House Republicans released the focal point of President Donald Trump’s so-called “big, beautiful bill” last week, eliminating $880 billion, mostly from Medicaid, as part of an effort to finance $4.5 trillion in tax cuts. The move is igniting one of the biggest political health care fights since the 2017 failed push to repeal the Affordable Care Act (ACA).
Key provisions in the republican proposal
The bill, stretching hundreds of pages, outlines major changes to Medicaid and related programs:
- $880 billion in Medicaid cuts to offset tax cuts from Trump’s 2017 tax law.
- New work requirements: Adults without dependents must complete 80 hours/month of work, education, or service.
- Twice-yearly eligibility verification for Medicaid, increasing from once a year.
- End to the COVID-era 5% Medicaid funding boost for states.
- Ban on federal Medicaid funds for immigrants lacking proof of citizenship.
- Freeze on provider taxes, which some states use to increase federal funding.
- Reduction in ACA-related funding as part of the larger health care cut.
Democrats push back, citing risks to coverage
While Republicans argue these cuts will root out “waste, fraud, and abuse,” Democrats warn the proposal will drastically reduce access to health care:
- 8.6 million people could lose coverage over the next decade, according to the Congressional Budget Office (CBO).
- Hospitals, particularly rural and community centers, may face closures.
- Seniors may lose access to essential services.
- Premiums could increase due to reduced federal subsidies.
Rep. Frank Pallone (D-NJ) called the bill “shameful,” likening it to a stealth attempt to dismantle the ACA:
“In no uncertain terms, millions of Americans will lose their health care coverage.”
Political path ahead: Divided GOP and tight timeline
Speaker Mike Johnson has set a Memorial Day deadline to pass the sweeping legislation. However, internal GOP resistance could stall momentum:
- Over a dozen House Republicans have voiced concerns over Medicaid cuts, fearing backlash from constituents.
- Trump has previously vowed not to cut Medicaid, though this proposal runs counter to that stance.
Despite the controversy, 11 House committees are actively working to assemble their portions of the package. The powerful Energy and Commerce Committee alone is responsible for $880 billion in savings, mostly from health care, but also includes:
- Rollbacks of Biden-era green energy programs.
- Cuts to climate change investment funds from the Inflation Reduction Act.
- Provisions to speed up approval for natural gas and oil pipeline projects.
Medicaid at the center of the fight
Medicaid, which currently serves more than 70 million Americans, is bearing the brunt of the proposed savings. The proposed changes are likely to:
- Increase the “churn” rate, where people cycle on and off Medicaid due to administrative hurdles.
- Cause coverage gaps due to in-person income verification requirements.
- Penalize states that expanded Medicaid coverage under the ACA provisions.
As lawmakers prepare for a week of nonstop hearings on the bill, the political fight over America’s health care safety net is poised to intensify—once again placing millions of vulnerable Americans at the center of a high-stakes debate.
