House Republicans unveil a Medicaid reform bill with work requirements and strict eligibility checks that could reduce coverage for millions while promising to save over $880 billion in the next decade.

At a Glance

• The GOP proposal requires work requirements for able-bodied adults aged 19-64, with exceptions for pregnant women
• Bill includes citizenship verification, tougher provider screenings, and bars funding for gender transition procedures for minors
• Congressional Budget Office predicts the plan would cut $715 billion in spending and leave 8.6 million fewer insured by 2034
• The bill aims to protect Medicaid for “truly needy” while reducing federal costs, according to Republican supporters
• The proposal faces opposition from Democrats and some Republicans concerned about healthcare access

Targeted Reforms to “Strengthen” Medicaid

House Republicans released a comprehensive bill targeting Medicaid with stricter eligibility verification and work requirements for able-bodied recipients. The 160-page healthcare section aims to advance President Trump’s agenda while generating significant savings. Unlike previous proposals, this bill avoids deeper cuts like lowering federal match rates or capping per-person federal spending, likely in an effort to attract moderate Republicans concerned about major program changes.

The proposed work requirements would apply to able-bodied adults aged 19 to 64 without dependents, with specific exemptions for pregnant women and hardship cases. This approach targets what Republicans describe as capable adults who choose not to work while preserving benefits for those truly in need. Additional provisions include mandatory verification of citizenship, nationality, or immigration status for Medicaid eligibility, and reduced federal funding for states that provide coverage to undocumented immigrants.

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

Republican Support and Internal Divisions

Rep. Brett Guthrie (R-Ky.), a key architect of the legislation, has strongly defended the proposal as necessary to protect the program’s future. “When so many Americans who are truly in need rely on Medicaid for life-saving services, Washington can’t afford to undermine the program further by subsidizing capable adults who choose not to work. That’s why our bill would implement sensible work requirements,” said Guthrie.

“When so many Americans who are truly in need rely on Medicaid for life-saving services, Washington can’t afford to undermine the program further by subsidizing capable adults who choose not to work. That’s why our bill would implement sensible work requirements”, said Rep. Brett Guthrie, R-Ky.

However, the bill has exposed divisions within Republican ranks. Sen. Josh Hawley (R-Mo.) expressed significant concerns about the proposal’s potential impact on Trump’s voter base, highlighting potential political risks. “It’s safe to say the Trump coalition was not pulling the lever for Medicaid cuts in November,” Hawley noted, suggesting the bill may face opposition even from within the GOP. The legislation needs near-unanimous Republican support in the House and Senate approval to become law.

House GOP Unveils Medicaid Overhaul Plan Amid Party Divisions

House Republicans have introduced a new Medicaid overhaul proposal aimed at cutting billions in federal spending. The plan, spearheaded by House Energy and Commerce Chairman Brett Guthrie, includes stricter work… pic.twitter.com/bYxMq9HANA

— Political Maverick (@PoliticalMav) May 12, 2025

Democratic Opposition and Budget Impact

Democrats have mounted strong opposition to the bill, citing a Congressional Budget Office analysis that estimates the changes would result in approximately 8.6 million fewer insured Americans by 2034. The proposal is projected to cut $715 billion in Medicaid spending over the next decade, drawing fierce criticism from Democratic lawmakers who view it as an attack on vulnerable populations rather than a genuine effort to improve program efficiency.

“Trump and Republicans have been lying when they claim they aren’t going to cut Medicaid and take away people’s health care”, said Rep. Frank Pallone, of New Jersey.

Sen. Ron Wyden (D-Ore.) has been particularly vocal in his criticism, arguing that the bill would harm American children, seniors, those with disabilities, and working families without meaningfully addressing waste, fraud, or abuse. The Medicaid cuts appear to be part of a larger Republican fiscal strategy, as Trump had previously ruled out cuts to Medicare and Social Security, leaving Medicaid as a primary target for budget reductions aimed at financing the extension of Trump’s 2017 tax cuts.

Timeline and Legislative Strategy

Republicans aim to complete this spending package by July 4, with a hard deadline in August due to debt limit concerns. Central to the package is extending Trump’s 2017 tax cuts and eliminating certain taxes, potentially offset by the substantial Medicaid savings. The GOP plans to use the budget reconciliation process to pass the package, which would allow them to bypass the Senate filibuster and potentially enact the changes with a simple majority vote.

The proposal includes several additional controversial elements, including barring Medicaid funding for gender transition procedures for minors and reducing cost-sharing for certain Medicaid Expansion patients. With substantial opposition expected and narrow margins in Congress, the bill’s future remains uncertain as lawmakers weigh fiscal goals against potential impacts on healthcare access for millions of Americans.