House Republicans have released a 160-page bill proposing major changes to Medicaid, including work requirements and stricter eligibility checks, that could leave 8.6 million Americans without health coverage by 2034.
Quick Takes
- The GOP proposal aims to save $880 billion over 10 years by implementing work requirements for able-bodied adults and enhancing eligibility verification processes.
- Pregnant women would be exempt from work requirements, but states covering undocumented immigrants would face federal funding cuts.
- The Congressional Budget Office estimates the changes would result in 8.6 million fewer Americans with insurance by 2034.
- The bill needs near-unanimous Republican support in the House and Senate approval, with some GOP members already expressing concerns.
- Democrats strongly oppose the measure, calling it the largest cut to Medicaid in history.
Medicaid Overhaul Details
House Republicans unveiled their plan to reshape Medicaid with stricter requirements for recipients while aiming for substantial budget savings. The 160-page health care section of the broader bill would implement work requirements for able-bodied adults aged 19 to 64 without dependents. These changes specifically target working-age adults while maintaining protections for traditionally vulnerable groups like children, pregnant women, and the elderly. The proposal is designed to advance President Trump’s agenda while addressing Republican concerns about program sustainability.
The bill includes several significant changes to Medicaid administration beyond work requirements. States would be required to implement more rigorous citizenship verification systems, with enhanced screening for healthcare providers. Notably, states providing Medicaid services to undocumented immigrants would face reduced federal funding. The proposal also prohibits Medicaid and Children’s Health Insurance Program funding for gender transition procedures for minors, reflecting conservative policy priorities and addressing concerns about program focus and spending.
GOP PROPOSAL FOR MEDICAID CUTS: The House Republicans' legislation includes work requirements, stricter eligibility checks, citizenship verification and funding cuts to states. https://t.co/cZ8Hn9wjMg
— NBC4 Washington (@nbcwashington) May 12, 2025
Republican Support and Internal Divisions
Kentucky Representative Brett Guthrie, a key supporter of the legislation, defends the proposal as necessary reform to ensure Medicaid’s long-term viability for those truly in need. “When so many Americans who are truly in need rely on Medicaid for life-saving services, Washington can’t afford to undermine the program further by subsidizing capable adults who choose not to work. That’s why our bill would implement sensible work requirements,” said Guthrie. However, the bill strategically avoids more extreme changes like per capita spending caps or reductions in federal matching rates that might alienate moderate Republicans.
Despite efforts to create a balanced approach, the proposal has already encountered resistance within Republican ranks. Missouri Senator Josh Hawley expressed skepticism about the political wisdom of Medicaid cuts, noting, “It’s safe to say the Trump coalition was not pulling the lever for Medicaid cuts in November.” This internal division highlights the challenge Republican leadership faces in securing the near-unanimous support needed to pass the legislation, especially when considering the slim Republican majority in the House and the requirement for Senate approval.
Democratic Opposition and Budget Impact
Democrats have mounted strong opposition to the Republican Medicaid proposal, characterizing it as damaging to vulnerable Americans while benefiting the wealthy. Representative Frank Pallone of New Jersey directly challenged Republican messaging, stating, “Trump and Republicans have been lying when they claim they aren’t going to cut Medicaid and take away people’s health care.” Democrats point to Congressional Budget Office projections showing that approximately 8.6 million Americans would lose health insurance coverage by 2034 if the bill becomes law.
The CBO estimates the proposal would reduce federal deficits by over $880 billion during the next decade, making it a significant component of Republicans’ broader economic agenda. GOP leaders aim to complete the spending package by July 4, with a final deadline in August due to debt limit concerns. The plan is to use the “reconciliation” process to bypass the Senate filibuster, though this strategy still requires maintaining nearly unanimous Republican support. The bill is tied to extending President Trump’s 2017 tax cuts and eliminating certain taxes, highlighting the fiscal and political trade-offs at stake.
Sources:
Fight over Medicaid cuts heats up as House Republicans release bill
House GOP Medicaid proposal sets work requirements and a showdown with fiscal hawks
