes against President Trump’s promises to lower West Virginians’ grocery and health care costs. Instead, it would increase costs for families, force new spending onto our state budget, and have an overall effect of reducing jobs rather than getting more people into the workforce. Our federal delegation must recognize this package contains more harm than good for the people of West Virginia and urge Congressional leaders to do more work to help everyday West Virginians.
