The page numbers provided link directly to the relevant sections in the Project 2025 document.
Medicaid and Medicare for Seniors
Project 2025 makes Medicare Advantage the default option for Medicare enrollees
For 30+ years, the Heritage Foundation (authors of Project 2025) has been lobbying to replace the traditional Medicare system with privatized health insurance and have had success with the implementation of Medicare Advantage (MA). The majority of MA plans are offered by large insurance companies which offer less patient healthcare choices due to a smaller network of MA providers. While being touted as ‘consumer choice’ and ‘increased innovation’, the MA program is based on lowering pay-outs for medical care in order to maximize profits for the insurance companies. In addition, the MA plans typically require burdensome pre-authorizations which subsequently have high rates of denial by MA plan administrators. Project 2025 would also ‘remove burdensome policies that micromanage MA plans’; these burdensome policies, better known as oversight, are leading to audits of MA plans for inflated billing and high denial rates for pre-authorizations. [465]
Project 2025 increases the cost of Medicare prescription drugs
The proposal would repeal the drug negotiation program for Medicare under the Inflation Reduction Act (IRA) of 2022. As of August 2024, the current administration has negotiated prices for the first set of ten drugs which will lower list prices for the drugs from 38 to 79%. It is estimated that when the negotiated prices take effect in 2026, there will be a savings of $1.5 billion in out-of-pocket costs for Medicare enrollees. An example of the savings is for Jardiance, a drug used to treat diabetes, heart failure, and chronic kidney disease; the drug list price in 2023 for 30-day supply was $573, the negotiated price for 2026 for 30-day supply will be $197.
Project 2025 would also reduce the government share in the catastrophic tier of Medicare Part D for out-of-pocket prescriptions and would require the pharmaceutical companies to have a larger share. There is no restriction in Project 2025 that would prevent the companies from passing on the costs to Medicare enrollees. [465]
Project 2025 decreases Medicaid coverage for low-income seniors
Project 2025 would change Medicaid payments to states by removing the current federal input of a fixed percentage of actual costs and implementing a capped payment amount regardless of actual costs for requirements such as long-term nursing care and home-based care options. The outcome is designed to deeply cut Medicaid spending by allowing states to drop coverage of benefits which are currently mandatory. [466]
Project 2025 gives states the power to deny Medicaid Coverage.
It allows states to put time limits on how long people can be on Medicaid which means that people could lose their health care after a certain amount of time, even if they still need it. States could eliminate certain benefits from Medicaid. This means that many people who are currently eligible for Medicaid would no longer be able to receive certain health care services. Project 2025 caps Medicaid payments to states without regard for their actual spending needs on health and long-term care. This could force states to outright deny coverage of particular benefits, especially costly services such as long-term care. [468] [466]
