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GPNYC Board
Aug 5

What Project 2025 Does to Medicare and Medicaid

Everyone and their cousin seems to be talking about Project 2025, a project of the Heritage Foundation think tank. And there are lots of issues that have been highlighted with Project 2025, but given that Gray Panthers has a history of focusing on health care, it is worth reflecting on what it proposes for Medicare and Medicaid. 


Here are a few lowlights that voters should be aware of, and alarmed about, given the amount of traction Project 2025 has gained:


It proposes adding “targeted time limits or lifetime caps on benefits to disincentivize permanent dependence.” [1]


Gray Panthers NYC believes that health care is a fundamental human right that everyone should have access to, regardless of their income level or employment status. It is highly unfortunate that Project 2025 doesn’t seem to agree. Having such caps be nationwide would harm lower-income individuals, and result in Americans losing health care. It also advances the belief that health care, which is needed for life-saving procedures, is a privilege rather than a right.


Project 2025 also proposes making “Medicare Advantage the default enrollment option.” [2]


There are some extremely significant disadvantages of Medicare Advantage, such as limited choice of doctors and difficulties in getting coverage for procedures. [3] These are significant issues, given that one may need more medical procedures as they get older. 


And it’s not just patients who are impacted. It’s rural hospitals who are impacted by the difficulties in getting coverage for procedures, given that Medicare Advantage plans routinely deny coverage. [4]


Given these serious issues with Project 2025, it seems highly unwise to default Americans to Medicare Advantage plans.


Project 2025 proposes switching Medicaid funding to possibly block grants or per capita grants. [5]


This is different from how it currently is, where the federal government covers a portion funds a percentage of a state’s costs, regardless of what the costs are. The lack of specificity on how the amount determined by the block or per capita grants is reached is of great concern; it raises the issue that the block grant/per capita grant model will create winners and losers.


Also of concern is that states would receive a fixed amount regardless of the actual costs. This could put a strain on states’ budgets. 


Project 2025 puts access to critical benefits in question.


When it comes to Medicaid, the Project looks “to eliminate obsolete mandatory and optional benefit requirements and, for able-bodied recipients, eliminate benefit mandates that exceed those in the private market. This should include flexibility to redesign eligibility, financing, and service delivery of long-term care to serve the most vulnerable and truly needy and eliminate middle-income to upper income Medicaid recipients.” [6]


The private markets are known for denying services, showing about as much compassion as a brick wall. So having benefit mandates that are in line with the private market is potentially perilous for Medicaid recipients. It’s particularly perilous for long-term care residents, many of whom rely on Medicaid.


To Summarize…


The writers of Project 2025 were most concerned with cutting health care spending to enact their version of fiscal discipline. The writers say that Medicare and Medicaid “operate as runaway entitlements that stifle medical innovation, encourage fraud, and impede cost containment, in addition to which their fiscal future is in peril.” It is with this pretense that politicians have looked to cut costs, and care, for holders of Medicare and Medicaid in the past, and it’s clear that this is the pretense here. Those cuts in costs and care would only be to the detriment of those who need the care.


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