House Republicans are dealing with major disagreements among themselves as they try to complete Medicaid. The effort is struggling because they need to balance their goals for big tax cuts with required spending cuts, which is causing tension between different groups in the party.
The original plan included $4.5 trillion in tax cuts and $2 trillion in spending cuts. However, because they are having trouble reaching the $2 trillion spending cut goal, they have had to reduce the planned tax cuts to $4 trillion. This smaller tax cut puts at risk the long-term survival of Trump’s 2017 tax cuts and other tax relief measures, such as exemptions for tips, overtime pay, and Social Security benefits for seniors.
According to NPR, the biggest disagreement within the party is over the proposed changes to Medicaid. The budget plan requires $1.5 trillion in spending cuts to pay for the tax cuts, and Medicaid is a major area where they want to make those cuts. Some proposed changes include requiring able-bodied adults to work to get Medicaid, limiting how much the federal government spends on Medicaid, changing how often people have to re-enroll from once a year to twice a year, and ending coverage for undocumented immigrants.
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These changes might now only be temporary, meaning Congress would have to approve them again later. Making things even more complicated, the House is considering raising income taxes on the highest earners to make room for other tax cuts. Some conservatives are pushing hard for big Medicaid reforms, saying they are necessary to meet the spending cut targets. However, moderates and lawmakers from competitive districts strongly oppose cuts that would take benefits away from Medicaid recipients, worrying about the political backlash.
New Jersey GOP Rep. Jeff Van Drew told reporters, “What we don’t want to do — I’ve been clear — is a bill through the House of Representatives that doesn’t even have a shot with the president or with the United States Senate. That would be insane. It’s stupid.”
One specific proposal to reduce how much the federal government pays for Medicaid expansion was dropped after moderates pushed back, and a Congressional Budget Office report warned that it could lead to job losses. Other ideas, like putting spending caps on Medicaid, are still being discussed. This could mean some people lose coverage.
The CBO estimates that a per-person spending cap could cause 1.5 million people to lose health insurance over the next ten years. Work requirements, which some Republicans , could also lead to many people losing coverage, even though they might save money.
Published: May 9, 2025 12:09 pm