Proposed GOP Medicaid Cuts Threaten Loss of Coverage for Millions

In the Concurrent Resolution on the Budget for Fiscal Year 2025 (H Con Res 14, 119th Congress), which the House Committee on Energy and Commerce released late Sunday evening, 160 pages of the bill detail extensive cuts to Medicaid and health care spending for 2025 through 2034.¹

With subparts A through C seemingly focused on reducing wasteful, fraudulent, and abusive financial practices (totaling $197 billion in cuts) and subpart D concentrating on individual accountability for Medicaid coverage ($715 billion in cuts), according to the Congressional Budget Office (email communication, May 11, 2025), the new recommendations propose changes hoping to reduce the budget deficit by $912 billion—but with implications of 8.6 million fewer individuals having health insurance coverage by 2034.² This is up from the proposed $880 billion in cuts announced in February.³

Opinions on the proposed cuts include party line agreement on the “common sense reconciliation bill,” as it was called by Congressman Brett Guthrie (R, Kentucky), chairman of the House Committee on Energy and Commerce, who also said that the proposed changes would strengthen Medicaid and cut waste, as well as that “Washington can’t afford to undermine the program further by subsidizing capable adults who choose not to work.”⁴

However, there are some Republicans, many in swing districts, who have expressed concern that the proposed Medicaid cuts are so significant.⁵

Among the contentious proposed changes to Medicaid funding are prohibiting Medicaid from funding gender reassignment surgery for children, limiting provider taxes with the expiration of premium tax credits, enforcing monthly work requirements, and establishing citizenship checks. Image Credit: © Jim Vallee-stock.adobe.com

One of those is Senator Josh Hawley (R, Missouri), who emphatically stated in an opinion piece in The New York Times, “A noisy contingent of corporatist Republicans is urging Congress to ignore all that and get back to the old-time religion: corporate giveaways, preferences for capital and deep cuts to social insurance,” in reference to President Donald J. Trump’s claims that his “one big, beautiful bill” encompasses tax cuts and insurance protection for the working class. Doing so would be “morally wrong and politically suicidal,” Hawley said. Missouri is among the 40 states to have expanded Medicaid coverage under the Affordable Care Act.⁶

The other Republicans who oppose the cuts, who represent larger-than-average Medicaid populations, are representatives Nick Begich (R, Alaska), Robert Bresnahan (R, Pennsylvania), Ken Calvert (R, California), Juan Ciscomani (R, Arizona), Eli Crane (R, Arizona) Gabe Evans (R, Colorado), Jeff Hurd (R, Colorado), John James (R, Michigan), Mike Lawler (R, New York), Dan Newhouse (R, Washington), and David Valadao (R, California).⁷

Meanwhile, the Partnership for Medicaid expressed its concern about the impact of these policy changes, also highlighting the higher numbers of uninsured individuals, reductions in coverage and access to care, higher total of uncompensated care, and exacerbated paperwork burdens.⁸ And Energy and Commerce Committee Ranking Member Frank Pallone Jr (D, New Jersey) stated, “This is not trimming fat from around the edges, it’s cutting to the bone. The overwhelming majority of the savings in this bill will come from taking health care away from millions of Americans.”⁹

Among the many contentious proposed changes to Medicaid funding are the following^2,4,8:

• Limiting provider taxes with the expiration of premium tax credits, with implications of funding gaps to Medicaid programs that could necessitate program cuts
• Instituting stricter requirements for eligibility
• Enforcing monthly work requirements in order to receive Medicaid for adults aged 19 to 64 years, excepting pregnant women; these can be racked up through work, community service, or other programs
• Establishing citizenship checks
• Having tougher screenings for health care providers who are reimbursed
• Cutting Medicaid funding to states in which illegal US residents are offered coverage
• Prohibiting Medicaid from funding gender reassignment surgery for children

Not included are per capita limits on Medicaid spending and a higher ceiling for a state’s burden for covering Medicaid expansion.²

Just last week, House Speaker Mike Johnson (R, Louisiana) was caught in the middle of the fray, with the aforementioned swing-district Republicans increasing their full-court press about the proposed cuts and more conservative party members threatening to torpedo the bill unless it contains $2 trillion in cuts.² Further, Trump has stated that Medicaid, along with Medicare and Social Security, will not be “hurt.”⁶

References

1. Committee print: Title IV—Energy and Commerce: Subtitle D—Health. House Energy and Commerce Committee. May 11, 2025. Accessed May 12, 2025. https://d1dth6e84htgma.cloudfront.net/Subtitle_D_Health_ae3638d840.pdf

2. Kapur S. Fight over Medicaid cuts heats up as House Republicans release bill. NBC News. May 12, 2025. Accessed May 12, 2025. https://www.nbcnews.com/politics/congress/fight-medicaid-cuts-heats-house-republicans-release-bill-rcna206210

3. Klein H. House passes budget resolution cutting billions from Medicaid funding. AJMC^®. February 25, 2025. Accessed May 12, 2025. https://www.ajmc.com/view/house-passes-budget-resolution-cutting-billions-from-medicaid-funding

4. Chairman Guthrie op-ed: a common sense budget reconciliation bill. News release. Office of Energy & Commerce Chairman Brett Guthrie; May 11, 2025. Accessed May 12, 2025. https://energycommerce.house.gov/posts/chairman-guthrie-op-ed-a-common-sense-budget-reconciliation-bill

5. Kapur S, Wong S, Stewart K. As GOP concerns about Medicaid cuts grow, hard-liners pressure Speaker Mike Johnson on lower deficits. NBC News. May 7, 2025. Accessed May 12, 2025. https://www.nbcnews.com/politics/congress/gop-concerns-medicaid-cuts-hardliners-pressure-johnson-deficits-rcna205390

6. Hawley J. Don’t cut Medicaid. The New York Times. May 12, 2025. Accessed May 12, 2025. https://www.nytimes.com/2025/05/12/opinion/josh-hawley-dont-cut-medicaid.html

7. Hooper K. Republicans’ plans for Medicaid have a political problem. Politico. February 24, 2025. Accessed May 12, 2025. https://www.politico.com/news/2025/02/24/medicaid-gop-cuts-republicans-congress-00205542

8. Medicaid proposals in reconciliation bill. The Partnership for Medicaid. May 9, 2025. Accessed May 12, 2025. https://medicaidplans.org/wp-content/uploads/2025/05/P4M-reconciliation-letter-05092025.pdf

9. Pallone blasts Republicans’ catastrophic health care cuts. News release. Energy & Commerce Committee Democrats; May 11, 2025. Accessed May 12, 2025. https://democrats-energycommerce.house.gov/media/press-releases/pallone-blasts-republicans-catastrophic-health-care-cuts