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We talked much of the spring about reconciliation legislation and Medicaid cuts, and on July 4 President Trump signed into law H.R. 1, the One Big Beautiful Bill Act. It was a demonstration of his priorities as well as his influence over the Republican Party and, by extension, Congress. It consumed all the air in the room in Congress for months, as the House worked to pass a bill, the Senate passed a different version, and there followed a struggle to have the House pass the Senate\u2019s version, including personal lobbying by the President. In the end, Speaker Mike Johnson, Majority Leader John Thune, and President Trump were successful in keeping enough (actually, almost all) of their caucuses voting the party line. Remember, Republicans control extremely slim majorities in both chambers of Congress, so as long as they hang together, they have the 50 percent majorities required to pass legislation through reconciliation procedure, just barely.

What\u2019s in the bill?

The bill does many things - it is, as the title suggests, big. And, because it was using the budget reconciliation procedure, which allows for passage by a simple 50 percent majority, all provisions had to have a budgetary impact, as determined by the Senate parliamentarian. It includes many tax provisions - including the extension of existing tax cuts, increase in the standard deduction and child tax credit, and the elimination of taxes on tips and overtime for a portion of such income.

The legislation includes spending components, like additional funding for specific projects at the Department of Defense and cuts to SNAP and Medicaid. It includes far more provisions than we can or should summarize here - the congress.gov summary can be found here. Instead, I\u2019ll focus on health care provisions with an impact on the prostate cancer community. Back in April, we discussed the many possible options for cuts to Medicaid, and some, but not all, of them were included.

Because the bill was being revised up until minutes before its final passage, it did not have a final score from the Congressional Budget Office, the nonpartisan team in Congress that analyzes legislation for its impact. However, as of July 1, CBO estimated that H.R. 1 would increase the deficit by $3.4 trillion over the next 4 years.

What\u2019s in the bill for health care?

The most comprehensive summary of all the health provisions in H.R. 1 comes, as ever, from the Kaiser Family Foundation. Rather than recreate their work, I\u2019ll summarize here. H.R. 1 achieves savings in Medicaid by making policy changes that will result in fewer people being covered.

The CBO has estimated that the Senate version of the reconciliation legislation (as of a few days before passage, so not final) would cause about 17 million who are currently insured to become uninsured. Some of that is because of changes to the marketplace plans offered in states (the premium subsidies eligible people receive will decrease, the time periods during the year when people can enroll will shrink, and some administrative changes that will make enrollment more complicated).

The biggest chunk of newly uninsured people will become uninsured because of changes to Medicaid. First, that\u2019s the implementation of work requirements. What's tricky here is that most people on Medicaid already meet the work requirements (as we discussed back in April), or meet the various exemptions (caregiver to a child, medically frail, etc) - what we've seen in the states that have tried work requirements is that they tend to kick people off Medicaid not because they aren't working, but because they failed to meet the reporting requirements, or didn't know about them, or something like that. Work requirements put a substantial administrative burden on state Medicaid programs (and cost money to implement), but they haven't been shown to increase employment rates. They do achieve cost savings because people do get kicked off of Medicaid, but not exactly for the intended reason.

Medicaid cuts also include barring states from offering Medicaid to undocumented individuals - there are 7 states that currently offer some version of Medicaid or a similarly structured program to provide this coverage. It is important to note that they have voted to offer this option and only use state funds (not federal dollars). About 1.4 million people are estimated to lose coverage because of this provision.

There are a few other provisions that either modify the enrollment process or make other administrative changes to Medicaid that are likely to result in fewer people enrolling - like requiring that states redetermine eligibility for Medicaid twice a year instead of once. That will likely catch some people who, in fact, have experienced personal changes that make them no longer eligible for Medicaid since their last eligibility determination, but it will also drop some people for whom the process is burdensome from an administrative perspective (if they don't have internet at home, experience language barriers, etc) if they have to do it more often. It will also require states to increase administrative capacity to conduct approximately twice as many determinations per year.

The final thing is limitations to provider taxes. States use taxes on providers to partly finance their Medicaid contribution - every state but Alaska uses these taxes in some way. They're a complicated piece of the puzzle, but the assumption from CBO is that if states have less money to spend on Medicaid, they will have to make adjustments to their Medicaid program, either by reducing eligibility, reducing benefits, or reducing payments to providers.

Medicaid programs will be required to impose cost sharing in Medicaid for adults in the expansion population. This exempts primary care and services delivered at federally qualified health centers and rural health clinics, but will likely have a larger impact on Medicaid recipients with higher health care needs.

These provisions don\u2019t necessarily hit right away - they\u2019ll be phased in over time, beginning in 2026, which will blunt the immediate impact.

How will this impact the prostate cancer community?

For those living with prostate cancer or at risk for diagnosis, losing coverage through Medicaid or an individual marketplace plan, whether because they become ineligible or because the plan becomes too expensive, could be the difference between getting timely screening or not. We know that health insurance is linked to better health outcomes. An increase in cost sharing for Medicaid patients with prostate cancer will make treatment more expensive and less accessible.

The short version

Almost 20 million people will lose health insurance coverage as a result of H.R. 1. Many of the people losing coverage are currently eligible, but will lose eligibility under these policy changes. The goal of Medicaid cuts in the legislation was to reduce the federal deficit - but in order to save money in Medicaid you essentially have to reduce the number of people who are eligible, reduce the benefits they are eligible for, or reduce payments to providers. Because of the cuts, and loss of insurance coverage, H.R. 1 will leave the prostate cancer community more vulnerable to poor outcomes and to financial toxicity from treatment.

"}, "widgetType": 4}, {"props": {"text": "Your story makes the difference and allows us to illustrate the impact of policy changes. Did Medicaid or a marketplace plan provide insurance that covered your or a loved one\u2019s prostate cancer treatment? ", "title": "How can you help?", "buttonUrl": "https://zerocancer.quorum.us/campaign/shareyourstory/", "mediaType": 1, "buttonText": "Tell us your story.", "hideCtaButton": false, "isLeftAligned": true, "backgroundColor": "#0077c8", "useBackgroundColor": true}, "widgetType": 23}, {"props": {"text": "You won't see a request for donations very often on the blog, but now is also a great time to support ZERO\u2019s programs. Blitz the Barriers will be even more important for increasing awareness and screening in high risk populations. ZERO 360 will have to help more Americans navigate the challenges, financial and otherwise, of their prostate cancer experience. We can\u2019t do any of this without your help.", "buttonUrl": "https://zerocancer.org/take-action/advocate?form=DONATE", "mediaType": 1, "buttonText": "Donate today.", "hideCtaButton": false, "isLeftAligned": true, "backgroundColor": "#0077c8", "useBackgroundColor": true}, "widgetType": 23}, {"props": {"content": "

As always, I\u2019m happy to answer your questions (and maybe they\u2019ll become a future Prostate Policy Pulse post!) - please email advocacy@zerocancer.org.

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Today, the Supreme Court released their final decisions of the current term, including a long-awaited decision about insurance coverage of preventive services. The decision kept intact the requirement that insurers cover without cost sharing all clinical preventive health services given an A or B rated recommendation by the United States Preventive Services Task Force.

The case, Kennedy v. Braidwood Management, hinged on the Appointments Clause of the Constitution. I\u2019d advise the SCOTUS devotees here to read the full decision, but I\u2019ll jump right to what this means for the prostate cancer community.

First, the USPSTF is the group that makes recommendations about clinical preventive services. They recommended against prostate cancer screening in 2012 (a D rating) and gave a more neutral recommendation in 2018 (a C rating). We have a background video from our Advocate Education Hub that goes deep on the USPSTF."}, "widgetType": 4}, {"props": {"title": "Background on the USPSTF", "content": "https://youtu.be/gOBlO3tb5zA"}, "widgetType": 11}, {"props": {"content": "

The USPSTF is currently in the process of updating the prostate cancer screening recommendation. Our team has submitted comments on the draft research plan and met with the staff over at the Agency for Healthcare Research and Quality, which supports the USPSTF. Our best guess was that the draft recommendation would be released somewhere around the end of 2025 or early 2026, but AHRQ staff was reduced by about half earlier this year, according to reports, and it is our understanding that the draft recommendation will be delayed by an indefinite amount of time. So maybe summer 2026, if we\u2019re lucky? Of course, we don\u2019t know what the recommendation will be, though we\u2019re sharing compelling data with the Task Force to help with the process.

Second, the PSA Screening for HIM Act attempts to get around the problem of the USPSTF recommendation by writing coverage for prostate cancer screening for high risk men without cost sharing directly into the U.S. Code. That means it doesn\u2019t matter how the USPSTF rates the PSA test or even if there is a USPSTF - if the bill passes, insurance companies would be required to cover prostate cancer screening for high risk men without copays, coinsurance, or deductibles.

In a sense, Braidwood didn\u2019t matter for prostate cancer screening, since it doesn\u2019t have an A or B rating anyway. However, if the Supreme Court had ruled differently, it could have introduced more ambiguity into the situation going forward, especially since there are already questions about what will happen with the updated USPSTF recommendation.

As it stands, we\u2019ll keep working to push the USPSTF to understand the value of prostate cancer screening, especially for those at high risk, AND we\u2019ll keep pushing to pass the PSA Screening for HIM Act. Dual strategies = more chances of success.

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Stay cool, and make sure you\u2019re up to date on all your preventive screenings!

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Things in the policy world have been a whirlwind in the last month - with more prostate cancer-related news coming out of DC in the last few weeks than in the average year (not sure this can be proven, but it feels like it). For today, we\u2019re going to stick to the President\u2019s Budget, but we\u2019ll be back for more over the coming weeks.

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The President\u2019s FY2026 Budget Request

Each year, the President sends a budget request over to Congress. Officially, this happens on the first Monday in February. In real life, it is often delayed, and in the first year of a new administration, it is generally substantially delayed as the new President and team have the opportunity to get up to speed and develop proposals. This year, President Trump\u2019s budget request for federal Fiscal Year 2026 included a few important things for the prostate cancer community:

A 40% cut to the National Institutes of Health, including a
37% cut to the National Cancer Institute.
The complete elimination of the cancer efforts at the Centers for Disease Control and Prevention.

NIH and NCI

Hopefully, if you\u2019ve found your way to our blog, you understand the critical importance of the work done at the NIH and NCI. America has been a global leader in biomedical research into cancer and other diseases and conditions for decades, and the NIH and NCI are the crown jewels of our system. Their research has made possible the 34% decline in cancer mortality since the early 1990s. The NCI is the largest funder of cancer research in the world. Cutting funding for the NIH and NCI means less biomedical research. In addition to potentially cutting off existing promising research and failure to support new and innovative ideas, federal cuts to research also reduce the opportunities to develop the next generation of researchers, the ones who might develop the next generation of treatments for prostate cancer or a new, more effective screening tool.

Federal investment is not the only source of research funding in the U.S., but it is a critical partner in this enterprise and supports basic scientific research, which helps us to understand foundational questions on which other research builds, and can help to ensure that scientific research addresses issues that are most important to the American people, even if they aren\u2019t necessarily the most commercially lucrative issues.

Check out this fantastic infographic from Research!America about the research and development pipeline.

CDC

If you\u2019re like most people, you\u2019re less familiar with what the CDC does in the fight against cancer. The CDC\u2019s Division of Cancer Prevention and Control forms the public health foundation for efforts to extend and improve the lives of those facing cancer, both now and in the future.

For example, ZERO\u2019s Blitz the Barriers initiative is focused on 12 target markets across the country that bear some of the highest burdens of prostate cancer.How did we identify those markets? How does anyone know where cancer rates are higher or lower? Or if the age and stage at diagnosis are going up or down? The National Program of Cancer Registries, together with the NCI\u2019s SEER Program, collects data on new cancer cases (including the type, extent, and location of the cancer), the type of initial treatment, and outcomes. That information is used to monitor trends in cancer, identify high risk groups, inform research, and allocate resources - it allows both public and private programs aimed at improving cancer outcomes to be more efficient and effective.

Cancer registries are just one program in the Division of Cancer Prevention and Control. The National Comprehensive Cancer Control Program sends money to states to support the efforts they identify as most important based on the needs of their communities through cancer control coalitions. Unfortunately, the search tool for the state cancer plans is currently offline, making it more difficult to look directly at the ways that states have chosen to tackle prostate cancer. To take Alabama as an example, the state set a goal of decreasing prostate cancer mortality by increasing education about screening, including for health care providers. (Reminder: secondary prevention refers to catching a disease early to prevent progression, as opposed to primary prevention, for example, smoking cessation to prevent lung cancer from developing in the first place.)

The Division of Cancer Prevention and Control doesn\u2019t have a specific prostate cancer program, but there is funding allocated to education and outreach efforts for high risk men, in addition to funding to ensure that prostate cancer is included in the registries and in the state cancer plans. That education and outreach funding has, in recent years, allowed for the creation of Talk to Nathan, and other patient tools, as well as a resource center.

With additional investment, we\u2019ve hoped to grow the CDC\u2019s efforts to include a national awareness campaign about prostate cancer, one of the things the CDC does best.

The DCPC also includes screening programs for breast, cervical, and colorectal cancers that increase access to early diagnosis for low income and uninsured patients. There are also awareness campaigns and resources for the prevention and control of other cancer types.

On our team, as well as across the cancer community, we suspected that the DCPC, and the rest of the National Center for Chronic Disease and Health Promotion (home to the DCPC) might be moved over to the newly proposed Administration for a Healthy America, which was discussed as an agency focused on chronic disease. Unfortunately, the cancer efforts were not included in the AHA proposed budget either. The President\u2019s FY26 budget proposal completely eliminates the critical work of the DCPC.

Anything else?

Yes, there\u2019s lots more in the budget request. For example, the request reduces funding to support the United States Preventive Services Task Force by about 40%. The USPSTF makes the recommendations for clinical preventive services - as many of you know, for years ZERO has been working to address the decline in screening rates many attribute to the USPSTF\u2019s previous recommendation against PSA testing and to its current lukewarm recommendation. The USPSTF is supposed to update its recommendations every 5 years - but hasn\u2019t had the necessary resources to hit that target for years. A large reduction in funding makes it impossible for the staff supporting that project to update those recommendations in a timely manner. The prostate cancer screening recommendation is currently in the update process and we anticipate delays.

That\u2019s just one more example that will have an impact on the prostate cancer community, but for those who really want to dig in, I offer the full appendix!

What comes next?

The President\u2019s budget request is simply that - a request. Congress officially holds the power of the purse and the normal appropriations process is underway right now. Hearings have begun in the House and Senate Appropriations Committees and Subcommittees. The federal fiscal year ends on September 30. Now, if this year is anything like most years this decade, the appropriations process will not be complete by then, and we\u2019ll have at least a short term continuing resolution to buy Congress additional time to negotiate.

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What about the PCRP?

The President\u2019s Budget request didn\u2019t include funding for the Prostate Cancer Research Program at DOD. But don\u2019t worry, it never does. The PCRP is part of the Congressionally Directed Medical Research Programs - keyword being \u201cCongressionally directed\u201d - that means that the President never asks for that funding - the Congress adds it in on top of the funding they provide to meet the defense needs of the nation.

That said, the House Appropriations Committee Subcommittee on Defense released their proposed funding levels for FY26 and it keeps the PCRP at $75 million - the same as FY25, but a 32% cut from FY24. We\u2019ll be working with our allies to fight this one as we go forward.

Don\u2019t forget to share this blog with your friends and family - sign up to receive alerts when we update.

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State-level Access to Early Detection

On the right, you can see the list of the states we are currently working to pass legislation in to remove out-of-pocket costs for prostate cancer screening for patients at-risk. If you don't see your state on this list, reach out to Georgia Bates, ZERO's State Government Relations & Advocacy Manager at Georgia@zerocancer.org and see what you can do in your state!

Over the past few years, we have have seen great success in passing cost-sharing legislation:

New York (2018)
Maryland (2020)
Rhode Island (2021)
Illinois (2022)
Oregon (2024)
Kentucky (2024)
Tennessee (2024)
Delaware (2024)
Washington, DC (2024)
Virginia (2025)

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Active State Campaigns

Click on your state to take action locally for prostate cancer! Don't see your state on this page? Never fear, we will keep you posted if legislation is introduced in your state down the road. In the meantime, send an encouraging message to your lawmakers and ask them to draft legislation in your state.

New Jersey

Ohio

Pennsylvania

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Officially, the federal budgeting and appropriations process kicks off when the President submits a budget proposal to Congress. Often in the first year of a new administration, the President\u2019s budget is delayed and Congress actually gets in front, and everything overlaps a little more. The full budget process is a thing for another post, but today, President Trump released the \u201cskinny budget,\u201d which is to say, a summary of the proposed budget that doesn\u2019t yet include all the details and Congressional Justifications from the various agencies. The full budget is expected later this month, but in the meantime, they released enough information to get us started.

This is a headline only blog today, so we\u2019re going to stick to the big stuff: the complete elimination of the National Center for Chronic Diseases Prevention and Health Promotion, which includes the Division of Cancer Prevention and Control with all of the CDC\u2019s cancer efforts. That\u2019s everything - including cancer registries (critical to knowing just how much cancer there is in the U.S., where rates are higher or lower, what communities are most impacted, how incidence and mortality rates are trending), the National Comprehensive Cancer Control Program (provides funding to states to tailor prevention and screening efforts to the needs of their population and creates a network for knowledge sharing), national awareness campaigns, and more. The CDC\u2019s prostate cancer activities have focused on education and outreach to high risk men, providing resources to those at greatest risk of disease.

This work is absolutely critical - for example, our Blitz the Barriers initiative is focusing on 12 markets that have higher prostate cancer incidence, mortality, or risk than the U.S. average. How do we know where those places are? Because of the data collected by CDC\u2019s National Cancer Registry Program. Yes, state health departments are involved and yes, state health departments might try to fill the gap if CDC went away. But they wouldn\u2019t necessarily collect the same data using the same methodologies. They wouldn\u2019t have a centralized infrastructure that can be used to compare data from multiple states. The CDC makes it possible for us to compare apples to apples - core public health work that is done most efficiently and effectively by the federal government.

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There is plenty more analysis to come with cuts at other HHS programs including the NIH, but for today, we urgently need your help - email your Members of Congress to ask them to protect the CDC\u2019s cancer efforts.

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Check out all the materials here at the White House website. And watch for more here - I\u2019ll do my best to keep you updated as we understand more.

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April 29, 2025 - With cuts to Medicaid potentially on the horizon, here is what you need to know about what those cuts may look like.

April 16, 2025 - Why does Medicaid matter for prostate cancer patients and those at risk, and why should the prostate cancer community care about cuts?

April 11, 2025 - What is a critical lifeline to screening, early detection, treatment, and survivorship care AND has been targeted for huge funding cuts? Medicaid. Here's what the prostate cancer community needs to know about budget resolutions, reconciliation, and Medicaid cuts.

April 9, 2025 - Welcome to the Prostate Policy Pulse - your source for the news that impacts the prostate cancer community from D.C. and state capitals across the nation. Also, today's update about the Prostate Cancer Research Program.

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A couple of weeks ago, we discussed the budget framework that instructed Congressional committees to cut $880 billion from Medicaid. While we know that it\u2019s nearly impossible to cut that much from Medicaid funding without having an impact on the individuals it covers, an $880 billion cut doesn\u2019t mean much unless we understand the policy changes necessary to achieve it.

We do not yet know what the cut will look like - Congress just returned from a district work period and will begin negotiating. Speaker Johnson has shared a goal of having a bill on the president\u2019s desk by Memorial Day (though this goal has already started to slip - House Majority Leader Steve Scalise just said \"We'd like to have it on the president's desk by June.\u201d). This means we\u2019re looking at just a few weeks for the House Energy and Commerce Committee to hammer out the policy changes that result in $880 billion in cuts. "}, "widgetType": 4}, {"props": {"text": "You can take action now to help protect patients for whom Medicaid is a lifeline, often literally. ", "title": "Don\u2019t want to read the next 2,000 words?", "buttonUrl": "https://zerocancer.quorum.us/campaign/medicaid/", "mediaType": 1, "buttonText": "Contact your elected officials now.", "hideCtaButton": false, "isLeftAligned": true, "backgroundColor": "#0077c8", "useBackgroundColor": true}, "widgetType": 23}, {"props": {"content": "

Additionally, even among many Republicans who voted for the budget resolution, Medicaid cuts that will reduce benefits for patients (which is most proposals, one way or another) are not popular. It is not clear that Republicans have the votes to pass legislation that achieves $880 billion in cuts - though that could certainly change. E&C Chair Brett Guthrie (R-Ky.) has said the committee can reform Medicaid \u201cin a way that doesn\u2019t take away people\u2019s benefits,\u201d demonstrating the attempt to thread a very small needle - make large cuts, but do it through \u201creform\u201d and in a way that voters can accept. Democrats would tell you it can\u2019t be done, and the results remain to be seen

What\u2019s on the table? Anything is possible, but here are a few ideas that have been circulating:

Cuts to DC FMAP
Cuts to FMAP for expansion population
Per capita caps on expansion population
Work requirements
Limiting the use of state taxes on providers

Again, this list is not exhaustive and some possibilities seem more likely to garner support than others.

Side note: to understand some of the policy proposals below, it\u2019s important to understand how Medicaid is funded. Check out the long version in the KFF Medicaid Financing primer and the short version below. Also, because Medicaid is a joint federal and state program, it has a profound impact on state budgets. If the federal government\u2019s spending goes down, some states will try to make up the difference to minimize the impact on patients and the health system. The Kaiser Family Foundation has a great article putting $880 billion in the context of state budgets.

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Cuts to FMAP

As mentioned above, FMAP, or the federal medical assistance percentage, is the amount of funding the federal government contributes to Medicaid, with the states picking up the rest. The most straightforward way to cut Medicaid would be to reduce the FMAP. Currently, the floor is 50% of Medicaid costs in a state and it goes as high as 77% in Mississippi for traditional Medicaid. For adults newly eligible for Medicaid because of expansion under the ACA, there is an enhanced FMAP of 90% (this was a powerful incentive for states to expand - there\u2019s value to be had in giving people health coverage, and if a state only had to pay 10% of the cost of supplying that coverage, the ROI was very high). The total share of Medicaid spending by the federal government is actually a combination of the traditional Medicaid FMAP and the enhanced FMAP.

Reducing the FMAP for the expansion population is on the list of possible ways to cut Medicaid. Eliminating the enhanced FMAP for expansion populations is estimated to save the federal government somewhere between $626 billion and $1.7 trillion, depending on whether or not states decide to keep the expanded eligibility in place (with the traditional FMAP rate they receive and picking up the difference in cost) or to eliminate expanded eligibility completely. Twelve states have trigger laws built into their Medicaid expansion that will automatically end or change expanded eligibility if the enhanced FMAP changes.

Kaiser Family Foundation (once again) does a better job than I can at explaining exactly who saves how much and what costs could be shifted under a couple of scenarios, so I\u2019ll just point to them here.

What I will say is this - if the enhanced FMAP for the expansion population goes away and states are unable or unwilling to make up the difference (and most state budgets are already much tighter than the federal budget), that savings will impact either eligibility or coverage for Medicaid. The math doesn\u2019t work any other way.

As we discussed earlier on this blog, the expansion population includes childless adults under the age of 65 - a key demographic for prostate cancer risk and diagnosis. Health coverage is critical to receipt of health services, whether that is preventive care, like screening, or treatment for disease.

Cutting the enhanced FMAP for expanded Medicaid eligibility is politically challenging. Most states and DC have opted for expansion, including plenty of red states. Republican Senators are hearing from their governors about the impact of FMAP cuts back home. This is an option that would get the Energy and Commerce Committee substantially towards their goal of $880 billion in savings, but it would come at a political price.

FMAP cut option #2

There is an easier (and smaller) FMAP cut option afoot. The District of Columbia has an FMAP rate of 70%, set by statute (rather than using the standard formula that determines the FMAP for states). If the standard formula was applied, DC\u2019s FMAP would drop to 50%. However, advocates in DC argue that because so much of the city\u2019s property is owned by the federal government and not subject to property taxes, that loss in revenue necessitates an enhanced FMAP.

DC hospitals and advocates are fighting their best on this one, but it may not be enough, especially since they don\u2019t have real representation in Congress. From a Congressional perspective, the political pain of this cut is less, but it only saves about $8 billion.

Per capita caps on Medicaid expansion

The current Medicaid funding model doesn\u2019t have any limitations on how much the federal government can spend. The FMAP formula guarantees the federal commitment to its portion of Medicaid expenses. Among the policy options being proposed is a transition to a per capita cap on Medicaid spending that would limit spending and future spending growth. The cap would vary by enrollment group and growth would be pegged to medical inflation.

Beyond that, policy details are vague, but the impact on individuals is similar to the effect of cutting FMAP. Either cuts in federal spending will shift Medicaid spending onto the states, or it will result in larger Medicaid spending reductions over the next 10 years. The impact on spending and enrollment would vary by state depending on the makeup of their individual Medicaid populations. Based on Kaiser Family Foundation analysis, combining per capita caps with the elimination of the enhanced FMAP for the Medicaid expansion population could pay for the $880 billion in current savings targets almost 3 times over, with potential drops in Medicaid eligibility of 36% at the end of 10 years. That\u2019s 30 million fewer people with Medicaid coverage.

Work requirements

Medicaid work requirements, sometimes known as \u201ccommunity engagement,\u201d have been around for a while. Eleven states added work requirements to their Medicaid programs between 2017 and 2021, but most weren\u2019t actually implemented and the federal waivers that permitted those programs were rescinded in 2021. Georgia, which has not otherwise expanded Medicaid, enacted work requirements for parents and childless adults under 65 below the poverty line - a group that was mostly not eligible for Medicaid previously.

Because states have been laboratories for this policy, we know a little bit about the implications of Medicaid work requirements. First, the structure can vary, but they typically look something like this:

Now, it\u2019s important to recognize that most adult Medicaid beneficiaries who meet these criteria already work full- or part-time.

https://www.kff.org/medicaid/issue-brief/understanding-the-intersection-of-medicaid-and-work-an-update/

A few other things are true about work requirements:

Reporting on work requirements has been shown to be a significant burden, and in states where work requirements were implemented, a substantial proportion of those who lost coverage did so because they failed to meet the reporting requirements and many were unaware of the requirements.
Individuals covered by Medicaid often work in low-wage positions with variable hours that don\u2019t offer health insurance benefits or affordable coverage (otherwise they wouldn\u2019t need Medicaid).
People eligible for Medicaid also often face transportation barriers, caregiving responsibilities, and chronic health conditions that can make finding and keeping a job challenging.
For individuals who do lose coverage because of work requirements, for any reason, they lose a vital lifeline to health care, potentially impacting their ability to work.

The Congressional Budget Office estimated that a bill to impose work requirements for Medicaid in 2023 would save the federal government about $109 billion over 10 years. However, CBO also estimated that it would cause an additional $60 billion in state spending, as some states would choose to provide coverage anyway, without federal support. The CBO also predicted that work requirements would have no impact on employment levels or the number of hours worked.

Limiting the use of state taxes on providers

One of the ways state governments provide funding for their portion of Medicaid funding is through taxes on health care providers. All states except Alaska use this option, levying a tax on a percentage of revenues, or a flat tax based on number of facility beds or inpatient days, or something similar, and they mostly apply to institutional providers like hospitals and nursing facilities, though not exclusively. This brief on provider taxes from the Medicaid and CHIP Payment and Access Commission explains it thoroughly.

Among other requirements, provider taxes have to remain below 6% of net patient revenues and one of the policies proposed would lower the Medicaid provider tax safe harbor from 6% under current law to 4% from 2026 to 2027 and 3% in 2028 and after. This proposal is projected to save $175 billion.

Opponents of restrictions say:

Provider taxes are permissible under current law and help fund Medicaid.
Restricting provider taxes will create financing gaps for states that could result in higher state taxes, reductions in Medicaid eligibility, lower provider payment rates, and fewer covered benefits.

Proponents of restrictions say:

Using provider taxes to increase state Medicaid spending inflates the match.
Provider taxes are a possible area of waste, fraud, and abuse.

If provider taxes are restricted as a funding option for states to support Medicaid, it essentially limits the amount of money available to states for Medicaid, and in turn the federal match. Reducing Medicaid funding has to come from somewhere, just like in the other proposals here, with a likely impact on eligibility or coverage.

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An old colleague once told me the two most important questions are the ones from kindergarten: So what? And who cares? $880 billion is a lot of money, but if we\u2019re talking about $880 billion in Medicaid cuts, so what? Why does Medicaid matter for prostate cancer patients and those at risk, and why should the prostate cancer community care about cuts?

What is Medicaid?

Not to be confused with Medicare (which pays for health costs for those over 65 and with certain disabilities), Medicaid is the joint federal and state program that covers health care costs for people with limited income and resources. The federal government sets the floor for Medicaid - defining the minimum benefits and minimum eligibility criteria. States have the option to increase benefits and eligibility - and each one decides differently. As the saying goes, if you\u2019ve seen one Medicaid program, you\u2019ve seen\u2026 one Medicaid program.

Traditionally, Medicaid has covered low-income children, pregnant women, parents of dependent children, elderly individuals, and individuals with disabilities. Since 2014, states have been allowed to cover nonelderly adults with incomes up to 133% of the federal poverty level AND the federal government has picked up a larger proportion of the cost of their care. Forty-one states and D.C. have chosen to expand Medicaid to include that population (and some have gone further). When we talk about Medicaid expansion populations, we\u2019re referring to the people who newly qualified for Medicaid in states that expanded their eligibility criteria. *this will be important later*

There is a subset of Medicaid beneficiaries referred to as \u201cdual eligibles\u201d - individuals who are eligible for both Medicaid and Medicare. For these people, Medicaid covers costs that Medicare does not - Medicare premiums, deductibles, coinsurance, and services not covered by Medicare (like long-term care). Dual eligibles, as a population, are especially vulnerable because they tend to be the poorest and sickest individuals covered by either program. Coordination of care for dual eligibles is both especially important for health outcomes and especially challenging because of the fragmentation of coverage and payers.

This is an oversimplification, but it will do for our purposes - if you want to learn more about Medicaid coverage - the Congressional Research Service has produced a fabulous and surprisingly readable summary.

Medicaid for Prostate Cancer Patients

Obviously, children and pregnant women are not high risk groups for prostate cancer (although Medicaid covers one in three children diagnosed with cancer). That isn\u2019t true for all Medicaid beneficiaries:

Adults in the Medicaid expansion population: the expansion population targets low-income childless adults - including men over the age of 40, many of whom are at high risk for prostate cancer.
Dual eligibles: low income adults who are disabled or over the age of 65 are often dually eligible for both Medicare and Medicaid. From a demographic perspective, this group is likely to fall into one or more high risk groups for prostate cancer.

What Medicaid covers:

The Medicaid expansion population doesn\u2019t receive special benefits compared to traditional Medicaid (which is fairly comprehensive health coverage with limited out of pocket costs), but it does make a larger number of people eligible for those benefits. For example, a childless 52 year old man who earns $20,000 per year is eligible for Medicaid benefits in Virginia because of Medicaid expansion, but would not have been covered under traditional Medicaid.

For individuals eligible for full Medicaid benefits, Medicaid covers:

Coverage for treatments: Medicaid covers various treatments for prostate cancer, including surgery, radiation therapy, hormone therapy, chemotherapy, and newer targeted therapies. The specific treatments covered can vary by state due to differences in Medicaid programs.
Diagnostic services: Medicaid covers diagnostic tests and procedures necessary for the detection and staging of prostate cancer, such as PSA tests, biopsies, and imaging studies.
Access to specialists: Medicaid provides access to oncologists and other specialists who are essential for the management and treatment of prostate cancer.
Prescription drug coverage: Medicaid covers prescription medications, including those used in the treatment of prostate cancer, such as hormone therapies and chemotherapy drugs.
Supportive care: Medicaid may cover supportive care services, such as pain management, counseling, and rehabilitation services, which are important for maintaining quality of life during and after treatment.

Prostate cancer patients who are dually eligible for both Medicare and Medicaid typically face complex healthcare needs, but benefit from more comprehensive coverage than those with Medicare alone. Again, dual eligibles are elderly or individuals with disabilities with limited income and resources. Almost 1 in 5 Medicare beneficiaries are also eligible for Medicaid. This group is generally in poorer health with high health care expenses.

For dual eligibles, Medicare acts as the primary payer, meaning Medicare benefits apply first. However, many covered Medicare services are subject to substantial cost sharing. Patients must meet a deductible and make copayments for hospital care and a deductible and 20% coinsurance on physician services. (There is some variation in Medicare patient costs depending on whether or not they have original Medicare or Medicare Advantage, as well as if a supplemental plan is involved, but for the sake of simplicity, we\u2019ll focus on traditional Medicare.)

For patients with both Medicare and Medicaid coverage, Medicaid supplements Medicare with:

Cost-Sharing: Covers Medicare's 20% coinsurance for treatments and doctor visits
Prescription Drugs: Covers Medicare Part D copays/coinsurance; May cover medications in the Part D \"donut hole\"; Can cover drugs not on Medicare formularies
Extended Care: Longer home health services beyond Medicare limits; Personal care assistance during recovery; Transportation to and from treatments
Medical Equipment: Additional coverage for supplies like incontinence products and specialized equipment
Long-Term Care: Nursing facility care if needed for advanced disease
Palliative and Hospice: Enhanced end-of-life care services

Medicaid can also pay Medicare Part B (physician services) premiums for eligible beneficiaries. Once again, I have greatly oversimplified, so if you\u2019re looking for more information, I highly recommend briefs from the Kaiser Family Foundation - like this one.

Special Considerations for Prostate Cancer Patients with Medicaid

Medicaid dramatically increases health care access for individuals - compared to those without health insurance, Medicaid beneficiaries make health care choices more like those with private health insurance - they delay care, go without, and do not fill prescriptions, all indicators of a lack of access to health care, at rates more like the private health insurance population than the uninsured population.

However, Medicaid is not without challenges. Perhaps the best known challenge is the relatively low rates paid by Medicaid, which in turn reduces the number of health care providers willing to accept those rates and see Medicaid patients. This can be particularly acute for specialists.

Care coordination can also prove difficult - most Medicaid patients receive their coverage through Medicaid managed care providers who are paid a flat fee per month and tasked with administering Medicaid benefits. Hypothetically, those managed care organizations have an incentive to proactively manage beneficiaries\u2019 care to avoid complications and events that increase costs. In practice, results have been mixed, sometimes limiting access to care in the effort.

Finally, insurance coverage alone doesn\u2019t improve outcomes. Especially if we\u2019re thinking of Medicaid coverage for a population at risk for prostate cancer, having coverage is only the first step in a chain of opportunities for something to go wrong or right in a person\u2019s prostate cancer experience. Education, awareness, screening opportunities, care coordination - all of these things continue to play a role in good prostate cancer outcomes for individuals and communities. But insurance coverage is a necessary first step.

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Medicaid provides comprehensive health insurance for low-income adults, including childless adults in states that have expanded the program, that covers screening, diagnosis, treatment, and ongoing care.
For low income seniors and people with disabilities, Medicaid can reduce the health expenses associated with Medicare and provide additional coverage for services Medicare doesn\u2019t cover.
Health insurance coverage is a necessary but not sufficient step to having better outcomes for prostate cancer. Medicaid provides health insurance coverage to millions of Americans who do not have access to or cannot afford other options.

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Next time, we\u2019ll talk about the possible cuts to Medicaid that could be coming because of reconciliation in Congress, and what they could mean for the prostate cancer community.

But in the meantime, it isn\u2019t too late to tell your elected officials what Medicaid means to you.

Like what you're reading? Tell a friend! Anyone can sign up to follow the Pulse here.

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Have you seen lots of news recently about tax cuts, Medicaid cuts, and lots of R-words like \"reconciliation\" and \"resolution?\" Have you wondered what it means for prostate cancer patients and those at risk?

This week\u2019s Congressional budget blueprint includes a directive to cut $880 billion from Medicaid. It\u2019s a complex and deeply concerning development that will almost certainly jeopardize care for those most at risk\u2013including prostate cancer patients.

That\u2019s the headline. But what led to this decision\u2013and what comes next? In today\u2019s Pulse, we break it down and help you understand what it means for our prostate cancer community\u2013and what we, together, can do about it.

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First, how did we get here?

Republicans have been pursuing a plan to enact President Trump's priorities, including extending tax cuts that will expire at the end of the year and cutting federal spending. However, the Senate requires 60 votes to move most legislation. Currently, the U.S. Senate is made up of 53 Republicans and 47 Democrats (actually, 45 Ds and 2 Independents who caucus with Democrats, but same difference, most of the time).

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(image credit: Washington Post https://www.washingtonpost.com/politics/interactive/2024/republicans-senate-control-119th-congress/)

That means that Republicans don't have enough votes to pass regular legislation. Enter: reconciliation. Reconciliation allows a simple majority in the Senate to pass limited kinds of legislation \"that would bring existing spending, revenue, and debt limit laws into compliance with current fiscal priorities established in the annual budget resolution.\" Check out this very deep dive from the Congressional Research Service if you are so inclined.

The first step in reconciliation is passing a budget resolution. The budget resolution lays out policy changes and instructions to relevant committees to develop legislation to make those changes. Those committees then have to develop the legislation, combine it into one large bill, pass each chamber with a simple majority (51 votes), and resolve any difference between them.

Short version: reconciliation allows Congress to make policy changes that have a budgetary impact with a lower vote threshold.

What happened so far:

After a good deal of back and forth (the Senate passed a budget resolution, the House didn't like it and passed their own budget resolution, the Senate didn't like it, the Senate passed more of a compromise resolution, the House still didn't like it, certain House Republicans revolted, then came back in line, etc), on Thursday, April 10, the House passed the Senate's second budget resolution, unlocking the next step in the reconciliation process.

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Now Congressional committees will develop legislation to meet the instructions in the budget resolution.

What was in the budget resolution (that could impact prostate cancer)?

Cuts to Medicaid funding. And other things - read more here about what was included in the final budget resolution.

What cuts to Medicaid funding?

First, there are different things in the budget resolution for the House and the Senate. This means that in step 4 in the image above, there could be substantial differences in the House and Senate bills that they will need to resolve.

Overall, the House committees are instructed to increase deficits by $2.3 trillion, with major cuts to Medicaid; and Senate committees are instructed to increase deficits by what amounts to $5.8 trillion, without clear implications for Medicaid cuts.

The House Energy & Commerce Committee (which has jurisdiction over Medicaid) is instructed to reduce the federal deficit by at least $880 billion over 10 years, with nearly all those cuts expected to come from Medicaid.
The Senate Finance Committee (which has jurisdiction over Medicaid and extending the tax cuts) is instructed to increase the deficit by $1.5 trillion over ten years (or $5.3 trillion if extending the tax cuts were counted).

The budget resolution does include a provision allowing the Senate Budget Committee chair to revise reconciliation instructions for legislative activity \u201crelating to protecting the Medicaid program.\u201d However, it isn't yet clear what exactly that means - is it substantive or semantic?

What we know:

Congressional committees will be working on the legislation to meet their targets (many already have been preparing for this situation).
It would be nearly impossible to cut $880 billion from the Medicaid program (10% of total spending over the next 10 years) without cuts to benefits or eligibility - there simply isn't enough waste, fraud, and abuse to hit that target.
Medicaid provides coverage for 11 - 13 million men over the age of 40 - who rely on that coverage for their regular screenings, prostate cancer treatment, and survivorship care.
State budgets would have a very difficult time making up for the federal cuts to Medicaid out of their budgets.
Many elected officials in both chambers and on both sides of the aisle have expressed concerns about cutting Medicaid.
Republicans can pass this legislation, but their margins are very, very slim.
Policymakers NEED to hear from their constituents during this process.

What we don't know:

How the House Energy and Commerce Committee will find $880 billion in cuts.
What the Senate Finance Committee will do.
How both chambers will resolve their differences.
What externalities might arise in the next few weeks that could impact this process (in this case, externalities is code for \"unrelated dumpster fires\").

What comes next?

Congress is at home for a district work period for the next two weeks. When they return, negotiations will begin in earnest. Speaker Johnson has expressed a goal of having a bill on the president's desk by Memorial Day.

As that bill develops, we'll see more details about how Congress intends to treat Medicaid and we'll share those updates, as well as when and how you can make your voice heard in specific ways.

For right now, the reconciliation instructions threaten health care coverage for millions of those with prostate cancer and at high risk for the disease. Medicaid is a lifeline for patients in underserved communities, and it's time for all of us to make sure our elected officials know that.

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What questions can we answer next time? What do you want to know about Medicaid or the process in Congress? Email me anytime at ali@zerocancer.org.

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Welcome ZERO Advocates, to the Prostate Policy Pulse. You might have noticed that things in D.C. have been a little hectic this year. If you\u2019re trying to keep up and wondering what these changes and proposed changes and overturned changes mean for the prostate cancer community, you\u2019re in the right place. On this page, we\u2019re going to do our best to tell you the prostate cancer policy news - what we know, what we don\u2019t know, and what that means for prostate cancer patients, survivors, and those at risk. Sometimes you\u2019ll get a deep dive on a specific topic that will help explain the context of the news that week. Sometimes you\u2019ll get a peek into our strategic thinking - why we choose to engage on one issue, but not another. You can always email me at ali@zerocancer.org to ask a question or suggest a topic to cover here.

With that, here we go!

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First, an update on the Prostate Cancer Research Program. As you may know, the Fiscal Year 2025 continuing resolution (the bill that provided funding for the federal government from March 14 to September 30, 2025) included a 57% cut to the Congressionally Directed Medical Research Programs, home of the Prostate Cancer Research Program. However, a 57% cut across the whole program isn\u2019t necessarily a 57% cut to the PCRP. There are 35 programs in the CDMRP, ranging from prostate and breast cancer to vision research to traumatic brain injury and psychological health. The Department of Defense (or more precisely, the Defense Health Agency and the CDMRP) still needed to decide how to allocate the remaining $650 million in funding. We had a hint when instructions from the House and Senate Appropriations Committees sent instructions to DoD with funding for 12 of those 35 programs, including $75 million for the PCRP.

$75 million for PCRP is about a 32% cut from the FY24 level of $110 million. That $75 million level seems to have been confirmed by a news release from CDMRP and an anticipated funding announcement from the PCRP. Those public announcements tell us a couple of things - first, that it does look like the Congressional instructions will hold. Second, that the PCRP is prioritizing the Clinical Consortium Award. That funding has supported the Prostate Cancer Clinical Trial Consortium, known as the most impactful investment at the PCRP and probably the entire CDMRP. Funding the consortium for a four year period as described in the pre-announcement would protect that investment with full funding for the next four years. That means that it would be protected in the case of more cuts in the near future and that in the coming three years all PCRP funding can be directed to their other awards.

The PCRP is also funding the Idea Award - that\u2019s a grant that takes a germ of an idea and gives a scientist funding to start exploring it. It targets investigators who haven\u2019t yet received PCRP funding and new investigators, focusing on the early stage of the research pipeline to ensure that innovation and impact are primed for the future.

However, these plans are not yet final - the DoD still has to officially send a spending plan to Congress. Nothing is guaranteed; this plan needs approval of the Defense Health Agency and a blessing from the Pentagon. But it does give us an idea of what the CDMRP and the PCRP are planning assuming they\u2019re able to move forward this year.

That\u2019s it for today - but check back here regularly for updates and you can sign up here to receive an email alert when we post here.

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