Topline
President Donald Trump insisted this week his signature policy bill won’t cut Medicaid—a narrative many Republicans have adopted to counter estimates the GOP’s proposed changes to the program could reduce Medicaid spending nearly $800 billion over the next 10 years with new work requirements and a ban on Medicaid for gender-transition care, among other measures.
President Donald Trump and House Speaker Mike Johnson, R-La., talk with reporters after a House … More
Key Facts
“There will be NO CUTS to Social Security, Medicare, or Medicaid,” Trump wrote Monday on Truth Social, claiming “the only ‘cutting’ we will do is for Waste, Fraud, and Abuse,” repeating the GOP’s narrative that the “One Big, Beautiful Bill Act” won’t directly reduce Medicaid spending—despite an estimate from the Congressional Budget Office that changes to the Medicaid program will ultimately leave more than 7.6 million people without benefits over the next 10 years.
The legislation, passed 215-214 by the House on May 22, largely along party lines, would revise Medicaid through four primary measures:
It would implement additional “eligibility and enrollment” rules, including new address verification standards, provider screening requirements and penalties for states that offer Affordable Care Act coverage to undocumented migrants by reducing their Medicaid spending.
The section addressing “wasteful spending” calls for a prohibition on funding for gender transition procedures for both adults and minors under the federal Medicaid program and the state Children’s Health Insurance Program (CHIP).
One of the ways the bill aims to tamp down on “abusive financing practices” is via a moratorium on new or increased provider taxes states collect to help pay for Medicaid expenses that aren’t covered by the federal government; proponents of the freeze argue states sometimes use the provider taxes to also pay providers, allowing states to report more Medicaid expenses and boost the matching funds they receive from the federal government.
The legislation would increase “personal accountability,” primarily by mandating new “community engagement” requirements for Medicaid recipients to log at least 80 hours per month of work, community service or a work program, or be enrolled in an educational program for at least 40 hours per month—representing the largest Medicaid-related cuts in the megabill, according to the CBO.
Big Number
64%. That’s the share of Medicaid recipients, ages 19-64, who already work, including 44% who work full-time, according to the Kaiser Family Foundation, which notes many eligible enrollees risk losing coverage because of the “administrative burden” of reporting requirements associated with work mandates.
Which Republican Senators Oppose The Bill?
Sens. Josh Hawley, R-Mo., Susan Collins, R-Maine, Lisa Murkowski, R-Alaska, Jerry Moran, R-Kansas, and Jim Justice, R-W.Va., have expressed concerns about the bill’s impact on public health care coverage, according to Politico. Sens. Rand Paul, R-Ky., and Ron Johnson, R-Wisc., have also expressed concerns the bill doesn’t go far enough in making spending cuts.
What Does The Bill Say About Medicaid For Immigrants?
The bill would reduce federal matching funds from 90% to 80% for 14 states plus the District of Columbia that offer coverage to some undocumented migrants through Medicaid expansion programs under the Affordable Care Act, according to the Kaiser Family Foundation.
Key Background
Congress approved topline spending goals earlier this year to enact Trump’s agenda, instructing relevant committees in the House and Senate to write policy legislation in line with the new figures. The bill approved by the House is the result of that work. The Energy and Commerce Committee, which oversees Medicaid, was tasked with finding $880 billion in cuts, and there was virtually no other way to enact them without making changes to Medicaid. Medicaid emerged as a major sticking point for Republicans negotiating the terms of the bill, with those who represent swing districts initially advocating for Medicaid to be left intact and fiscal hawks pushing for even more cuts. It was changed at the final hour to move up the start date for work requirements from 2029 to 2026 to appease hard-liners who threatened to withhold their votes and imperil the bill’s passage. It was also revised to prohibit gender-affirming care for adults, in addition to minors, as the initial version proposed, among other revisions. The Medicaid cuts will help pay for increased spending on the border, an extension of Trump’s 2017 tax breaks, and new provisions to eliminate taxes on tips and overtime, among other measures.
Why Did House Republicans Who Initially Advocated For Medicaid To Be Preserved Change Their Minds?
A small group of House Republicans, including Reps. Don Bacon, R-Neb., and Nicole Malliotakis, R-N.Y., publicly expressed concerns about slashing Medicaid spending, but ultimately voted for the bill. Malliotakis was among eight who are members of the Hispanic Conference or represent districts with sizeable Hispanic populations and sent a letter to House Speaker Mike Johnson, R-La., last month warning “slashing Medicaid would have serious consequences, particularly in rural and predominantly Hispanic communities.” Malliotakis told CNN over the weekend she agreed to accept the Medicaid changes because they target “people in the country illegally” and “people who refuse” to meet work requirements. Bacon said in late April he would accept no more than $500 billion in Medicaid cuts, though it’s unclear why he agreed to a bill estimated to exceed that figure by at least $200 billion.
Further Reading
Trump’s ‘Big Beautiful Bill’ Passes House: What That Means For You (Forbes)
Medicaid Cuts Threaten A Key House Vote On Trump’s Agenda Today—Here’s Why The GOP Is Divided (Forbes)
