How Federal Budget Cuts May Impact Chronic Pain Care
/By Mara Baer,
President Trump recently signed a sweeping budget reconciliation bill – known as the One Big Beautiful Bill -- that makes significant cuts to Medicaid of nearly $1 trillion. The legislation will fundamentally change the way Medicaid is administered by states and reduce health care coverage for millions over time.
The Republican-led effort was positioned to reform and right-size the Medicaid program, which over 70 million Americans rely on for healthcare coverage. But the reality is that for many people, including those living with chronic pain, significant losses of access to care and coverage will result. The new law’s provisions will:
Establish new work requirements for Medicaid eligibility for people aged 19-64
Reduce provider fees and related federal funding, further reducing state Medicaid revenues
Mandate more frequent Medicaid eligibility determinations
Disallow access to Affordable Care Act tax credits for those failing to meet the new work requirements.
While some of the law’s provisions do not take effect until 2026 or later, states must act now to implement complex and costly requirements. Many have already begun the process. For example, in my home state of Colorado, a special legislative session is being considered to try and tackle some of the financial impacts.
Some of the key direct impacts on people with Medicaid who live with chronic pain include:
Coverage losses. Work requirements for Medicaid beneficiaries to attest they are working at least 80 hours a month or get a work exemption. High impact chronic pain, which significantly interferes with daily life activity, already prevents as many as 21 million Americans from working. Their ability to meet the new work requirements will be left to individual states, with some states having more onerous standards than others.
Widening disparities. Data shows that chronic pain patients on Medicaid have worse pain severity and mental and physical functioning than non-Medicaid beneficiaries. As individuals lose their coverage or have reduced access to pain care, the disparity between these groups will widen.
Reduced access to multi-modal care. Research has found that there are disparities in coverage of chronic pain treatments by Medicaid and commercial insurance, with insurers providing more “restorative” therapies, such as physical therapy and chiropractic care. With state budget cuts, states will have to become even leaner in benefit structures and access, leading to possible reductions in comprehensive pain care, further widening the gap in insurance coverage.
Fewer mental health services. Medicaid is the largest payer for mental health services. Because chronic pain and mental health are so intertwined, pain patients losing Medicaid coverage or experiencing service reductions for mental health face potentially significant impacts. This may include increased need for crisis services and more emergency department services.
With states now having to figure out how to implement these changes, some will have to make hard choices. Will new limits on benefits be required? Will they need to expand the use of prior authorization to help manage costs? Reduce benefits to the adult population? Cut new and innovative health services?
It is hard to know, but any of these issues can hit chronic pain patients particularly hard. Staying up-to-date on what is happening in your state will be important.
In addition to these issues, Affordable Care Act subsidies that help people buy coverage are set to expire at the end of the year. Many anticipate that Republicans in Congress will allow this expiration to happen. Combined with the expected coverage losses from the budget reconciliation bill, the number of uninsured Americans is expected to increase by 17 million.
If we do some basic math, applying the statistic that 1 in 4 Americans live with chronic pain, that’s over 4 million people in chronic pain losing coverage. From my point of view, even one is too many.
Mara Baer has lived with Neurogenic Thoracic Outlet Syndrome for over 10 years. She is a writer, speaker, and health policy consultant offering services through her women-owned small business, AgoHealth. Mara is a member of the National Pain Advocacy Center’s Science and Policy Council and writes a newsletter on Substack called Chronic Pain Chats.
