Poverty, hunger, and chronic illness will likely increase while the wealthiest Americans reap huge tax breaks under the budget reconciliation bill passed by the House last week.
In Massachusetts, hundreds of thousands of low-income residents could lose food assistance and health care coverage, leading to an even greater divide between rich and poor at a time when rising costs are straining those already struggling to get by, an analysis by the Congressional Budget Office shows.
The bill, which now heads to the Senate, would impose work requirements for Medicaid and expand them for SNAP benefits, and take food and health aid away from immigrants fleeing persecution who are here legally but don’t have green cards.
This disruption of the social safety net could cost Massachusetts more than $1.5 billion a year by increasing state contributions for these benefits and penalizing the state for continuing to use its own funds to provide health care services to low-income immigrants who aren’t eligible for federal Medicaid, including undocumented children and pregnant women.
House Republicans say the restrictions in President Trump’s “big, beautiful bill’’ would reduce waste and fraud and promote personal responsibility.
The extension of the tax credits in the bill would also disproportionately benefit the wealthiest Americans. The fifth of residents earning the least would get just 1 percent of the bill’s net tax cuts next year, according to the Institute on Taxation and Economic Policy, while the top fifth would get 68 percent.
“The purpose of this bill is to give tax cuts to the richest people in the country,’’ said Viviana Abreu-Hernandez, president of the Massachusetts Budget and Policy Center. “They are doing this by cutting the budget for services that the most vulnerable populations in the country need to be able to survive.’’
The bill would require Medicaid recipients between the ages of 19 and 64 to work, train, or volunteer at least 80 hours a month, unless they are disabled or have dependent children, among other exceptions. In Massachusetts, this would disqualify 162,000 residents currently receiving MassHealth — the state’s Medicaid plan — and put up to 350,000 at risk of losing it, according to the Center on Budget and Policy Priorities. More than three-quarters of MassHealth members under age 65 were part of working families, according to a report last year by the Blue Cross Blue Shield of Massachusetts Foundation.
Work requirements don’t increase employment, however, according to Center for Budget and Policy Priorities research, but do result in people losing benefits, taking on more medical debt, and delaying medical care.
Work requirements would also be levied on more recipients of the Supplemental Nutrition Assistance Program. In addition to those already required to work, recipients with children above the age of 6, including grandparents up to age 65, would have to work — or be enrolled in job training or community service — at least 20 hours a week to receive benefits for more than three months. For parents who can’t afford child care or don’t have transportation, this is untenable, advocates say.
Immigrants here legally would also become ineligible for SNAP under the House bill. Undocumented immigrants are already barred from benefits.
All told, more than 250,000 Massachusetts residents, including children, are at risk of losing some or all of their SNAP benefits, according to the Massachusetts Law Reform Institute — more than a quarter of those currently receiving aid.
For the first time in the program’s history, states would have to pay for a portion of SNAP benefits, ranging from 5 to 25 percent, depending on their payment error rate. States’ share of administrative costs would also rise, from 50 to 75 percent. The federal SNAP program, known colloquially as food stamps, has been a stabilizing force during recessions, supporting families and, in turn, local economies when state resources are dropping.
In Massachusetts, SNAP adds more than $2.6 billion a year to the economy, benefiting more than 5,500 farmers and retailers. The proposed cuts — which Erin McAleer, chief executive of the anti-hunger nonprofit Project Bread calls “the most devastating attack on food assistance in our lifetime’’ — would force the state to absorb $710 million in new costs each year, the organization said.
Some states might even opt to stop offering SNAP benefits entirely.
With fewer people on MassHealth, hospitals, nursing homes, and community health centers would get less revenue; people would get sicker and crowd emergency rooms — changes that would also impact patients without MassHealth.
Administrative costs for tracking work requirements, more frequent eligibility renewals, and other changes will put an additional burden on state coffers. To compensate for these changes, states may cut back on benefits or tighten eligibility requirements, advocates said. Some might raise taxes.
What isn’t in doubt is the effect the bill could have on income inequality.
The House measure would decrease household resources in the lowest tenth of the income distribution by 2 to 4 percent over the next eight years — mainly due to the loss of Medicaid and SNAP — and increase resources for households in the top 10 percent by the same margin — largely because of tax reductions — according to the Congressional Budget Office.
“It’s going to make sick people sicker,’’ said Kate Symmonds, a senior health law attorney at the Massachusetts Law Reform Institute. “It’s going to make poor people poorer. … It’s going to make wealthy people richer.’’
Regardless of what the Senate does, the bill will cause harm, said Victoria Negus, senior economic justice advocate at the institute, following an election in which one of voters’ biggest concerns was the cost of groceries.
“This package as a whole says to the American people: We are prioritizing the needs of the wealthy and the few, the well connected and the privileged, over every family in this country who is working hard to get by and does not make enough money to put food on the table or afford health care,’’ she said. “It is a monumental step back in efforts to end hunger and poverty and improve health outcomes.’’
Katie Johnston can be reached at katie.johnston@globe.com. Follow her @ktkjohnston.
