The proposal to reduce federal Medicaid spending put forth by Energy and Commerce Committee Chairman Joe Barton on Tuesday, October 26, would fundamentally alter the federal government’s role in assuring that the coverage offered to millions of Americans through Medicaid remains affordable. This proposal revokes many of the federal standards that have long served to assure that children, in particular, do not face financial barriers to care in Medicaid; it allows states to levy higher charges for most services for adults living below the poverty line; and it eliminates nearly all of the federal standards governing the affordability of coverage for other adults, including those with disabilities and chronic medical conditions.