WASHINGTON — House Republicans released the first draft of their legislation cutting Medicaid to help pay for $5 trillion of tax cuts in what President Donald Trump calls the “big, beautiful bill” at the center of his domestic policy agenda.
The legislation would impose new limits on Medicaid benefits to unemployed adults and require more frequent eligibility checks as part of a reform package that would save $715 billion on federal health spending over a decade, according to a preliminary analysis by the Congressional Budget Office.
“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,” House Energy and Commerce Committee Chair Brett Guthrie (R-Ky.) said in a Wall Street Journal op-ed accompanying the bill release.
The legislation, which also includes changes to health insurance rules under the Affordable Care Act, would result in 8.6 million fewer Americans having health care coverage a decade from now, per the CBO analysis. Republican committee aides disputed the CBO analysis but did not provide a separate estimate of the bill’s impacts.
“Republicans finally released the bill they’ve been drafting behind closed doors for months to make catastrophic cuts to Americans’ health care all so they can give tax breaks to billionaires and corporate interests,” Rep. Frank Pallone (D-N.J.), the committee’s top Democrat, said Sunday.
“This bill confirms what we’ve been saying all along, Trump and Republicans have been lying when they claim they aren’t going to cut Medicaid and take away people’s health care,” Pallone said.
The bill would set up new “community engagement requirements,” commonly known as work requirements, so that unemployed adults without children or disabilities would have to prove to state governments they are either working, volunteering or taking classes at least 80 hours a month. Enrollees would have to verify their eligibility twice a year, instead of once, and states would have less flexibility to fund their programs by taxing health care providers such as nursing homes that are major recipients of Medicaid spending.
Guthrie’s draft omits some of the steeper cuts that conservative House Republicans demanded, such as across-the-board reductions in the percentage of Medicaid costs covered by the federal government in its arrangements with states to administer the program.
One of the most prominent hardliners, Rep. Chip Roy (R-Texas), suggested he wouldn’t support the legislation because it left out cuts to higher federal spending in states that expanded Medicaid coverage as a result of the Affordable Care Act.
“I sure hope House & Senate leadership are coming up with a backup plan,” Roy wrote on social media, “because I’m not here to rack up an additional $20 trillion in debt over 10 years or to subsidize healthy, able-bodied adults, corrupt blue states, and monopoly hospital ceos.”
House Speaker Mike Johnson (R-La.) has been trying to balance the demands for steeper cuts from hardliners like Roy with the demands of moderate Republicans who have insisted there be no across-the-board cuts to Medicaid, and Guthrie’s draft is an attempt to stake out that middle ground.