House Republicans have unveiled a sweeping Medicaid reform bill that would implement work requirements and stricter eligibility checks while cutting billions in funding, setting the stage for a contentious battle over the future of America’s largest health insurance program.
Quick Takes
- The Republican proposal would add work requirements for able-bodied adults between 19 and 64 without dependents, with exceptions for pregnant women and hardship cases.
- The bill would require verification of citizenship, nationality, or immigration status for Medicaid eligibility and cut funding to states covering undocumented immigrants.
- Congressional Budget Office projections estimate the plan would reduce spending by $715 billion and leave 8.6 million fewer Americans insured by 2034.
- Republicans claim the reforms would strengthen Medicaid for truly vulnerable populations, while Democrats argue it sacrifices healthcare for tax cuts.
- The proposal is part of a larger $880 billion Republican budget package aiming to extend Trump’s 2017 tax cuts.
Work Requirements and Eligibility Restrictions
The 160-page health care section of the Republican bill establishes new guidelines for Medicaid recipients. Work requirements would specifically target able-bodied adults aged 19 to 64 without dependents, requiring them to verify employment or participation in approved activities to maintain benefits. The proposal makes notable exceptions for pregnant women and those experiencing hardship situations, preserving coverage for these vulnerable groups while aiming to reduce enrollment among those Republicans consider capable of self-sufficiency.
Beyond work requirements, the bill institutes rigorous citizenship verification protocols and strengthens provider screening procedures. It also includes provisions to penalize states that extend Medicaid coverage to undocumented immigrants by reducing their federal matching rates. The proposal avoids more severe measures like per capita spending limits or decreasing the federal contribution for the Affordable Care Act’s Medicaid expansion.
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
Budget Impact and Republican Support
According to Congressional Budget Office projections, the Medicaid reforms would generate approximately $715 billion in savings over the next decade, contributing to the larger $880 billion budget reduction package. The proposal represents a strategic compromise within Republican ranks, seeking to satisfy fiscal conservatives’ demands for spending cuts while avoiding the most politically risky measures that might alienate moderate party members and voters concerned about healthcare access.
The legislation emerged as a targeted approach after President Trump ruled out cuts to Medicare and Social Security during his campaign, leaving Medicaid as the largest remaining entitlement program eligible for reduction. Republicans aim to complete the spending package by July 4, with a hard deadline in August due to debt limit concerns. The plan includes using the budget reconciliation process to bypass the Senate filibuster, requiring near-unanimous Republican support in the closely divided House.
Democratic Opposition and Republican Division
Democrats have launched a unified counteroffensive against the proposal, characterizing it as an attack on vulnerable Americans’ healthcare access. The Congressional Budget Office’s projection that 8.6 million fewer Americans would have insurance by 2034 has become a central talking point in their opposition. Some Democrats have explicitly linked the healthcare cuts to Republican tax priorities, framing the debate as a choice between public health and tax breaks for the wealthy.
Cracks have also appeared in Republican unity, with some lawmakers expressing concern about potential impacts on rural hospitals and working-class constituents. Senator Josh Hawley of Missouri noted the political risks, stating, “It’s safe to say the Trump coalition was not pulling the lever for Medicaid cuts in November.” Meanwhile, some fiscal conservatives argue the bill doesn’t go far enough in restructuring the program. This internal tension reflects the complex political calculations surrounding healthcare reform for the Republican majority.
Additional Provisions and Timeline
Beyond the headline-grabbing work requirements and eligibility changes, the Republican proposal contains several other significant provisions. The bill would prohibit Medicaid and Children’s Health Insurance Program (CHIP) funding for gender transition procedures for minors. It would also reduce cost-sharing for certain Medicaid expansion patients and implement stricter verification requirements for eligibility. These additional measures reflect conservative priorities beyond simple budget considerations.
The Medicaid reforms are part of a larger Republican legislative agenda that includes extending the 2017 Trump tax cuts and eliminating certain taxes implemented under previous administrations. The package also features rollbacks of clean energy provisions and increased spending for defense and border security. With a tight timeline for passage and significant opposition, the coming weeks will determine whether Republicans can maintain sufficient unity to advance their vision for Medicaid’s future.
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
