Congress and Medicaid Cuts: Where Are We and What's Next?

What Has Happened Since Last Week

Last week, the House Energy & Commerce (E&C) Committee voted along party lines to pass a “markup” of the reconciliation bill that emerged over the weekend. See Community Catalyst’s new blog post with the full rundown.

Maria S., a Floridian, describes the potential impact of cuts to Medicaid.

Though there were several amendments offered by Democratic members – including those aimed at making the enhanced premium tax credits permanent, closing the coverage gap, making room for people losing Medicaid under the other provisions to get access to more affordable coverage, and others – they all failed along party line votes.

ICYMI: Below is our quick review of what’s in the markup. See Community Catalyst's full breakdown of the proposed cuts and their likely impacts here.

• Mandatory Work Requirements that require states to verify, at the time of enrollment and during eligibility determinations, that all “able-bodied” adults, 19-64 years of age, comply with 80 hours per month of employment, community service, work program, or education enrollment as part of eligibility requirements. If people aren’t able to navigate this new red tape, they’ll not only lose their Medicaid coverage, but will also be locked out of subsidized health insurance on the Marketplace.

• Increased frequency for eligibility determinations to every six months for individuals enrolled in Medicaid expansion.

• Prospectively ending the 5% enhanced federal match established under the American Rescue Plan Act (ARPA) for states that newly expand Medicaid.

• Shifting costs to Medicaid expansion enrollees through required increased cost sharing up to 5% of an individual's income.  

• Restricting retroactive coverage for Medicaid and CHIP to one month prior to an individual’s application date.

• Prohibiting Medicaid funding to large providers that offer family planning and abortion care services.  

• Delaying implementation of the final rule to Streamline Enrollment in Medicare Savings Programs by 10 years.

• Delaying implementation of the final rule for Minimum Staffing Standards for Long-term Care Facilities by 10 years.

According to the CBO, these would be the largest cuts to Medicaid in the history of the program and would cause at least 13.7 million people to lose their health insurance coverage, including the number of people who will lose coverage if Congress fails to extend the enhanced premium tax credits – and House Republicans are banking on that failure.

Additionally, the Ways & Means and Agriculture Committees moved their markups forward this week, which included additional ACA cuts – mostly targeting immigrant communities – and cutting $300 billion from SNAP, which will shift an unsustainable share of costs to states, ensuring that people will lose access to vital food/nutrition supports.

What Comes Next

The Budget Committee voted late last night to move the reconciliation bill forward. This is after Speaker Johnson’s right flank sank the scheduled Budget Committee vote on Friday, demanding additional cuts from several programs and a faster timeline for implementing the proposed Medicaid work requirements (the current text has them going into effect January 1, 2029).

Here’s how that changes things:

• The timeline the Speaker laid out last week has shifted slightly. The Rules Committee vote will now take place this Wednesday at 1:00 a.m. ET – that’s right, they’re taking the Rules Committee vote in the dead of night to try to secret through any changes to the text and get the bill to the House floor for a vote of all the members before they head out for the Memorial Day recess at the end of the week.

• We can expect additional changes to the text. The Speaker has promised House Freedom Caucus members changes that meet their demands in exchange for allowing the bill to move out of the Budget Committee. We don’t yet know what that will look like, since tilts to the right will rankle moderates who are already uneasy about voting for Medicaid cuts. What we do know is that the Rules Committee is likely to make a lot of those changes so the text they vote on will be important to review, as will any additional amendments from members as the bill moves to the House floor.

Now that these markups have moved through their respective committees, they will be consolidated into one big bill by the House Budget Committee. Speaker Johnson has said he’s aiming to get the bill to the floor for a full House vote by  Thursday, May 22. Here’s the timeline he’s laid out though this timeline could always slip.

If the House is able to move the bill through these steps, it will then be sent to the Senate. Critically, we’re not expecting the Senate to go through a standard committee process with their version of the bill, which will leave a much shorter timeline to mobilize around Senate targets.

Take Action: Contact House Members Now

 With potentially only a few days left before this bill comes to the floor, now is the time to ramp up communication with members of Congress. Our work over the next week is to try to peel off a handful of members to keep this bill from moving forward and/or to make it extremely difficult for members to vote with leadership.

Here’s how we do it:

• Flood member offices with phone calls if you/your organization are in their district or state. We’re using SEIU’s call in number, 866-426-2631, and this template script. All members should be hearing from their constituents – let’s not leave any stone unturned. You can also send your member an email or social media post with a couple of quick clicks.

• Send in Medicaid stories. Health care champions in the House are still collecting community stories from people in key House districts to read on the floor and/or use to amplify the disconnect between the needs of communities and the actions House leaders are taking. Share your story with us here.

• Please sign and share this petition with your networks to tell Congress: HANDS OFF MEDICAID!

Additional Resources

• Use this KFF tracker to help keep up with the specifics of each of the Medicaid provisions (including proposed implementation dates)

• CBPP’s Congressional District Data compilation on Medicaid, SNAP, and CTC.