Republicans are backing away from broad proposals to slash federal funding to Medicaid and inching toward a more modest approach, fearful of the political risk of cutting a program that has swelled to the point thatit now insures 1 in 5 Americans.
They are leaning toward smaller changes such as adding work requirements and extra eligibility checks — ideas more palatable to moderate and vulnerable Republicans, many of whom are loath to cut a program that covers a substantial slice of their constituents and risk a political backlash in next year’s midterm elections.
“Obviously there would be political ramifications for something like that,” Rep. Juan Ciscomani (R-Arizona) said Thursday, referring to proposals to reduce the federal government’s Medicaid payments to states or overhaul its method for paying them. House Speaker Mike Johnson (R-Louisiana) ruled out the first option and backed away from the second one this week.
Ciscomani, who represents a swing district where 24 percent of people are on Medicaid, said he supports work requirements, more eligibility checks and fraud-reduction efforts, but said anything more would be “very problematic for my population in Arizona, especially my district.”
Those measures alone, however, are unlikely to add up to the $880 billion in savings Republicans are seeking from programs under the jurisdiction of the Energy and Commerce Committee as they draft the “big, beautiful bill” at the center of President Donald Trump’s agenda. How to trim spending on Medicaid has become one of the hardest debates to resolve as House Republicans rush to pass the bill by Memorial Day.
Trump has repeatedly said the program should not be touched, and far-right influencer Laura Loomer, who often has the president’s ear, criticized the idea of Medicaid cuts on X this week.
Johnson ruled out some cuts to the program this week after protests from House Republicans who say they will not vote for the bill if it includes them.
“What I press leadership on a lot is my district is very reliant on [Medicaid], and when hospitals close, they don’t open back up,” said Rep. David G. Valadao (R-California), who represents a swing district where 68 percent of people are enrolled in Medicaid. “I do agree that there are areas where there’s waste, fraud and abuse. Let’s focus on that.”
The last two times Republicans tried to cut Medicaid — in 1994 and then again as part of an Affordable Care Act repeal effort in 2017 — the efforts ultimately fizzled. The program has only grown since. Eight more states have expanded Medicaid in the years since the 2017 repeal effort,and half of House Republicans now represent districts with at least 21 percent of constituents in Medicaid, according to KFF.
The stakes are especially high in nine states with “trigger” laws requiring them to end or change Medicaid expansion if the federal match rate drops. Three more states — Missouri, Oklahoma and South Dakota — embedded Medicaid expansion into their constitutions, making it hard for them to roll back coverage if they suddenly had to foot more of the bill on their own.
Three Republicans facing tough races next year — Reps. Zach Nunn of Iowa, Don Bacon of Nebraska and Derrick Van Orden of Wisconsin — introduced a resolution this week that would prohibit Republicans from cutting Medicaid benefits for children, seniors, pregnant women or people with disabilities in the bill. But Bacon said Thursday that he was reassured by Johnson’s commitment not to cut Medicaid payments to states.
Rep. Andy Harris (R-Maryland), the chairman of the hard-right House Freedom Caucus, said in a brief interview that Republicans might need to reduce that payments to states that Johnson ruled out cutting to keep the bill from adding to the deficit.
“If we eliminate all the fraud, waste and abuse — and there’s plenty of it — we’re left with at least a 25 increase in [projected Medicaid spending] over the next 10 years,” Harris said on the House floor. “Only in Washington could anyone claim that’s a cut.”
Any Medicaid cuts that House Republicans come up with would also have to be approved by the Senate. Sen. Thom Tillis (R-North Carolina), who is up for reelection next year in a competitive state, said he was unconcerned about potential cuts because Trump had pledged that the bill would not harm Medicaid beneficiaries. Instead, Tillis expects the bill to include work requirements and other more limited changes to the program.
“I believe if we implement those, we’ll be doing Medicaid a service and it won’t have a political consequence,” Tillis said in a brief interview.
Rep. Jeff Van Drew (R-New Jersey), who won reelection by 17 points last year, said he wasn’t concerned that voting for Medicaid cuts would cost him his seat — but he’s worried it could hurt Republicans’ chances of holding the House. Even Republicans who don’t represent swing districts should be concerned about cuts that could imperil the party’s majority, he said.
Vulnerable Republicans are already facing attack ads in some districts.
Protect Our Care, a liberal nonprofit, is spending $10 million on ads and billboards urging Republicans not to cut Medicaid, according to Brad Woodhouse, the group’s executive director. The group is working on another round of ads that will air if Republicans pass the bill.
Woodhouse, a longtime Democratic strategist, compared this effort to Republicans’ failed attempt to repeal the Affordable Care Act, also known as Obamacare, which helped Democrats recapture the House in 2018. This time around, Republicans are considering cutting funding for Medicaid in the same bill in which they are seeking to extend tax cuts that disproportionately aid the richest Americans, he said.
“They’re going to take health care away from poor people to pay for tax cuts for the rich,” Woodhouse said. “That’s an ad that makes itself.”
Democrats running against vulnerable Republicans are already gearing up to talk about possible Medicaid cuts as an example of how the party in power is hurting voters on a personal level. Medicaid covers 1 in 4 births in the United States, it is the largest payer of long-term care, and it is especially critical for rural hospitals, which cover lower-income patients.
“If these cuts go through … you may not feel the pain right now, but it is coming,” said Bob Harvie, a Democrat on the Board of Bucks County Commissioners in Pennsylvania who is challenging Rep. Brian Fitzpatrick, one of three House Republicans who represent a district that Democratic presidential nominee Kamala Harris won last year.
For Sarah Trone Garriott, the Democratic state senator challenging Nunn in Iowa, the biggest concern may be how any funding cuts to Medicaid would affect rural hospitals, which are struggling with staffing and at risk of closure.
“If there are cuts to Medicaid, it is going to impact everybody in my state. Rural hospitals will close,” said Trone Garriott, a Lutheran pastor who has worked as a hospital chaplain.
Nunn said in a statement that he woulddefend Medicaid “for Iowa’s most vulnerable, and fight the fraud & abuse hurting all Americans.”
“Iowa’s rural hospitals are lifelines that must be protected,” Nunn said.
Rep. Richard Hudson (R-North Carolina), chairman of the National Republican Congressional Committee, accused Democrats of misrepresenting what the bill would do. He predicted that the Medicaid changes being discussed would be popular and said he was encouraging Republicans to campaign on them.
“The Democrats are killing Medicaid by loading it with illegals and able-bodied adults who don’t qualify,” Hudson said, describing the message he is giving Republicans.
Republicans such as Rep. Darrell Issa (California) have presented the proposed changes as a return to Medicaid the way it was under former presidentBill Clinton — before the Affordable Care Act expanded it to cover people up to 133 percent of the federal poverty level.
“The wrongful inclusion of significant numbers of people, including undocumented people, including people who are not entitled and including able-bodied men who aren’t looking for jobs — those are not cuts to Medicaid, those are a return to the sanity of Bill Clinton,” Issa said Thursday.
Undocumented immigrants aren’t allowed to enroll in Medicaid, and there are no reliable estimates of fraud in the program.
Republicans started running ads this week defending more than a dozen incumbents who represent swing districts. American Action Network, a conservative nonprofit organization, is spending $7 million on ads praising House Republicans for “supporting President Trump’s common sense reforms to root out waste, fraud and abuse.”
