THE MEDICAID DIVIDE — Sometimes, a significant policy difference between presidential candidates is in what isn’t being said. Former President Donald Trump’s RNC platform doesn’t mention Medicaid, the safety-net insurance program, but Vice President Kamala Harris’ DNC platform mentions Medicaid 26 times. “[Republicans] view it more like welfare and cash assistance, unlike liberals and Democrats who view it as insurance coverage,” said Drew Altman, president of KFF. “A Harris administration would certainly want to continue to build on incremental efforts to expand Medicaid. … Trump’s silence on Medicaid is almost deafening.” What Trump could do: Trump campaign spokesperson Karoline Leavitt told Pulse that his call for large-scale deportations would “end the financial drain” on the U.S. health care system and ensure Medicaid can care for qualified citizens. Most states do not cover undocumented immigrant adults. Those that do use state money. The Trump administration approved 13 states’ requests to tie Medicaid to employment, though only Arkansas’ launched due to litigation. His administration also called on states to seek waivers that would allow them more flexibility over Medicaid coverage — including cutting it. The America First Policy Institute, a Trump-blessed think tank, calls for work requirements and “increased flexibility” in Medicaid. And, the Heritage Foundation’s Project 2025 — from which Trump has distanced himself recently — called for “targeted time limits or lifetime caps” on Medicaid. Still, how much of what Trump could do would hinge on control of Congress. If Republicans control both chambers, they could look to use Medicaid cuts to finance extensions of Trump-era tax cuts, said Edwin Park, a research professor at the Georgetown University McCourt School of Public Policy. Brian Blase, a former Trump policy adviser and president of the Paragon Health Institute, said it’s unclear whether there would be as much focus on work requirements as before, given the time those take to implement and legal challenges. He expects that a Trump administration would ensure Medicaid covers only eligible people more seriously than a Harris administration and would crack down on so-called state “financing gimmicks” to get more federal money. Harris’ pledge: The DNC platform claims that Trump would “gut” Medicaid, adding that Democrats would support Medicaid expansion and push Congress to allow Medicaid-like coverage for millions in states that haven’t expanded the program. “Health care is on the ballot this year and voters will remember that when they reject Donald Trump in November,” Harris spokesperson Dory MacMillan said. Harris has hammered Republicans, including those in swing state Georgia, for not expanding Medicaid under the Affordable Care Act , a decision that Michelle Au, a Democrat in Georgia’s House of Representatives, called “physically and fiscally irresponsible.” Harris wants states to offer a year of postpartum Medicaid coverage, which nearly all states have done. “I wouldn’t expect any giant reform of the Medicaid program, but … a different philosophy that values the program tremendously,” Altman said. WELCOME TO THURSDAY PULSE. We’re excited for the return of the NFL season. Go 49ers — and Ravens. Send your tips, scoops and feedback to bleonard@politico.com and ccirruzzo@politico.com and follow along @_BenLeonard_ and @ChelseaCirruzzo.
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