UNEVEN MEDICAID CUTS — If Republicans move forward with deep cuts to Medicaid, the pain won’t be spread evenly across states, Robert reports. Advocates and experts say states with higher proportions of low-income and aging residents are likely to be hit the hardest. And many of them are red states. “We operate a bare bones program,” Debbie Smith, campaign director with the advocacy group Cover Alabama, said. “I would expect that people would be cut off from Medicaid and that benefits would be reduced. I would expect that hospitals would be in crisis.” Republicans are searching for savings as part of a larger spending package to extend President Donald Trump’s 2017 tax cuts, slated to expire after this year. Leaders have long targeted Medicaid as an area to extract savings, but any proposal could face blowback from local officials who don’t want to pick up the slack from any cuts. “I don’t see how a governor, regardless of red or blue state, can possibly sit on the sidelines of this conversation,” Barbara Sears, a former director of Ohio’s Medicaid program and former GOP state representative, said. Medicaid is a joint state-federal program that offers insurance to low-income and certain other populations. Republicans on the House Energy and Commerce Committee are considering installing a per-enrollee cap on state spending. The cap would likely change with medical inflation, which can blunt any impact on coverage or benefits, E&C Chair Brett Guthrie (R-Ky.) said. “The overall thing for me is we have a $1.8 trillion budget deficit. It isn’t sustainable,” he said. “It’s not cutting the program; we want to make it sustainable.” But the impact won’t be felt the same from state to state. For instance, a state that goes over the cap could deal with the gap by cutting payments to providers instead of cutting benefits or changing eligibility thresholds. Advocates, however, say cutting payments could exacerbate issues with getting enough providers to take Medicaid patients. Cuts could also hit rural facilities especially hard, with many hospitals in such areas shuttered. “It is like watching a train wreck happen again and again,” Michele Johnson, executive director of the advocacy group Tennessee Justice Center, said. “These rural hospitals are the largest employers in that area.” States might also have restrictions on raising taxes. Oklahoma, for instance, requires a three-fourths majority to get a new tax passed. WELCOME TO TUESDAY PULSE. A new study is offering hope for people with peanut allergies: 32 children who consumed increasing amounts of store-bought peanut butter over 18 months — under the supervision of an allergist — were able to overcome their allergies. Send tips, scoops and feedback to khooper@politico.com and ccirruzzo@politico.com, and follow along @Kelhoops and @ChelseaCirruzzo.
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