On Thursday, August 14, 2025, House Republicans narrowly passed a sweeping budget plan by a vote of 216 to 214, advancing President Donald Trump’s ambitious agenda on immigration, energy, and tax cuts. But at the heart of the plan lies a contentious issue that’s stirring anxiety across the country: the prospect of massive cuts to Medicaid, the health care program relied on by millions of Americans—especially those in vulnerable communities.
The budget resolution, which now moves forward in Congress, instructs Senate committees to identify at least $4 billion in spending cuts. Most notably, it calls for the House Energy and Commerce Committee to slash $880 billion from the programs it oversees over the next decade. While the bill does not explicitly mention Medicaid cuts, the sheer size of the required reductions makes it all but inevitable that Medicaid—along with Medicare—will bear the brunt. As reported by Business Insider, Speaker Mike Johnson and Senate Majority Leader John Thune have both reassured conservatives that the GOP is committed to significant spending reductions in addition to the promised tax cuts.
“We want to find at least $1.5 trillion in cuts,” Johnson said at a joint news conference with Thune before the pivotal vote. The plan is the next step in utilizing the special fast-track legislative power known as reconciliation, which allows Republicans to push through Trump’s so-called “big, beautiful bill” in the narrowly divided Senate, sidestepping the threat of a Democratic filibuster.
Yet, the details of the cuts remain uncertain. Republicans now face the daunting task of fleshing out their proposal, including how deeply Medicaid will be affected. The federal government currently covers about 72% of Medicaid spending, and as of July 2024, more than 79 million Americans—roughly 23.3% of the population—are enrolled in Medicaid or the related Children’s Health Insurance Program (CHIP), according to Business Insider’s analysis of federal data.
The stakes are particularly high in states like North Carolina, where, as The Washington Post reported, about 650,000 people have signed up for Medicaid since the legislature voted to expand the program 18 months ago. This expansion was the culmination of years of hard-fought political battles in the state, which remains deeply divided along partisan lines. Now, these new recipients face the real risk of losing coverage under provisions in President Trump’s One Big Beautiful Bill Act.
The threat to Medicaid isn’t just theoretical. In Missouri, for example, 20.3% of residents rely on Medicaid. Senator Josh Hawley, a Republican and Trump ally from Missouri, voiced his unease, telling reporters it was “a big concern” if the legislation would slash the program. Hawley emphasized that President Trump had previously promised to “love and cherish” Medicaid, reflecting the complicated political calculus facing Republicans from states with large Medicaid populations. Missouri, Oklahoma, and South Dakota even have constitutional mandates requiring Medicaid expansion, illustrating just how deeply the program is woven into the fabric of state-level health care.
Despite these concerns, efforts to soften the blow have so far fallen short. Senators Hawley, Lisa Murkowski, and Susan Collins joined Democrats in an unsuccessful attempt to strip the Medicaid cut language from the bill before it passed the Senate. The reality, as several GOP leaders have acknowledged, is that reaching the $880 billion target will almost certainly require deep reductions to Medicaid, particularly its expansion components.
Some Republican leaders have floated ideas for how to achieve these savings. Among the proposals: instituting per-capita Medicaid caps to limit the amount of federal funding each enrollee can receive—a move that could save up to $900 billion, according to estimates cited by Business Insider. Others have suggested adding work requirements for Medicaid recipients or reducing the Federal Medical Assistance Percentages (FMAP), the share of Medicaid spending covered by Washington. There are even arguments, mostly from critics of the program, that some current recipients could obtain insurance through other means, such as employer coverage.
But the debate over Medicaid cuts is only part of the story. On August 16, 2025, the nonpartisan Congressional Budget Office (CBO) released a letter at the request of Senators Sheldon Whitehouse, Ron Wyden, Jeff Merkley, and Representative Brendan Boyle, confirming that President Trump’s so-called Big, Beautiful-for-Billionaires Law will trigger the Statutory Pay-As-You-Go (PAYGO) Act. According to the CBO, this means a mandatory $45 billion cut to Medicare in 2026, with total Medicare cuts reaching $536 billion over nine years. Sequestration cuts to other non-Medicare programs are expected to total $120 billion in 2026.
Critics have been vocal in their condemnation. “We all know that Trump’s Big, Beautiful-for-Billionaires Law explodes the deficit with tax breaks for the ultra-rich and giant corporations, while slashing Medicaid and eliminating programs to feed hungry families. But Republicans are playing a shell game by hiding the sneak attack on Medicare that they tucked into their law,” said Senator Whitehouse. “CBO has now confirmed it: Trump’s Big, Beautiful-for-Billionaires Law triggers sequestration next year, resulting in massive, mandatory cuts to Medicare and other treasured programs. No Republican who voted for this bill can credibly say that they want to protect Medicare.”
Senator Wyden echoed these concerns, stating, “If Republicans were serious about protecting Medicare from cuts, they wouldn’t have passed a bill that triggers half a trillion dollars in cuts to Medicare. The reality is, Trump said he wouldn’t cut Medicaid, and then he turned around and passed the biggest Medicaid cut in history.”
Senate Budget Committee Ranking Member Jeff Merkley warned, “Congressional Republicans’ dangerous Big, Betrayal Law not only guts programs like Medicaid, the Affordable Care Act, and food assistance, but today we’re reminded that it also forces cuts to Medicare and many other critical programs. Because Republicans were so hell bent on passing a law that gives tax cuts to billionaires – that adds trillions to the national debt – their reckless actions have now triggered automatic spending cuts – meaning that without future Congressional action, seniors and people with disabilities will pay the price and have less access to care.”
The CBO letter makes clear that the law will increase the deficit by $2.1 trillion through 2029 and by $3.4 trillion through 2034, primarily by funding tax cuts for the ultra-wealthy and corporations while slashing Medicaid and other safety-net programs. The PAYGO sequestration process will automatically kick in unless Congress acts to waive it—a step Republicans have so far declined to take.
For ordinary Americans, the consequences are anything but abstract. In North Carolina, the 650,000 people who gained health coverage through Medicaid expansion now face the possibility of losing it, just as families in states like New Mexico, California, and New York—where over a third of residents are on Medicaid—brace for uncertainty. The debate over Medicaid and Medicare cuts has become a flashpoint in the broader struggle over the future of America’s social safety net, with each side accusing the other of playing politics with the health and well-being of millions.
As the legislative process grinds on, the fate of Medicaid, Medicare, and the people who rely on them hangs in the balance. The coming months will reveal whether lawmakers can find a path that protects the country’s most vulnerable, or if the partisan battle over budgets will leave millions caught in the crossfire.
