The party-line vote was a first step in bringing the budget reconciliation bill to the full House.
The House Energy and Commerce Committee approved changes to Medicaid that will reduce federal spending by $712 billion over 10 years.
The approval came in a party-line 30–24 on May 14 after a marathon session lasting more than 26 hours, and marked the first step toward passage of a larger bill that is intended to fund President Donald Trump’s agenda.
Medicaid became a target in the budget reconciliation process after Republicans asked the committee to find $880 billion in cumulative spending reductions through 2034.
During the debate, Republicans and Democrats painted vastly differing pictures of the proposed changes to Medicaid and how they would impact beneficiaries.
Republicans presented the reforms as a series of commonsense measures that would extend the viability of the $914 billion program, largely by ensuring that only people entitled to receive Medicaid benefits are enrolled in the program.
Democrats said the changes were calculated to provide tax breaks to billionaires by creating barriers to enrollment and treatment for low-income, disabled, and elderly people and would rob millions of low-income Americans of health coverage.
The committee’s chairman, Brett Guthrie (R-Ky.), summarized the provisions of the bill, saying, “All of this is part of our effort to strengthen Medicaid for the people that need it most.”
Ranking Member Frank Pallone (D-N.J.) said, “This is not a moderate bill, and it is not focused on cutting ‘waste, fraud, and abuse.’ Instead, Republicans are intentionally taking health care away from millions of Americans so they can give giant tax breaks to the ultra-rich who don’t need them.”
Changes
Under the bill, able-bodied adults who do not have dependents would have to complete “community engagement requirements” to remain eligible for Medicaid. That will mean spending 80 or more hours per month—or an average of 20 hours a week—at work, on education, or in volunteer service.
Enrollees would also have to verify that they remain eligible for the low-income program twice a year instead of annually.
Medicaid enrollment grew to an all-time high of 94 million in March 2023, just before the annual verification requirement was reinstated after a freeze during the COVID era.
The bill would also add a requirement for some Medicaid recipients who make more than 100 percent of the federal poverty level to pay certain out-of-pocket expenses. Those copayments would be determined by each state, limited to $35, and would not apply to emergency, prenatal, or pediatric care, or to primary care checkups.
People owning a home worth more than $1 million will not qualify for the low-income program.
Also, federal reimbursement for Medicaid enrollees who joined under the Affordable Care Act, which is about 25 percent of all enrollees, would be reduced from 90 percent to 80 percent for states that allow people illegally residing in the country to enroll in Medicaid.
About 1.4 million people who lack legal status are currently enrolled in Medicaid, according to the Congressional Budget Office.
About a dozen states currently offer Medicaid to some people who don’t have legal status.
The bill would also remove the 5 percent pandemic incentive payment offered to states to increase their enrollment.
The bill proposes a freeze on new state taxes on Medicaid providers. Currently, 49 states levy various taxes on health care providers, return most of the money to providers in the form of increased payments, and thereby increase the Medicaid reimbursement they receive from the federal government.
The changes in this bill do not include previous proposals to cut the federal funding provided to states for their Medicaid programs, or to cap the amount of reimbursement states can receive, after moderate Republicans opposed those measures.
Pushback
Democrats pressed two points in the debate. The first was that the bill’s provisions would leave millions without health care. The second was that the true aim of the bill was to benefit the wealthy, a likely reference to the GOP plan to extend the Tax Cuts and Jobs Act (TCJA) of 2017, which is due to expire.
“This agenda will kick at least 13.7 million people off of health care coverage,” Rep. Diana DeGette (D-Colo.) said. “And you will do it to give a tax cut to rich people who just want to be rich.”
Republicans responded by saying that statements about the loss of health care for vulnerable, low-income people were wildly overstated and that the overburdened Medicaid program would not survive, putting all supports at risk, without some intervention.
“This budget does not cut Medicaid, Medicare, or Social Security benefits for the Americans who truly need them,” said Rep. Erin Houchin (R-Ind.), disputing the claim that 13.7 million would lose health coverage.
“Pregnant women, children, individuals with disabilities, low-income seniors, and vulnerable families—these Americans will continue to have access to the care they need and deserve.”
Rep. Julie Fedorchak (R-N.D.) said, “Valuable dollars for Medicaid are being spent on people who do not meet the very eligibility requirements established by the Democrats in this room.”
Outlook
The proposed changes would achieve the spending reductions that Republicans are after, according to the Congressional Budget Office, and would also increase the number of uninsured Americans.
The nonpartisan information service estimates they will reduce deficit spending by more than $715 billion from 2025 through 2034.
Including other items within the committee’s purview—energy, the environment, and communications—the committee’s action would produce a cumulative $912 spending reduction by 2034.
The Congressional Budget Office also projects that the proposed changes to the Medicaid program would increase the number of uninsured people in the United States by at least 7.7 million by 2034.
Speaker Mike Johnson (R-La.) has said he hopes to pass the full budget reconciliation bill through the House and forward it to the Senate for consideration by May 26.