Hasta ahora, cinco estados informaron que ya han recibido, en total, más de 170.000 nombres, una medida del gobierno federal sin precedentes, que significa involucrar al programa de salud estatal-federal en la campaña del presidente contra la inmigración.

Defensores de los derechos de los inmigrantes advierten que esta decisión impone una carga adicional a los estados al tener que duplicar las verificaciones y podría llevar a que algunas personas pierdan su cobertura médica simplemente por no haber entregado a tiempo la documentación.

Sin embargo, el doctor Mehmet Oz, administrador de los Centros de Servicios de Medicare y Medicaid (CMS), afirmó en una publicación en la plataforma social X el 31 de octubre que se estaban gastando más de $1.000 millones “de los contribuyentes [que pagan impuestos federales] en financiar Medicaid para inmigrantes ilegales” en cinco estados y Washington D.C.

El gasto total de Medicaid superó los $900 mil millones en el año fiscal 2024.

Ni la declaración de Oz ni un video adjunto aclararon el período durante el cual se realizaron estos gastos, y los voceros de los CMS no respondieron de inmediato a las preguntas solicitadas.

Las normas federales limitan la elegibilidad para Medicaid y para el Programa de Seguro de Salud Infantil (CHIP) a los ciudadanos estadounidenses y a algunos inmigrantes que residen legalmente en el país.

Las personas sin estatus migratorio legal no pueden recibir ninguna cobertura de salud financiada por el gobierno federal, incluidos Medicaid, Medicare y los planes adquiridos en los mercados de seguros creados por la Ley de Cuidado de Salud a Bajo Precio (ACA).

Varios estados dijeron estar en desacuerdo con las declaraciones de Oz.

“Nuestros pagos para la cobertura de personas indocumentadas cumplen con las leyes estatales y federales”, declaró Marc Williams, vocero del Departamento de Política y Financiamiento de la Atención Médica de Colorado, que administra el programa estatal de Medicaid. “La cifra de $1.5 millones a la que hicieron referencia hoy los líderes federales se basa en un hallazgo preliminar inexacto y ha sido refutada por datos de expertos de nuestro departamento”.

Agregó: “Resulta decepcionante que la administración anuncie esta cifra como definitiva cuando es claramente exagerada y las conversaciones aún se encuentran en la fase de información y debate”.

Funcionarios del Medicaid de Illinois criticaron duramente los comentarios del jefe de los CMS.

“Una vez más, el gobierno de Trump está difundiendo información errónea sobre el uso habitual de los fondos de Medicaid”, declaró Melissa Kula, vocera del Medicaid de Illinois.

“Esto no es un reality show, y no existe ninguna conspiración para eludir la ley federal y brindar cobertura de Medicaid a personas que no cumplen con los requisitos. El Dr. Oz debería dejar de promover teorías conspirativas y concentrarse en mejorar la atención médica para los estadounidenses”, dijo Kula.

La Autoridad de Atención Médica del Estado de Washington, que administra el programa estatal de Medicaid, también fue contundente. “Las cifras que el Dr. Oz publicó en redes sociales son inexactas”, afirmó la portavoz Rachelle Alongi. “Nos sorprendió mucho ver la publicación del Dr. Oz, especialmente considerando que seguimos colaborando de buena fe con los Centros de Servicios de Medicare y Medicaid (CMS) para responder a sus preguntas y aclarar cualquier confusión”.

En agosto, los CMS comenzaron a enviar a los estados los nombres de personas inscritas en Medicaid que la agencia sospechaba que podrían no ser elegibles, exigiendo a las agencias estatales del programa que verificaran su estatus migratorio.

En octubre, KFF Health News contactó a 10 agencias estatales de Medicaid. Cinco de ellas proporcionaron cifras aproximadas de los nombres que habían recibido de la administración Trump hasta la fecha, pero suponen que llegarán más: Utah recibió 8.000 nombres; Colorado, 45.000; Pennsylvania, 34.000; Ohio, 61.000; y Texas, 28.000.

Actualmente, más de 70 millones de personas están inscritas en Medicaid.

La mayoría de esos estados no aceptaron hacer más comentarios. Otros cinco —California, Nueva York, Georgia, Florida y Carolina del Sur— se negaron a revelar cuántos nombres se les pidió que revisaran, o directamente no respondieron.

Oz afirmó en su publicación de X que California había malgastado $1.300 millones en atención médica para personas no elegibles para Medicaid, mientras que Illinois gastó $30 millones, Oregon $5.4 millones, el estado de Washington $2.4 millones, Washington D.C. $2.1 millones y Colorado $1.5 millones.

“Notificamos a los estados y muchos ya han comenzado a reembolsar el dinero”, dijo. “Pero, ¿qué habría pasado si nunca hubiéramos preguntado?”.

La directora de Medicaid de Washington D.C., Melisa Byrd, declaró que los CMS habían identificado gastos administrativos del programa del distrito, que cubre a personas independientemente de su estatus migratorio, que no debieron haberse facturado al gobierno federal, y que su agencia ya ha corregido algunos de esos errores.

“Administramos un programa grande y muy complejo, y cuando ocurren errores, los corregimos”, afirmó. El programa planea reembolsar $654.014 a los CMS para mediados de noviembre.

Los cinco estados, más Washington D.C., están gobernados por demócratas, y el presidente Donald Trump no ganó en ninguno de ellos en las elecciones de 2024.

En los últimos días, el subsecretario de Salud y Servicios Humanos, Jim O’Neill, comenzó a publicar en la plataforma social X fotos de personas que, según él, son delincuentes convictos que viven en Estados Unidos sin autorización y que han recibido beneficios de Medicaid.

No se pudo contactar a O’Neill para obtener declaraciones.

“Estamos muy preocupados porque esto, francamente, parece un desperdicio de recursos estatales y refuerza la agenda antiinmigrante de la administración”, dijo Ben D’Avanzo, estratega senior de políticas de salud en el National Immigration Law Center, una organización de defensa de los derechos de los inmigrantes. “Esto duplica lo que los estados ya hacen”, añadió.

Como parte de la ofensiva contra las personas sin estatus legal, el presidente ordenó en febrero a las agencias federales que se aseguraran de que quienes no tienen la residencia en regla no obtuvieran beneficios que violaran la ley federal.

En junio, el secretario de Salud y Servicios Humanos (HHS) Robert F. Kennedy le ordenó a los CMS que compartieran con el Departamento de Seguridad Nacional (DHS) la información sobre las personas inscritas en Medicaid. Esto provocó una demanda por parte de varios estados preocupados de que esa información se utilizara para campañas de deportación.

En agosto, un juez federal ordenó al HHS que dejara de compartir esa información con las autoridades migratorias.

Las agencias estatales de Medicaid normalmente utilizan bases de datos administradas por la Seguridad Social, el Departamento de Seguridad Nacional y otras agencias gubernamentales para verificar el estatus migratorio de los solicitantes.

Si los estados tienen que volver a contactar a las personas inscritas para verificar nuevamente su estatus migratorio o ciudadanía, algunas podrían perder su cobertura injustificadamente, por ejemplo, si no ven la carta donde se les solicitan documentos o no responden a tiempo.

“No estoy segura de que haya evidencia suficiente que justifique esta verificación adicional”, dijo Marian Jarlenski, profesora de políticas de salud en la Escuela de Salud Pública de la Universidad de Pittsburgh.

Oz dejó en claro que la administración Trump no está de acuerdo.

En el comunicado de agosto, los CMS explicaron que estaban pidiendo a los estados que verificaran la elegibilidad de las personas cuyo estatus migratorio no pudo ser confirmado mediante bases de datos federales. “Esperamos que los estados actúen con rapidez y supervisaremos los progresos mes a mes”, dijo la agencia.

Leonardo Cuello, profesor investigador del Georgetown University Center for Children and Families, calificó la orden de los CMS a los estados como “algo sin precedentes” en los 60 años de historia del programa Medicaid.

Dijo que es posible que el gobierno federal no haya podido verificar el estatus migratorio de algunas personas porque sus nombres estaban mal escritos o desactualizados, como cuando una beneficiaria aparece con el apellido de soltera en lugar del de casada.

Los listados también pueden incluir a personas que recibieron ayuda a través de Medicaid de Emergencia, un programa que cubre los gastos de servicios de emergencia en hospitales, incluidos el parto y la atención de trabajo de parto, sin importar el estatus migratorio.

“Los CMS están haciendo revisiones inútiles del estatus migratorio de personas cuyos gastos hospitalarios fueron cubiertos por el Medicaid de Emergencia”, explicó Cuello.

Oz señaló en su publicación que la ley federal “permite a los estados usar fondos de Medicaid para tratamientos de emergencia, independientemente de la ciudadanía o el estatus migratorio de los pacientes”, y que los estados pueden “crear legalmente programas de Medicaid para inmigrantes indocumentados usando sus propios impuestos estatales, siempre y cuando no se utilicen fondos federales”.

Todos los estados que mencionó Oz administran sus propios programas de este tipo.

Estas revisiones representan una carga adicional para las agencias estatales de Medicaid, que ya están ocupadas con los preparativos para implementar la ley tributaria y de gasto público que Trump firmó en julio.

Esta ley, que los republicanos han llamado la “One Big and Beautiful Bill”, establece numerosos cambios en Medicaid, incluyendo la imposición de requisitos laborales en la mayoría de los estados a partir de 2027. También les exige que revisen la elegibilidad de las personas inscritas al menos dos veces al año.

“Temo que los estados realicen verificaciones innecesarias que impongan una carga a ciertos beneficiarios, que perderán la cobertura médica cuando no deberían”, explicó Cuello. “Esto será mucho trabajo para los CMS y los estados, con muy pocos resultados reales”.

Dado que la nueva política permite a la agencia divulgar públicamente los datos, Cuello opinó que el esfuerzo tiene más valor político que práctico.

Brandon Cwalina, vocero del Departamento de Servicios Sociales de Pennsylvania —que administra Medicaid—, dijo que el estado ya exige que toda persona solicitante demuestre su ciudadanía o, cuando corresponde, su estatus migratorio.

“Sin embargo, la lista de nombres y las instrucciones emitidas por los CMS el mes pasado constituyen un nuevo procedimiento, y el departamento está revisando cuidadosamente esa lista para encarar las acciones correspondientes”, explicó.

En su publicación, Oz no mencionó a Pennsylvania, estado que Trump ganó en 2024.

Cuando un residente legal no tiene número de Seguro Social, el estado verifica su estatus usando una base de datos del Departamento de Seguridad Nacional, además de revisar los documentos migratorios específicos, agregó.

Otras agencias estatales de Medicaid dijeron que todavía no han comenzado a contactar a las personas inscritas.

“Estamos elaborando un procedimiento para realizar estas revisiones”, dijo Jennifer Stroehecker, directora de Medicaid en Utah, durante una reunión en agosto con una junta asesora estatal.

Renuka Rayasam y Rae Ellen Bichell colaboraron con este artículo.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Advocates say the push burdens states with duplicative verification checks and could lead people to lose coverage just for missing paperwork deadlines. But the administrator of the Centers for Medicare & Medicaid Services, Mehmet Oz, said in a post on the social platform X on Oct. 31 that more than $1 billion “of federal taxpayer dollars were being spent on funding Medicaid for illegal immigrants” in five states and Washington, D.C.

Medicaid’s overall spending topped $900 billion in fiscal year 2024.

It wasn’t clear from Oz’s statement or an accompanying video over what period the spending happened, and CMS spokespeople did not immediately respond to questions, either for an earlier version of this article or after Oz’s statement was posted.

Only U.S. citizens and some lawfully present immigrants are eligible for Medicaid, which covers low-income and disabled people, and the closely related Children’s Health Insurance Program. Those without legal status are ineligible for federally funded health coverage, including Medicaid, Medicare, and plans through the Affordable Care Act marketplaces.

Several states disputed Oz’s comments.

“Our payments for coverage of undocumented individuals are in accordance with state and federal laws,” said Marc Williams, a spokesperson for Colorado’s Department of Health Care Policy & Financing, which administers the state’s Medicaid program. “The $1.5 million number referenced by federal leaders today is based on an incorrect preliminary finding, and has been refuted with supporting data by our Department experts.”

He added: “It is disappointing that the administration is announcing this number as final when it is clearly overstated and the conversations are very much in the education and discussion phase.”

Illinois Medicaid officials blasted Oz’s comments.

“Once again, the Trump administration is spreading misinformation about standard uses of Medicaid dollars,” said Illinois Medicaid spokesperson Melissa Kula. “This is not a reality show, and there is no conspiracy to circumvent federal law and provide ineligible individuals with Medicaid coverage. Dr. Oz should stop pushing conspiracy theories and focus on improving health care for the American people.”

The Washington State Health Care Authority, which runs the state’s Medicaid program, was also blunt.

“The numbers Dr. Oz posted on social media today are inaccurate,” said spokesperson Rachelle Alongi. “We were very surprised to see Dr. Oz’s post, especially considering we continue to work with CMS in good faith to answer their questions and clear up any confusion.”

In August, CMS began sending states the names of people enrolled in Medicaid that the agency suspected might not be eligible, demanding state Medicaid agencies check their immigration status.

KFF Health News in October reached out to Medicaid agencies in 10 states. Five provided the approximate number of names they had received from the Trump administration, with expectations of more to come: Colorado had been given about 45,000 names, Ohio 61,000, Pennsylvania 34,000, Texas 28,000, and Utah 8,000. More than 70 million people are enrolled in Medicaid.

Most of those states declined to comment further. Medicaid agencies in California, Florida, Georgia, New York, and South Carolina refused to say how many names they were ordered to review or did not respond.

Oz said in his X post that California had misspent $1.3 billion on care for people not eligible for Medicaid, while Illinois spent $30 million, Oregon $5.4 million, Washington state $2.4 million, Washington, D.C., $2.1 million, and Colorado $1.5 million.

“We notified the states, and many have begun refunding the money,” he said. “But what if we had never asked?”

Washington, D.C.’s Medicaid director, Melisa Byrd, said CMS had identified administrative expenses for the district program that covers people regardless of immigration status that should not have been billed to the federal government and her agency has already fixed some of those areas. “We run a big program that is very complex and when mistakes or errors happen, we fix them,” she said.

The program plans to pay $654,014 back to CMS by mid-November.

All five states, plus Washington, D.C., are led by Democrats, and President Donald Trump didn’t win any of them in the 2024 election.

In recent days, Deputy Health and Human Services Secretary Jim O’Neill began posting pictures on X of people he said are convicted criminals living in the U.S. without authorization who had received Medicaid benefits.

O’Neill could not be reached for comment.

“We are very concerned because this seems, frankly, to be a waste of state resources and furthers the administration’s anti-immigrant agenda,” said Ben D’Avanzo, senior health advocacy strategist with the National Immigration Law Center, an advocacy group. “This duplicates what states already do,” he said.

As part of the administration’s crackdown on people in the U.S. without authorization, President Donald Trump in February directed federal agencies to take action to ensure they are not obtaining benefits in violation of federal law.

In June, advisers to Health and Human Services Secretary Robert F. Kennedy Jr. ordered CMS to share information about Medicaid enrollees with the Department of Homeland Security, drawing a lawsuit by some states alarmed that the administration would use the information for its deportation campaign against unauthorized residents.

In August, a federal judge ordered HHS to stop sharing the information with immigration authorities.

State Medicaid agencies use databases maintained by the Social Security Administration and Department of Homeland Security to verify enrollees’ immigration status.

If states need to go back to individuals to reverify their citizenship or immigration status, it could lead some to fall off the rolls unnecessarily — for example, if they don’t see a letter requesting paperwork or fail to meet a deadline to respond.

“I am not sure that evidence suggests there really is a need for this” extra verification, said Marian Jarlenski, a health policy professor at the University of Pittsburgh School of Public Health.

Oz made clear that the Trump administration disagrees.

“Whether willful or not, the states’ conduct highlights a terrifying reality: American taxpayers have been footing the bill for illegal immigrants’ Medicaid coverage, despite many Democrats and the media insisting otherwise,” Oz said in his X post.

In an August press release, CMS said it would ask states to verify eligibility for enrollees whose immigration status could not be confirmed via federal databases. “We expect states to take quick action and will monitor progress on a monthly basis,” the agency said.

Leonardo Cuello, a research professor at Georgetown University’s Center for Children and Families, called the CMS order to states “unprecedented” in the Medicaid program’s 60-year history.

He said the federal government may have been unable to verify certain individuals’ immigration status because names were misspelled or outdated, such as when a beneficiary is identified by their maiden instead of married name. The names may also include people helped by Emergency Medicaid, a program that covers the cost of hospital emergency services, including labor and delivery, for people regardless of immigration status.

“CMS is conducting pointless immigration status reviews for people whose hospital bills were paid by Emergency Medicaid,” Cuello said.

Oz noted in his post that federal law “does permit states to use Medicaid dollars for emergency treatment, regardless of patients’ citizenship or immigration status,” and that states can “legally build Medicaid programs for illegal immigrants using their own state tax dollars, so long as no federal tax dollars are used.”

The states Oz mentioned all run their own such programs.

The verification checks create an added burden for state Medicaid agencies that are already busy preparing to implement the tax and policy law Trump signed in July. The measure, which Republicans call the One Big Beautiful Bill Act, makes many changes to Medicaid, including adding a work requirement in most states starting by 2027. The law also requires most states to more frequently check the eligibility of many adult Medicaid enrollees — at least twice a year.

“I fear states may do unnecessary checks that create a burden for some enrollees who will lose health coverage who should not,” Cuello said. “It’s going to be a whole lot of work for CMS and states for very little pay dirt.”

Cuello said the effort may have “greater political value than actual value.”

Brandon Cwalina, a spokesperson for the Pennsylvania Department of Human Services, which runs Medicaid in the state, said the state already requires every Medicaid applicant to verify their citizenship or, where applicable, their eligible immigration status.

However, he said, the directive issued by CMS “constitutes a new process, and DHS is carefully reviewing the list in order to take appropriate actions.”

Oz did not name Pennsylvania, which Trump won in 2024, in his post.

If a lawful resident does not have a Social Security number, the state confirms their legal status by checking a database from Homeland Security, as well as verifying specific immigration documents, he said.

Other state Medicaid agencies said they also needed to regroup before reaching out to enrollees.

“Our teams just received this notice and are working through a process by which we will perform these reviews,” Jennifer Strohecker, then Utah’s Medicaid director, told a state advisory board in August.

Renuka Rayasam and Rae Ellen Bichell contributed reporting.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Mientras tanto, un nuevo informe muestra que más de 154 millones de personas con cobertura médica a través de sus empleos enfrentan fuertes aumentos de precios. Y, concluye la investigación, la situación podría empeorar.

Según una encuesta anual de empleadores publicada el 22 de octubre por KFF, las primas de los seguros médicos que ofrecen los empleadores aumentaron 6% en 2025, alcanzando un promedio de $26.993 al año para una cobertura familiar.

Es la primera vez en dos décadas que el costo de asegurar a una familia de cuatro personas aumenta 6% o más durante tres años consecutivos, según los datos de KFF.

En los últimos cinco años, la prima promedio por cobertura familiar ha aumentado un 26%, en comparación con un alza del 29% en los salarios de los trabajadores y casi un 24% en la inflación. Hoy, el seguro médico para una familia cuesta más o menos lo mismo que comprar un Toyota Corolla híbrido nuevo.

La prima promedio anual para un plan individual proporcionado por los empleadores subió un 5%, alcanzando los $9.325, casi $3.000 más que en 2016, según la encuesta.

“Nos preocupa que los costos de salud sigan subiendo”, dijo Eric Trump, encargado del área contable de Steve Reiff Inc., una pequeña empresa en South Whitley, Indiana, especializada en el arenado y la pintura de maquinaria pesada.

Trump, quien no tiene relación con el presidente Donald Trump, comentó que los costos de los planes médicos que ofrece la empresa subieron un 8% para el año fiscal 2026, más o menos lo mismo que en los últimos años.

Los trabajadores de Reiff pagan aproximadamente el 50% del costo de su cobertura médica. Cerca de la mitad de los 20 empleados rechazaron el seguro porque obtienen la cobertura a través de un familiar o prefieren no tener cobertura, explicó. “No podemos hacer mucho; no tenemos suficientes empleados para distribuir el costo”.

La mayoría de las personas que acceden al seguro médico a través del trabajo contribuyen al pago de sus primas. Este año, el trabajador promedio aportó $1.440 por cobertura individual y $6.850 por cobertura familiar.

Con el tiempo, muchos trabajadores han tenido que asumir deducibles más altos —el monto que deben pagar de su bolsillo por servicios médicos antes de que su seguro comience a cubrir los costos—. Más de un tercio de los trabajadores asegurados están inscritos en planes con un deducible de $2.000 o más por persona. Según el informe, la proporción de trabajadores con un plan de este tipo ha aumentado un 32% en los últimos cinco años y un 77% en la última década.

Los crecientes costos de los medicamentos y las hospitalizaciones suelen destacarse como las principales causas del incremento en el precio de los seguros médicos, y ninguno de estos factores muestra señales de disminuir.

“Los primeros informes indican que los costos seguirán en alza en 2026, lo que podría provocar aumentos aún más elevados en las primas, a menos que los empleadores y las aseguradoras encuentren formas de compensar estos costos mediante cambios en los beneficios, el reparto de gastos o el diseño de los planes”, señala la encuesta de KFF.

Una de las cuestiones que más preocupa a los empleadores es el alto precio de los medicamentos GLP-1 para bajar de peso, que cada vez más empresas cubren. Los precios elevados, junto con la alta demanda, han llevado a algunas compañías a restringir o eliminar la cobertura de estos medicamentos.

“Las grandes empresas saben que estos nuevos medicamentos para bajar de peso, muy costosos, son un beneficio importante para sus trabajadores, pero su precio a menudo supera las previsiones”, afirmó en un comunicado de prensa Gary Claxton, autor del estudio y vicepresidente senior de KFF.

“No es una sorpresa que algunas compañías estén reconsiderando el acceso a los medicamentos para bajar de peso”, agregó.

Los empleadores suelen responder al aumento de los costos de salud trasladando parte de esos gastos a sus trabajadores, pero no está claro cuánto más ellos pueden resistir económicamente. La encuesta mostró que casi la mitad de las grandes empresas dijeron que sus empleados están “bastante” o “muy” preocupados por cuánto les toca pagar de su propio bolsillo.

Aunque el aumento en el precio de los seguros pagados por las empresas ha superado la inflación general, la cuestión ha recibido poca atención en el Congreso en los últimos meses.

Para ayudar a financiar la ampliación de los recortes fiscales, la ley tributaria y de gasto público del presidente Trump reduce en miles de millones de dólares el monto que el gobierno destina a Medicaid, el programa de seguro de salud federal y estatal que cubre a 70 millones de personas de bajos ingresos y con discapacidades. Los analistas presupuestarios del Congreso pronostican que estos recortes harán que millones de personas pierdan su cobertura médica a lo largo de la próxima década.

El gobierno federal está cerrado desde el 1 de octubre, ya que los demócratas se niegan a aprobar un nuevo presupuesto federal a menos que los republicanos acepten prorrogar los subsidios que ayudan a unas 22 millones de personas a adquirir cobertura de salud a través de los mercados de ACA.

Sin la intervención del Congreso, estos subsidios (también llamados créditos fiscales) expirarán y las primas se duplicarán para muchos consumidores a partir de enero.

El informe de KFF se basa en una encuesta realizada este año a 1.862 empleadores públicos no federales y privados, seleccionados al azar, con 10 o más trabajadores.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Premiums for job-based health insurance rose 6% in 2025 to an average of $26,993 a year for family coverage, according to an annual survey of employers released Oct. 22 by KFF, a health information nonprofit that includes KFF Health News.

It’s the first time in two decades that the cost of covering a family of four has risen by 6% or more for three consecutive years, data from KFF shows.

Over the last five years, the average premium for family coverage has increased by 26%, compared with a 29% increase in workers’ wages and nearly 24% growth in inflation. The average cost for family coverage is now about the same as a new Toyota Corolla hybrid.

The average annual premium for an individual health plan provided by employers increased by 5% to $9,325 — nearly $3,000 higher than in 2016, according to the survey.

“It’s a concern as health costs just keep going up,” said Eric Trump, controller at Steve Reiff Inc., a small company in South Whitley, Indiana, that specializes in sandblasting and painting heavy equipment.

Trump, who is not related to President Donald Trump, said his company’s health insurance costs rose 8% for the 2026 fiscal year — roughly the same as they have in the last few years.

Workers at Reiff pay about half the cost of their health coverage. About half of its 20 current employees decline the insurance because they get coverage through a family member or choose to go uninsured, he said. “There’s not a lot we can do as we don’t have enough employees to spread out the costs.”

Most people with job-based insurance contribute to the cost of their premiums, with the average worker this year contributing $1,440 for individual coverage or $6,850 for family coverage.

Over time, more workers have paid increasingly higher deductibles, the amount they must spend out-of-pocket on medical services before their insurer pitches in. More than one‑third of covered workers are enrolled in a plan with a deductible of $2,000 or more for an individual. The share of workers with such a plan has increased 32% over the last five years and 77% over the last 10 years, the report said.

Rising drug and hospital costs are often cited as major culprits for rising health insurance costs, and neither shows signs of ebbing.

“Early reports suggest that cost trends will be higher for 2026, potentially leading to higher premium increases unless employers and plans find ways to offset higher costs through changes to benefits, cost sharing, or plan design,” the KFF survey said.

One big concern among employers is the high price of GLP-1 drugs for weight loss, which a growing number of companies cover. Their high prices, combined with strong demand, have led some workplaces to tighten or eliminate coverage for weight loss.

“Large employers know these new high-priced weight-loss drugs are an important benefit for their workers, but their costs often exceed their expectations,” study author Gary Claxton, a KFF senior vice president, said in a press release. “It’s not a surprise that some are rethinking access to the drugs for weight loss.”

Employers typically respond to higher health costs by shifting costs to their workers, but it’s unclear how much more financial pain workers can take. The survey found nearly half of large employers said their employees have “moderate” or “high” concerns about their level of cost sharing.

While the rising cost of employer-sponsored insurance has outpaced general inflation, the issue received scant attention in recent months on Capitol Hill. To help pay for extending tax cuts, Trump’s tax and spending law reduces by billions of dollars the amount the government spends on Medicaid, the state-federal health insurance program for 70 million low-income and disabled people. Congressional budget scorekeepers predict the cuts to Medicaid will lead to millions more people becoming uninsured over the next decade.

The federal government has been shut down since Oct. 1 as Democrats refuse to vote for a new spending measure unless Republicans agree to extend tax credits that help about 22 million people buy health coverage through the ACA marketplaces. Without congressional action, the tax credits will expire, and premiums will double for many consumers, starting in January.

The KFF report is based on a survey this year of 1,862 randomly selected nonfederal public and private employers with 10 or more workers.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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But in the past couple of years, she’s fallen from 600 pounds to 385, and her blood pressure and blood sugar levels are down, too. “I’m not as fatigued as I used to be, and I’ve been able to go back to church,” she said.

Hines, 46, credits her weight loss to Trulicity, part of a new class of expensive weight loss drugs known as GLP-1s, and her Medicaid coverage for it. “It’s a blessing,” she said.

In a state where the obesity rate ranks among the highest in the country, many health providers were thrilled when Mississippi Medicaid in 2023 began covering GLP-1s for people 12 and older. Only 13 states cover the drugs for Medicaid enrollees for obesity, and Mississippi’s Medicaid program typically has some of the sparsest benefits and strictest eligibility rules.

Hines is one of relatively few enrollees to have used the new Medicaid benefit, which weight loss doctors in the state say has been hindered by national drug shortages, the state’s prior authorization process for the drugs, and a lack of marketing. Just 2% of adults on Mississippi Medicaid who meet the weight-related criteria had been prescribed a GLP-1 as of December 2024, according to a report to the state’s Medicaid Drug Utilization Review Board.

“It’s a little sad to have so many people out there not benefiting,” said William Rosenblatt, a family doctor in Columbus who treats Hines. “These drugs get to the root cause of so many health conditions.”

Already-scarce Medicaid coverage of the highly touted weight loss drugs could become more limited, with federal Medicaid funding cuts expected in the wake of the massive tax-and-spending bill President Donald Trump signed into law in July. The Congressional Budget Office estimated that the law would reduce Medicaid spending by about $911 billion over a decade.

“The law is going to create fairly intense pressure on states not to expand benefits,” said Michael Kolber, a partner in the health consulting firm Manatt. That may be especially true for these drugs, which often cost around $1,000 a month and could be used by a large percentage of Medicaid recipients, he said.

GLP-1s, which have been used for years to treat Type 2 diabetes, have gained widespread attention as a way to lose weight and reduce obesity-related conditions and their long-term costs.

But states may remain reluctant to offer the expensive drugs for obesity, because Medicaid recipients frequently churn on and off the coverage as their income changes. And because the drugs’ health benefits may take years to materialize — such as averting a future heart attack — the long-term financial advantages could accrue to other insurers.

Even ahead of the federal cuts, which will largely take effect in 2027, states are already feeling the pinch. North Carolina’s Medicaid program dropped its coverage of the drugs this month, citing their high cost.

Coverage for the weight loss drugs presents a dilemma for the Trump administration, which has identified as priorities attacking chronic health conditions and reducing federal spending. Health and Human Services Secretary Robert F. Kennedy Jr. has downplayed the need for the drugs and said more emphasis should be placed on eating better and exercising more.

In 2024, the Biden administration proposed that Medicare and Medicaid cover weight loss drugs to help tackle obesity as a public health crisis. In April, the Trump administration revoked the Biden-era proposal, saying the programs would not cover GLP-1 drugs for weight loss.

But in August, The Washington Post reported the Trump administration was considering a five-year pilot program for Medicare and Medicaid to cover the drugs after all. No details have been released. Asked for comment on the report, Centers for Medicare & Medicaid Services spokesman Alexx Pons told KFF Health News that all decisions go through a cost-benefit review.

Meanwhile, the Trump administration has included the GLP-1 drugs Ozempic, Wegovy, and Rybelsus on its list of 15 medicines that will be subject to price negotiations with pharmaceutical manufacturers under its Medicare Part D program, a system created during the Biden administration amid opposition from Republicans. The results of those negotiations are expected to be announced this fall.

Most private insurers don’t cover GLP-1s for weight loss, which can make the drugs unaffordable for those paying out of pocket.

Further analysis provided to Mississippi’s Medicaid drug review board shows that, in the first 15 months the drugs were covered, only about 2,900 Medicaid enrollees age 12 or older started treatment. Nearly 90% of them were female, and many had high blood pressure and high cholesterol.

The analysis also found most enrollees using the drugs lived in the southern, central, or northern parts of Mississippi — not along the Mississippi Delta on the western side of the state, where obesity rates are highest, at nearly 50%.

About 40% of adults in Mississippi are obese, just one percentage point behind top-ranked West Virginia, according to federal data.

Mississippi Medicaid spokesman Matt Westerfield told KFF Health News that the state spent $12 million in the first 15 months, providing the weight loss drugs to 2,200 adult members. He said the state approved the new drugs on the logic that treating obesity would improve enrollees’ health and eventually could lead to cost savings by reducing diseases caused by obesity.

Westerfield said that while utilization has been below the state’s projections, such treatment decisions are up to patients and their doctors. He said the state has been “raising awareness” of the drugs among health care providers, but he declined to comment further.

Rosenblatt, who works for Baptist Medical Group, part of a large regional health system, said some doctors have less incentive to prescribe the medicine, because the state doesn’t pay them to counsel patients about necessary dietary changes when taking the new drugs.

He called the drugs “game changers,” adding that he has seen patients lose 50 pounds or more within a few months of starting the drugs and no longer need medications for diabetes or other conditions.

A New England Journal of Medicine study published in 2021 found participants receiving GLP-1 drugs were more likely to show significant, sustained weight loss compared with those getting a placebo.

Other recent studies have shown the drugs help people with obesity lower their high blood pressure and reduce their odds of heart attacks or strokes.

Mississippi is one of 10 states that have not expanded Medicaid eligibility under the 2010 Affordable Care Act to everyone with an income under 138% of federal poverty level, or $21,597 this year.

In Mississippi, Medicaid does not cover adults without dependent children. Parents qualify only if their income is below 22% of the federal poverty level, or $5,863 for a family of three this year.

The state’s prior authorization process requires doctors to document to the state that patients meet certain obesity levels and that a treatment plan is in place. Doctors must demonstrate that enrollees are losing weight every six months to renew their prescription.

At the Hattiesburg Clinic — a large, multi-specialty group with a location in Hattiesburg, Mississippi — Virginia Crawford, a physician who specializes in obesity, said she was surprised so few patients are getting the drugs. A year ago, there were shortages of the drugs that could have curtailed physicians prescribing them. And she said the state’s prior authorization requirements for the drug could discourage primary care doctors. Many common medications do not require progress reports or even prior authorization.

“We need to make patients more aware that this option is available for them,” she said.

Lauren Scott, 40, of Laurel, Mississippi, said that with the help of Medicaid coverage, she lost nearly 100 pounds taking Wegovy.

“It’s just been amazing,” she said of how the drug drastically cut her appetite. “I remember going to Outback with my husband, and we got the onion ring appetizer and 16-ounce ribeye and salad with extra ranch dressing. I had some onion rings and started on the salad and realized I could not eat any more of this.”

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By January 2027, President Donald Trump’s far-reaching domestic policy law will require many adult, nondisabled Medicaid enrollees in 42 states and Washington, D.C., to work or volunteer 80 hours a month or go to school.

But under the law, Medicaid enrollees in counties where unemployment is at least 8% or 1.5 times the national unemployment rate could be shielded from the work requirement, if their state applies for an exemption.

A new analysis by KFF shows that exemption in the GOP’s work requirement could offer a reprieve to potentially millions of Americans caught in a tough spot — needing to work to secure health insurance but having trouble finding a job.

The Congressional Budget Office projected the work requirement would apply to 18.5 million Medicaid enrollees, causing about 5.3 million to lose their government health coverage by 2034. CBO spokesperson Caitlin Emma confirmed to KFF Health News that analysts factored the unemployment rate exemption into their projections. Only states that expanded Medicaid under the 2010 Affordable Care Act or a special waiver must enact a work requirement, under the federal law.

But how many people could be exempt depends on how the Trump administration interprets the law, in addition to whether their states’ officials apply.

For example, if Trump officials exempt people in counties where the unemployment rate has been above the law’s thresholds for any month over a 12-month period, about 4.6 million Medicaid enrollees in 386 counties could qualify for an exemption today based on the latest unemployment data, according to KFF, a health information nonprofit that includes KFF Health News.

That amounts to just under a quarter of all Medicaid enrollees subject to the work requirement.

Under that one-month threshold, “the impact could be fairly significant,” said Jennifer Tolbert, a co-author of the analysis and the deputy director of KFF’s Program on Medicaid and the Uninsured.

But, she said, the Trump administration is more likely to adopt a stricter threshold based on average unemployment over a 12-month period. That would align with work requirements under the federal Supplemental Nutrition Assistance Program, the food assistance commonly known as food stamps.

Only about 1.4 million Medicaid enrollees living in 158 counties could be exempted under that standard, or about 7% of the total subject to work requirements, KFF found. That’s about 7% of enrollees who live in expansion states who would otherwise need to meet the new requirement.

Based on the 12-month criteria, about 90% of Medicaid enrollees who could be exempted based on high unemployment reside in five states, according to KFF: California, New York, Michigan, Kentucky, and Ohio. California alone accounts for over half of those who could be exempted.

The unemployment rate exemption is one of several carve-outs from the Medicaid work requirement in the GOP’s law. The law also exempts parents with children under 14, people who are disabled or frail, and those who are pregnant, incarcerated, or in a substance use disorder program, among others. The high unemployment provision is different than most because it exempts people living in entire counties.

Two top Republicans key to the bill’s passage — House Speaker Mike Johnson and Sen. Mike Crapo, chair of the Senate Finance Committee — did not respond to requests for comment.

To qualify for the Medicaid exemption, states would have to apply to the federal government on behalf of individuals in eligible counties. And if a county earned an exemption, the government would determine how long it applies.

Even if the federal government grants exemptions broadly, health advocates fear some Republican-led states could balk at applying for exemptions in order to keep enrollment down, as they say has been the case with SNAP exemptions. As of 2023, 18 states did not have an exemption under the SNAP program, even though some of their residents might be eligible.

“It’s not a guarantee that people can rely on,” said Emily Beauregard, executive director of Kentucky Voices for Health, an advocacy group that intends to push for the broadest possible exemptions to help people maintain their coverage. Eastern Kentucky has several counties with perennially high unemployment.

In advocating for Trump’s bill, many Republicans in Washington argued that most people who gained Medicaid benefits under the Affordable Care Act should be working to get off of government assistance.

But as Georgia’s and Arkansas’ experiences have shown, Medicaid work requirements can be costly for states to run and frustrating for enrollees to navigate. About 18,000 people in Arkansas, or nearly a quarter of the state’s adults who gained Medicaid coverage through the ACA expansion, lost coverage when the state had a work requirement in 2018 and 2019. A court ended the state’s work requirement program.

Critics point out that most Medicaid enrollees already work or have a disability or caregiving responsibilities, and they argue the reporting requirements merely serve as a bureaucratic hurdle to obtaining and keeping coverage. Under the GOP law, enrollees’ work status needs to be verified at least twice a year.

Most of the coverage losses due to work requirements occur among people who work or should qualify for an exemption but nevertheless lose coverage due to red tape, research shows.

Not every state must implement a work requirement under Trump’s law, only those that chose to expand Medicaid coverage to more low-income people through the ACA or a federal waiver. The ACA has provided hundreds of billions in federal dollars to help states cover everyone making up to 138% of the federal poverty level — $21,597 for an individual in 2025.

Forty states and Washington, D.C., took up the expansion. Georgia and Wisconsin partly expanded their Medicaid eligibility by getting a federal waiver, adding them to the list of states subject to the work requirement. These two states were not included in the KFF analysis because of a lack of county-level enrollment data.

Jennifer Wagner, director of Medicaid eligibility and enrollment at the left-leaning Center on Budget and Policy Priorities, said she is pleased the law makes some exceptions for places where jobs are scarce. It could limit how many people lose coverage because of the work requirement, she said.

Wagner said SNAP’s unemployment rate exemption has helped millions of people avoid losing their food assistance, but its impact also depends on whether a state seeks the waiver.

She is concerned the Trump administration may make it difficult for counties to get exempted under the Medicaid law.

“I’m glad it’s in there as it will certainly help people, but it’s still a terrible bill,” she said. “This will not really blunt the harm of the bill.”

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Some children’s hospitals collectively stand to lose billions of dollars in revenue once Trump’s wide-ranging tax and spending law, which Republicans called the “One Big Beautiful Bill,” is fully enacted, according to the Children’s Hospital Association. Kids account for nearly half of enrollees in Medicaid, the state and federally financed health program for low-income and disabled people, and its related Children’s Health Insurance Program.

The law will cut federal Medicaid spending by about $900 billion over a decade.

The reduction “cannot be achieved without directly affecting coverage and care for Arizona’s kids, especially the most vulnerable among them,” said Robert Meyer, chief executive of Phoenix Children’s, a pediatric hospital system. About half of the system’s revenue comes from Medicaid.

Trump’s law locks into place much of his domestic agenda, including a massive expansion of immigration enforcement and an extension of tax cuts that largely benefit the wealthiest Americans. The cuts to Medicaid are expected to partially offset the cost of the president’s priorities, which will add more than $3 trillion to the nation’s deficit, according to the Congressional Budget Office. About 7.5 million Americans will lose Medicaid coverage by 2034 as a result, the CBO estimates.

Throughout debates over the measure, Republicans insisted the Medicaid cuts would affect only nondisabled adults enrolled in the program who don’t work and immigrants living in the U.S. without legal status. “Our legislation preserves Medicaid, strengthens Medicaid for the people who actually need it and deserve it,” House Speaker Mike Johnson said June 1 on NBC News’ “Meet the Press.” “And we’re going to get rid of the fraud, waste, and abuse.”

Meyer, though, warned that unless some cuts are reversed, Phoenix Children’s would lose about $172 million a year in payments that supplement the health system’s regular Medicaid revenue, for treating low-income children covered by the program. Medicaid typically pays lower rates for care than commercial insurance or Medicare, the federal program for people age 65 and older.

The supplemental payments, known as state-directed payments, are financed largely by federal taxpayers through complicated tax arrangements adopted by nearly all states. The payments have helped the Phoenix system open additional pediatric clinics, increase mental health staffing, and screen children for abuse and other trauma, Meyer said.

A provision of Trump’s law would cap the amount of directed payments states could make to any hospital, including those for children. But the cap, which doesn’t take effect until 2028, will be phased in over a decade — and hospitals are already lobbying to ensure that never happens. Days after voting for Trump’s law, Sen. Josh Hawley (R-Mo.) introduced legislation that would eliminate provisions of the measure cutting Medicaid payments to hospitals.

If the law isn’t changed, at least 29 states would need to reduce their payments, according to an analysis by KFF, a health information nonprofit that includes KFF Health News.

The extra Medicaid funds, on average, make up more than a third of children’s hospitals’ total Medicaid revenue and about 14% of their operating revenue overall, according to the Children’s Hospital Association.

Richard Park, a director at Fitch Ratings, a credit rating agency, said the Medicaid funding cuts present a “long-term headwind” for children’s hospitals. Hospital officials say that if the payments are cut and states don’t replace the funding, they could be forced to cut staff and services.

“Services the hospitals provide that require longer admissions or bring in less revenue are going to be in the crosshairs, for sure,” Park said.

Children’s hospitals are especially vulnerable to changes in Medicaid because they count on the program for about half their revenue — a much higher proportion than general acute-care hospitals do.

Most children’s hospitals are in good financial condition, however, because they face little competition — there are seldom more than one or two in a metropolitan area — and strong philanthropic support. And the funding cuts won’t affect all the nation’s approximately 200 children’s hospitals.

In 2023, Phoenix Children’s had a $163 million surplus on nearly $1.5 billion in revenue, according to its 2023 IRS tax return.

Under the law, the extra payments in the District of Columbia and 40 states that expanded Medicaid under the Affordable Care Act would be capped at Medicare payment rates. The 10 states that didn’t expand would be able to pay up to 110% of Medicare rates.

The Biden administration had allowed states to pay up to their average commercial insurance rates. That’s generally about 2.5 times the Medicare rate, according to KFF.

Medicaid’s traditionally low fees to health providers can make doctors, dentists, and other specialists reluctant to treat patients in the program.

Brian Blase, president of the conservative Paragon Health Institute and a key architect of Medicaid changes in the new law, said cutting state-directed payments is justified because states should not pay hospitals more to treat Medicaid patients than they do for Medicare patients. Unlike regular Medicaid payments for specific health services, hospitals are not always held accountable for how they spend the extra money, he said.

He said state-directed payments to children’s hospitals and other facilities amount to “corporate welfare,” often helping financially strong institutions get richer.

Blase said states have little incentive to pay hospitals less because the money from state-directed payments comes mostly from federal taxpayers.

In Norfolk, Virginia, Children’s Hospital of The King’s Daughters depends on more than $11 million annually in state-directed payments to make up for what it says is a shortfall between Medicaid’s low reimbursement rates and the cost of advanced care.

The cuts to Medicaid in Trump’s law “will have serious and far-reaching consequences to our services, programs, and patients,” spokesperson Alice Warchol told KFF Health News. “Medicaid supplemental funding helps us pay for the highly specialized pediatric medical, surgical, and psychiatric physicians that are needed to care for every child who needs our services.”

In fiscal 2023, King’s Daughters had a $24 million surplus on $646 million in revenue, according to its federal tax return.

King’s Daughters has used the extra Medicaid money to expand treatment for abused and neglected children and mental health services, Warchol said.

How states account for the extra payments made to hospitals varies. For instance, Utah Medicaid Director Jennifer Strohecker said her state does not track how the money gets spent.

Other states, such as Texas, use the money as an incentive for hospitals to improve their performance in treating patients. They track how well the facilities do each year and publish the findings in public reports.

Matthew Cook, president and chief executive of the Children’s Hospital Association, said that even with the extra funding, Medicaid doesn’t cover the full cost of treatment for its patients.

While some children’s hospitals have strong balance sheets, boosted by philanthropy, that is not the case for all, Cook said. And the Medicaid funding cuts come on top of reductions in other federal payments, including for training doctors and research, he said.

At Phoenix Children’s, Meyer said, the loss of extra funding would curtail expansions of care for children and growth of the hospital’s workforce. The hospital hopes Congress delays or reverses the cuts — but it’s not counting on it, he said.

“We see this grace period as a godsend to get ourselves ready to close the funding gap,” he said.

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Algunos hospitales infantiles podrían perder miles de millones de dólares en ingresos una vez que se aplique por completo la amplia ley fiscal y de gasto de Trump, conocida por los republicanos como la One Big Beautiful Bill, según la Asociación de Hospitales Infantiles.

Los niños representan casi la mitad de los inscritos en Medicaid —el programa estatal y federal de atención médica para personas de bajos ingresos y con discapacidades— y en el Programa de Seguro Médico Infantil (CHIP).

La ley reducirá el gasto federal en Medicaid en aproximadamente $900.000 millones  durante una década.

Ese recorte “no se consigue sin afectar directamente la cobertura y atención para los niños de Arizona, especialmente los más vulnerables”, advirtió Robert Meyer, director ejecutivo de Phoenix Children’s, un sistema hospitalario pediátrico. Alrededor de la mitad de los ingresos del sistema provienen de Medicaid.

La ley de Trump encaja con su agenda nacional, que incluye una dura aplicación de las leyes de inmigración y la extensión de recortes de impuestos que en su mayoría benefician a los estadounidenses más ricos. Se espera que los recortes a Medicaid compensen parcialmente el costo de estas prioridades presidenciales, que aumentarán en más de $3.000 billones el déficit nacional, según la Oficina de Presupuesto del Congreso (CBO, en inglés). Esta oficina estima que unos 7,5 millones de personas perderán la cobertura de Medicaid para 2034 como resultado de la ley.

Durante los debates sobre la medida, los republicanos afirmaron que los recortes a Medicaid afectarían únicamente a los adultos sin discapacidad inscritos en el programa y que no trabajan, así como a inmigrantes sin estatus legal en el país. “Nuestra legislación protege a Medicaid, lo fortalece para las personas que realmente lo necesitan y lo merecen”, dijo Mike Johnson, presidente de la Cámara de Representantes, en el programa Meet the Press de NBC News, el 1 de junio. “Y vamos a eliminar el fraude, el despilfarro y el abuso”.

Pero Meyer advirtió que, a menos que se reviertan algunos de los recortes, Phoenix Children’s perdería cerca de $172 millones al año en pagos complementarios que refuerzan los ingresos regulares del sistema provenientes de Medicaid, por la atención a niños de bajos recursos cubiertos por el programa. En general, Medicaid paga tarifas más bajas que los seguros privados o Medicare, el programa federal para personas mayores de 65 años.

Estos pagos, conocidos como pagos dirigidos por el estado (state-directed payments), se financian en gran parte con impuestos federales a través de complejos arreglos fiscales adoptados por casi todos los estados. Según Meyer, esos pagos han permitido al sistema de Phoenix abrir más clínicas para niños, aumentar el personal de salud mental y realizar evaluaciones para detectar maltrato infantil y otros traumas.

Una disposición de la ley de Trump impondrá un tope al monto que los estados pueden pagar a cualquier hospital, incluidos los hospitales infantiles. Pero ese límite, que entrará en vigencia en 2028, se implementará gradualmente durante una década. Y los hospitales ya están haciendo lobby para evitarlo. Días después de votar a favor de la ley de Trump, el senador Josh Hawley, republicano de Missouri, presentó un proyecto de ley para eliminar las disposiciones que recortan los pagos de Medicaid a hospitales.

Si no se modifica la ley, al menos 29 estados tendrían que reducir sus pagos, según un análisis de KFF, una organización sin fines de lucro dedicada a brindar información sobre salud, que incluye a KFF Health News.

En promedio, estos fondos adicionales de Medicaid representan más de un tercio de los ingresos por Medicaid de los hospitales infantiles y alrededor del 14% de sus ingresos operativos totales, de acuerdo con la Asociación de Hospitales Infantiles.

Richard Park, director en la agencia de calificación crediticia Fitch Ratings, advirtió que los recortes al financiamiento de Medicaid representan un “obstáculo a largo plazo” para los hospitales pediátricos. Según directivos hospitalarios, si se eliminan esos pagos y los estados no compensan los fondos perdidos, podrían verse obligados a reducir personal y servicios.

“Los servicios que requieren hospitalizaciones más largas o que generan menos ingresos estarán, sin duda, en la mira”, dijo Park.

Los hospitales infantiles son especialmente vulnerables a los cambios en Medicaid porque dependen del programa para aproximadamente la mitad de sus ingresos, un porcentaje mucho mayor que los hospitales generales.

Aún así, la mayoría de los hospitales infantiles mantienen una buena situación financiera, porque tienen poca competencia —es raro que haya más de uno o dos en cada área metropolitana— y reciben un fuerte respaldo filantrópico. Además, los recortes no afectarán a todos los hospitales infantiles del país.

En 2023, Phoenix Children’s tuvo un superávit de $163 millones sobre ingresos totales cercanos a los $1.500 millones, según su declaración de impuestos.

Según la nueva ley, los pagos complementarios en el Distrito de Columbia y en los 40 estados que expandieron Medicaid bajo la Ley de Cuidado de Salud a Bajo Precio (ACA) se limitarán a las tarifas de pago de Medicare. Los 10 estados que no expandieron Medicaid podrán pagar hasta el 110% de las tarifas de Medicare.

La administración Biden había permitido a los estados pagar hasta el promedio de las tarifas de los seguros privados, lo cual equivale a unas 2,5 veces la tarifa de Medicare, según KFF.

Las tarifas tradicionalmente bajas de Medicaid para proveedores de salud pueden hacer que médicos, dentistas y otros especialistas se muestren reacios a atender a pacientes del programa.

Brian Blase, presidente del conservador Paragon Health Institute y uno de los arquitectos clave de los cambios a Medicaid incluidos en la nueva ley, dijo que es justificable recortar los pagos dirigidos por el estado, ya que los estados no deberían pagar más por la atención a pacientes de Medicaid que lo que se paga por Medicare. A diferencia de los pagos regulares de Medicaid por servicios específicos, los hospitales no siempre tienen que rendir cuentas sobre cómo usan esos fondos extra, señaló.

Blase afirmó que los pagos dirigidos a hospitales infantiles y otras instituciones constituyen una forma de “subsidio corporativo”, que en muchos casos ayuda a que instituciones sólidas financieramente se enriquezcan aún más.

Agregó que los estados tienen pocos incentivos para reducir esos pagos, ya que la mayoría del dinero proviene de los contribuyentes federales.

En Norfolk, Virginia, el hospital infantil Children’s Hospital of The King’s Daughters depende de más de $11 millones anuales, en pagos dirigidos por el estado, para compensar lo que considera una brecha entre las bajas tarifas de Medicaid y el costo de ofrecer atención médica avanzada.

Los recortes a Medicaid incluidos en la ley de Trump “tendrán consecuencias graves y de gran alcance sobre nuestros servicios, programas y pacientes”, dijo la vocera Alice Warchol a KFF Health News. “La financiación complementaria de Medicaid nos ayuda a pagar a los médicos especializados en pediatría médica, quirúrgica y psiquiátrica que se necesitan para atender a cada niño que requiere nuestros servicios”.

En el año fiscal 2023, King’s Daughters tuvo un superávit de $24 millones sobre ingresos de $646 millones, según su declaración de impuestos federal.

Warchol explicó que el hospital ha usado los fondos adicionales de Medicaid para ampliar los servicios de atención a niños maltratados o abandonados, y para fortalecer los servicios de salud mental.

La forma en que los estados contabilizan estos pagos adicionales varía. Por ejemplo, Jennifer Strohecker, directora de Medicaid en Utah, dijo que su estado no hace seguimiento sobre cómo se gasta ese dinero.

En otros estados, como Texas, el dinero se utiliza como incentivo para que los hospitales mejoren la calidad de la atención. Allí se evalúa el desempeño de las instalaciones cada año y los resultados se publican en informes públicos.

Matthew Cook, presidente y CEO de la Asociación de Hospitales Infantiles, señaló que incluso con los fondos adicionales, Medicaid no cubre el costo total del tratamiento de sus pacientes.

Si bien algunos hospitales infantiles tienen balances sólidos gracias a la filantropía, no todos están en esa situación, advirtió Cook. Además, los recortes a Medicaid se suman a otras reducciones en fondos federales, como los destinados a la formación de médicos y la investigación.

En Phoenix Children’s, según Meyer, la pérdida de esos fondos adicionales reduciría la atención a los niños y el crecimiento de su fuerza laboral. El hospital espera que el Congreso retrase o revierta los recortes; pero no cuenta con ello, dijo.

“Vemos este período de gracia como una bendición para prepararnos y cerrar la brecha de financiación”, afirmó.

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But Republicans ignored those pleas, made even deeper cuts, and sent the legislation on July 3 to the White House, where Trump signed it the next day.

The law’s passage marked a rare political loss for some of the health industry’s biggest players. When unified, doctors, hospitals, and insurers have stood among the most powerful lobbying forces in Washington and have a long track record of blocking or forcing changes to legislation that could hurt them financially.

But health industry lobbyists are catching their breath and assessing the damage after Trump’s massive bill raced through Congress in less than two months with only Republican votes.

Several lobbyists offered various reasons for being unable to stave off big cuts to Medicaid, a $900 billion state-federal health insurance program that covers an estimated 72 million low-income and disabled people nationally and accounts for 19% of all spending on hospital care, about $283 billion a year, according to the latest data. But nearly all agreed that GOP lawmakers were more worried about angering Trump than facing backlash from local hospitals and constituents back home.

“Members were more scared of Trump issuing a primary challenge than disappointing local voters who may find their hospital has to close or their insurance premium may go up,” said Bob Kocher, a partner with venture capital firm Venrock who served in the Obama administration, referring to election primaries leading into the midterms.

Consider what happened to Sen. Thom Tillis (R-N.C.). After he took to the Senate floor to announce his opposition to the bill because of its cuts to Medicaid, Trump threatened to support a challenger to run against Tillis next year. Shortly thereafter, Tillis announced his retirement from politics.

But other factors were at work.

The health industry’s warnings to lawmakers may have been dismissed because hospitals, health centers, and other health care provider groups are seen by Republicans as strong backers of the Affordable Care Act, the law known as Obamacare that’s considered Democrats’ biggest domestic achievement in decades.

The ACA expanded government health insurance coverage to millions of people previously not eligible. And no Republicans voted for it.

“Hospitals’ support of the ACA has frustrated Republicans, and as a result there is less a reservoir of goodwill to hospitals than in the past,” Kocher said.

Ceci Connolly, chief executive of the Alliance of Community Health Plans, said her lobbying team spent extra time on Capitol Hill with lawmakers and their staffers, raising concerns about how the legislation would imperil health care coverage.

“There was almost an overriding sense on the part of Republicans in Congress to deliver a major victory for President Trump,” she said. Her group represents health plans that provide coverage in about 40 states. “That superseded some of their concerns, reluctance, and hesitation.”

Connolly said she repeatedly heard from GOP lawmakers that the focus was on delivering on Trump’s campaign promise to extend his 2017 tax cuts.

She said the concerns of some moderate members helped lead to one concession: a $50 billion fund to help rural hospitals and other health providers.

The money, she said, may have made it easier for some lawmakers to support a bill that, in total, cuts more than $1 trillion from Medicaid over a decade.

Another twist: Many new lawmakers were clearly still learning about Medicaid, she said.

Republicans also seemed eager to reduce the scope of Medicaid and Affordable Care Act marketplace coverage after enrollment in both programs soared to record levels during the pandemic and the Biden administration, she said. Trump’s law requires states to verify eligibility for Medicaid at least every six months and ends auto-enrollment into marketplace plans — steps health policy experts says will reverse some of those gains.

Charles “Chip” Kahn, a longtime health lobbyist and CEO of the Federation of American Hospitals, which represents for-profit hospitals, said the industry’s message was heard on Capitol Hill. But because the bill dealt with so many other issues, including tax cuts, border security, and energy, lawmakers had to decide whether potential health coverage losses were more important.

It was very different than in 2017, when Republicans tried to repeal Obamacare but failed. Trump’s 2025 measure, Kahn said, isn’t a health reform bill or a health bill.

It “left us with an outcome that was unfortunate.”

There were some successes, however, Kahn said.

Industry lobbying did prevent the federal government from reducing its share of spending for states that expanded Medicaid under the ACA. Hospitals and other Medicaid advocates also persuaded Congress not to cap the program’s open-ended federal funding to states. Both measures would have tallied billions more in additional Medicaid funding cuts.

The new law doesn’t change eligibility rules for Medicaid or change its benefits. But it does stipulate that states require most Medicaid enrollees who gained coverage via the ACA’s expansion to document that they work or volunteer 80 hours a month, a provision the Congressional Budget Office predicts will lead to about 5 million people losing coverage by 2034.

The law also limits states’ use of a decades-old system of taxing health providers to leverage extra federal Medicaid funding. This was another loss for the hospital industry, which has supported the practice because it led to higher payments from Medicaid.

Medicaid generally pays lower fees for care than private insurance and Medicare, the program for people 65 and older as well as those with disabilities. But due to provider taxes, some hospitals are paid more under Medicaid than Medicare, according to the Commonwealth Fund, a health research nonprofit.

Kahn credits the Paragon Health Institute, a conservative think tank, and its CEO Brian Blase for pushing the argument that provider taxes amounted to legalized “money laundering.” Blase advised Trump on health policy in his first term.

One hospital executive who asked for his name to be withheld to avoid professional retribution said the message — that some facilities had used this play to increase their profits — resonated with GOP lawmakers. “They thought some hospitals were doing fine financially and did not want to reward them,” he said.

Still, Kahn, who is retiring at the end of the year, said he was pleased the Senate delayed implementation of the provider tax cuts until 2028. That will give the health industry a chance to revise the law, he speculated, possibly after the 2026 midterm election changes the balance of power in Congress.

In rural northeastern Louisiana, Todd Eppler, CEO of Desoto Regional Medical Center, had hoped Congress would pass the initial House version of the bill, which didn’t include cuts to provider-tax funding. But he said any impact on his hospital in Mansfield, located in House Speaker Mike Johnson’s district, will be offset by the $50 billion rural health fund.

“I am happy where we ended up,” Eppler said. “I think they listened to rural hospitals.”

Hospitals have argued for decades that any cuts in federal funding to Medicaid or Medicare would harm patients and lead to service reductions. Because hospitals are usually one of the largest employers in a congressional district, industry leaders often also warn of potential job losses. Such arguments typically give lawmakers pause.

But this time around, that message had little traction.

One health industry lobbyist, who asked not to be identified to speak candidly without risking professional repercussions, said there was a sense on Capitol Hill that hospitals could withstand the funding cuts.

But there’s also a belief that trade groups including the American Hospital Association, the largest hospital industry lobbying organization, could have been more effective. “There is lot of concern that AHA statements were too soft, too little, and too late,” he said.

AHA helped lead a coalition of hospital organizations that spent millions of dollars on television advertising against the GOP bill. Its president and CEO, Rick Pollack, said in a statement before the House voted on the legislation that the cuts to Medicaid would be a “devastating blow to the health and well-being of our nation’s most vulnerable citizens and communities.”

Pollack said in a statement to KFF Health News that the appeal of tax cuts drove Republican lawmakers to pass the law.

“Hospitals and health systems have tirelessly advocated to protect coverage and access for millions of people,” he said. “We will continue to raise these critical issues to mitigate the effects of these proposals.”

The nation’s largest trade group for doctors, the American Medical Association, also opposed the funding cuts to Medicaid and other federal health programs. Its president, Bobby Mukkamala, said in a July 1 statement that the changes “will shift costs to the states and specifically to physicians and hospitals to provide uncompensated care at a time when rural hospitals and physician practices are struggling to keep their doors open.”

But the AMA was also focused on securing higher Medicare fees for doctors. The law ultimately included a one-time 2.5% Medicare pay bump for doctors in 2026. This wasn’t a victory because it left out the House version’s permanent payment fix that would have tied doctor pay to the medical inflation rate. Mukkamala noted the temporary lift but described it as falling “far short of what is needed to preserve access to care for America’s seniors.”

Joe Dunn, chief policy officer at the National Association of Community Health Centers, said his organization worked relentlessly this year to prevent deeper Medicaid cuts that would financially hurt nonprofit clinics. Health center administrators visited Washington in February, made thousands of phone calls, and sent emails to members of Congress.

One payoff was that the health centers were exempted from the law’s requirement that providers charge some Medicaid enrollees up to $35 copayments for services.

But at the end of the day, Dunn said, many GOP House and Senate members simply wanted to finish the bill. “They went in a direction that satisfied the president’s timelines and goals,” he said.

Chief Washington correspondent Julie Rovner contributed to this report.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Now, as Congress steamrolls toward passing historic Medicaid cuts of about $1 trillion over 10 years through Trump’s tax and spending legislation, red-state governors are saying little publicly about what it does to health care — even as they face reductions that will punch multibillion-dollar holes in their states’ budgets.

Medicaid, a program jointly run by states and the federal government, covers more than 70 million low-income or disabled people, including nearly half of the nation’s children. Republicans say the $900 billion-a-year program was allowed to grow too large under Democrats Barack Obama and Joe Biden by adding nondisabled adults they say don’t deserve government assistance, and they have long sought to scale it back.

Some of the biggest health cuts in the legislation Trump calls the “One Big Beautiful Bill” are achieved through new policies that would reduce enrollment by imposing more paperwork demands on enrollees, including a requirement that many prove they’re working. Those policies would affect only states that expanded Medicaid to more low-income people under the Affordable Care Act.

Nineteen of those states are led by Republican governors. Their silence on the bill’s health measures is giving political cover to GOP lawmakers from their states as they seek to cut Medicaid coverage for millions of people who gained it within the last decade.

KFF Health News contacted all 19 governors for comment on the legislation’s Medicaid cuts. Only six responded. Most said they backed imposing a work requirement on adult Medicaid enrollees.

“Implementing work requirements for able-bodied adults is a good and necessary reform so that Medicaid is being used for temporary assistance and not a permanent entitlement,” said Drew Galang, a spokesperson for Gov. Patrick Morrisey of West Virginia.

“Governor Rhoden supports workforce participation as a requirement of Medicaid expansion eligibility,” said Josie Harms, a spokesperson for South Dakota Gov. Larry Rhoden, adding that congressional lawmakers have the governor’s support: “South Dakota has an excellent federal delegation, and Governor Rhoden trusts them to fight for South Dakota’s priorities while delivering on President Trump’s promises.”

In a sign of how the political winds have changed, none of the governors said anything about another of the legislation’s significant cuts, to provider taxes — a tool that nearly all of their states use to help pay their share of Medicaid and gain additional funds from the federal government. That change is expected to cost states billions.

No Longer a Bipartisan Issue

In contrast to the radio silence from GOP governors, Democratic governors have campaigned against the megabill for weeks.

Pennsylvania Gov. Josh Shapiro posted on the social platform X that Trump and congressional Republicans were misleading Americans by saying they were cutting only waste, fraud, and abuse in Medicaid.

“They’re rushing to kick hundreds of thousands of Pennsylvanians off their healthcare — and lying about it,” he posted. “The damage this will do here in Pennsylvania and across America is staggering and will be felt for years to come.”

In New York, Gov. Kathy Hochul on July 1 charged that Trump’s legislation would devastate hospitals and could lead to more than 34,000 job cuts in her state.

“The collective impact of the GOP reconciliation bill in Washington, D.C., could force hospitals to curtail critically needed services such as maternity care and psychiatric treatment, not to mention to downsize operations, and even close entirely,” she said in a statement.

In 2017, the chorus was bipartisan, as Republican governors in Ohio, Nevada, and Massachusetts spoke out against cutting Medicaid. Trump’s bill to repeal much of the Affordable Care Act and roll back its Medicaid expansion narrowly failed in the Senate.

“It’s been surprising that red-state governors, particularly those in Medicaid expansion states, haven’t spoken out against Medicaid cuts,” said Larry Levitt, executive vice president for health policy at KFF, a health information nonprofit that includes KFF Health News. “Republican governors were a potent political force in the failed 2017 effort to repeal and replace the ACA, including Medicaid expansion.”

What’s changed since 2017, policy experts say, is that there are fewer moderate Republican governors, and GOP state executives who advocated for Medicaid expansion over a decade ago are no longer in office.

Additionally, seven of the then-red states that expanded Medicaid did so via ballot initiative, mostly over opposition from their governors.

In fact, the Medicaid work requirement is backed by many Republican governors, even if it means less federal Medicaid money and leads to fewer people covered.

Several states, including Arkansas and Ohio, have already passed state laws to implement a requirement that adults enrolled under the ACA’s Medicaid expansion work, volunteer, go to school, or participate in job training. Most states have yet to bring work requirement programs to fruition because they are waiting for federal government approval.

Charles “Chip” Kahn, president of the Federation of American Hospitals, a trade group of investor-owned hospitals, said that while fewer governors have engaged publicly in trying to block Medicaid cuts under the bill, federal lawmakers are hearing from legislators in their states.

A political dilemma for Republican governors is that, unlike in 2017, the bill before Congress is not legislation aimed expressly at repealing Obamacare. With a scope broader than health care, it would extend many of Trump’s tax cuts and direct billions in new spending toward border security, immigration enforcement, and the military, while also cutting health care spending.

“It’s like playing multidimensional chess rather than focusing on one issue,” Kahn said.

Larry Jacobs, director of the Center for the Study of Politics and Governance at the University of Minnesota, said some Republican governors may have expressed concerns privately to their states’ GOP senators but are not speaking out publicly for fear of drawing Trump’s wrath.

“Why are they being cagey? Trump and not wanting to be ‘Liz Cheney’d,’” Jacobs said, referring to the Republican former Wyoming lawmaker whom Trump helped oust after she served as vice chair of an inquiry into his attempts to overturn the results of the 2020 election.

Walking Political Tightropes

The political peril Republican lawmakers face in publicly challenging Trump remains explicit. On June 29, Sen. Thom Tillis (R-N.C.) announced he would not run for reelection after he voiced concerns about the bill and the president threatened to back a primary challenger. Tillis was one of three GOP senators to vote against it on July 1, though it still narrowly passed.

In addition to the work requirement, the biggest Medicaid cuts in the bill stem from its restrictions on provider taxes — levies that states impose on hospitals, nursing homes, and other health care institutions to help increase their federal reimbursement. Much of the additional money is then returned to the health care providers in the form of higher payments for their Medicaid patients.

The practice, which has been adopted in every state but Alaska, has been criticized by some Beltway Republicans as “money laundering” — even though the taxes are approved by state lawmakers and the federal Centers for Medicare & Medicaid Services and have been allowed under federal law for decades.

The Senate bill would limit the money states could raise — a move that would mean billions in funding cuts to states and their hospitals.

The states with Republican governors that expanded Medicaid are Alaska, Arkansas, Idaho, Indiana, Iowa, Louisiana, Missouri, Montana, Nebraska, New Hampshire, Nevada, North Dakota, Ohio, Oklahoma, South Dakota, Vermont, Virginia, West Virginia, and Utah.

One of the governors who expressed concerns about repealing the Obamacare Medicaid expansion in 2017 was Jim Justice of West Virginia, a Democrat at the time.

In a June 2017 letter to West Virginia Sen. Shelley Moore Capito, a Republican, Justice wrote: “Since so many of our people count on Medicaid, any cut to Medicaid would destroy families in West Virginia.” He added that “the consequences would be beyond catastrophic.”

On July 1, Justice — elected to the Senate as a Republican last year — voted for Trump’s megabill, including its Medicaid cuts.

“The Senator believes this bill strikes a good balance between protecting the most vulnerable and those who rely on the program while rooting out waste, fraud, and abuse to ensure the program is run efficiently for those deserving,” William O’Grady, a Justice spokesperson, said in an email July 2.

KFF Health News correspondent Arielle Zionts contributed to this report.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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This story can be republished for free (details).