On February 25, 2025, House Republicans narrowly passed a budget resolution that calls for up to $2 trillion in spending cuts, with $880 billion specifically targeted from programs under the Energy and Commerce Committee's jurisdiction, which includes Medicaid.
The budget resolution itself does not directly cut Medicaid, but it creates a framework that leaves little alternative.
Explaining this last part is a long story but here's why the $880 billion in cuts will inevitably target Medicaid:
## Scale of the Cuts
The proposed $880 billion in cuts is an enormous sum that represents a significant portion of federal healthcare spending[1][4]. This amount is so large that it cannot be achieved through minor adjustments or by targeting only waste and inefficiencies.
## Limited Scope for Cuts
The House Energy and Commerce Committee, which is tasked with finding these savings, oversees Medicaid along with other health programs[8]. However, Medicaid represents one of the largest expenditures under this committee's jurisdiction. Other programs simply aren't large enough to yield savings of this magnitude without decimating them entirely.
## Medicaid's Share of Spending
Medicaid is one of the largest federal programs, covering nearly 80 million Americans[7]. It accounts for a substantial portion of the spending overseen by the Energy and Commerce Committee. Given its size, any significant cuts to the committee's budget would inevitably affect Medicaid.
## Political Constraints
While Medicare is another large health program, it's politically more difficult to cut due to its popularity among older voters. This leaves Medicaid as the primary target for large-scale savings in healthcare spending[4].
## Historical Precedent
The proposed cuts would be the largest in Medicaid's history, surpassing all previous cuts combined[5]. This unprecedented scale indicates that Medicaid is the primary target, as there are few other areas where such massive savings could be achieved.
## Budget Reconciliation Rules
The special budget reconciliation process being used requires that savings come from within the committee's jurisdiction[8]. This severely limits options for finding cuts elsewhere in the federal budget.
## Structural Changes Required
Cuts of this magnitude would necessitate fundamental changes to Medicaid's structure, such as reducing federal matching rates for expansion states or imposing strict eligibility requirements[2][4]. These are not minor tweaks but major alterations to the program's core functioning.
In conclusion, the sheer size of the proposed cuts, combined with the limited scope of alternative savings and the political realities of healthcare spending, make it virtually impossible to achieve $880 billion in savings without significantly impacting Medicaid. This would likely result in millions losing coverage and substantial disruptions to the healthcare system as a whole[3][6].
Citations:
[1] BREAKING: Republicans Pass Spending Bill with Dramatic Potential Medicaid Cuts https://www.hcinnovationgroup.com/policy-value-based-care/article/55270805/breaking-republicans-pass-spending-bill-with-dramatic-potential-medicaid-cuts
[2] Medicaid is Even Leaner as Accountability Improves https://healthlaw.org/medicaid-is-even-leaner-as-accountability-improves/
[3] Medicaid is a Lifeline for People with Disabilities. Congress Must Act to Save It. https://www.aclu.org/news/disability-rights/medicaid-is-a-lifeline-for-people-with-disabilities-congress-must-act-to-save-it
[4] Slashing Medicaid to Pay for Trump’s Tax Cuts Could Lead to Vast State Shortfalls https://www.nytimes.com/2025/02/25/us/politics/medicaid-cuts-republican-budget.html
[5] The House Budget Resolution's Medicaid cuts would be the largest ... https://unidosus.org/blog/2025/02/21/house-budget-resolutions-largest-medicaid-cuts-in-us-history/
[6] Proposed Medicaid cuts would threaten access to health care for all https://thealliance.health/proposed-medicaid-cuts-would-threaten-access-to-health-care-for-all/
[7] Cutting Funding for Medicaid Will Increase Homelessness https://endhomelessness.org/blog/cutting-funding-for-medicaid-will-increase-homelessness/
[8] What Can House Republicans Cut Instead of Medicaid? Not Much. https://www.nytimes.com/2025/02/25/upshot/republicans-medicaid-house-budget.html
[9] Medicaid Cuts Threaten A Key House Vote On Trump’s Agenda Today—Here’s Why The GOP Is Divided https://www.forbes.com/sites/saradorn/2025/02/25/medicaid-cuts-threaten-a-key-house-vote-on-trumps-agenda-today-heres-why-the-gop-is-divided/
[10] House GOP (Barely) Advances Trump’s Billionaire Budget to Gut Health Care for Kids and Seniors, Give Handouts to the Rich https://democrats.org/news/house-gop-barely-advances-trumps-billionaire-budget-to-gut-health-care-for-kids-and-seniors-give-handouts-to-the-rich/
[11] House budget plan advances, paving way for major Medicaid cuts https://www.fiercehealthcare.com/payers/house-budget-plan-advances-paving-way-major-medicaid-cuts
[12] The Debate Over Federal Medicaid Cuts: Perspectives of ... - KFF https://www.kff.org/medicaid/report/the-debate-over-federal-medicaid-cuts-perspectives-of-medicaid-enrollees-who-voted-for-president-trump-and-vice-president-harris/
[13] The Republican House Budget Resolution's Potential $880 Billion in Medicaid Cuts by Congressional District https://www.americanprogress.org/article/the-republican-house-budget-resolutions-potential-880-billion-in-medicaid-cuts-by-congressional-district/
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