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If Medicare or Social Security won't see cuts, what does that mean for Medicaid?

ARI SHAPIRO, HOST:

One of the most memorable moments in President Biden's address came when he mentioned that some Republicans want to cut Medicare and Social Security before they'll vote to raise the debt ceiling. Republicans in the chamber booed loudly and called him a liar. And the president responded.

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PRESIDENT JOE BIDEN: As we all apparently agree, Social Security and Medicare is off the books now, right? They're not to be touched? All right.

(CHEERING)

SHAPIRO: Well, as NPR's Selena Simmons-Duffin explains, there's another federal health program that may still be on the table for cuts.

SELENA SIMMONS-DUFFIN, BYLINE: If you want to cut federal spending, as House Republicans say they do, there aren't so many places to look, says Larry Levitt, executive vice president for health policy at KFF.

LARRY LEVITT: If you take Medicare and Social Security off the table, and probably defense spending as well and tax increases, the next biggest chunk of the federal budget is Medicaid.

SIMMONS-DUFFIN: Medicaid provides health insurance for low-income Americans. It's funded in part by states and in part by the federal government, and a lot of people are enrolled, currently more than 1 in 4 Americans, 91 million people, compared to 65 million in Medicare.

LEVITT: There have been proposals to cap federal spending on Medicaid or convert it into a block grant to states for decades. I mean, this goes back to when Ronald Reagan was president. And in every case, these proposals have failed because of substantial political pushback.

SIMMONS-DUFFIN: Just ask the man currently looking for federal spending cuts, House Speaker Kevin McCarthy. In 2017, when Republicans tried to repeal the Affordable Care Act and cut federal Medicaid spending, McCarthy told CNN this.

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KEVIN MCCARTHY: We're not taking a benefit away. Nobody on Medicaid is going to be taken away.

SIMMONS-DUFFIN: And in the end, the effort failed and Medicaid remained intact. Levitt says, at the time, the cuts to Medicaid got opposition from a huge range of folks.

LEVITT: From advocates for low-income people, from hospitals, from nursing homes, but also from governors, including Republican governors and some Republican senators, as well.

SIMMONS-DUFFIN: One reason - when low-income people lose their health coverage, they're more likely not to get early treatment when they need health care and to end up in the emergency room. The state often ends up paying for that very expensive care anyway.

LEVITT: Health policy experts often use the analogy of a water balloon. You know, you can push on one part of the balloon, for example, you can try to reduce federal spending, but the money is going to show up somewhere else. And it's typically states and governors that are on the hook for figuring out how to pay for health care for people.

SIMMONS-DUFFIN: So he says, even though Medicaid may not seem to be as politically untouchable as Medicare and Social Security, history has shown that it is, in fact, quite hard to cut. Selena Simmons-Duffin, NPR News. Transcript provided by NPR, Copyright NPR.

Selena Simmons-Duffin reports on health policy for NPR.