House Republicans are navigating a complex landscape as they reconsider proposed cuts to the Medicaid program, a vital safety net for millions of Americans. As of May 7, 2025, Speaker of the House Mike Johnson has announced that the GOP will not pursue drastic reductions to Medicaid funding, a decision influenced by pressure from centrist lawmakers and concerns over the potential loss of health coverage for constituents.
In a recent meeting, Johnson indicated that controversial options, such as lowering the federal share of Medicaid costs and implementing per capita funding caps, are unlikely to be included in the party's reconciliation bill aimed at offsetting $4.5 trillion in tax breaks. This retreat comes amid a Congressional Budget Office (CBO) report that warns such cuts could lead to millions losing their health insurance.
According to the CBO, any reduction in Medicaid funding would not only decrease enrollment but also increase the number of uninsured individuals. The report highlighted that under various proposed cuts, enrollment could decrease significantly, resulting in approximately 10 million people losing Medicaid coverage.
"This non-partisan Congressional Budget Office analysis confirms what we’ve been saying all along: Republicans’ Medicaid proposals result in millions of people losing their health care," said Rep. Frank Pallone, D-N.J., who, along with Sen. Ron Wyden, D-Ore., requested the CBO report.
As the GOP grapples with the implications of these cuts, moderate Republicans are gaining traction. Representative Juan Ciscomani emphasized that the focus should remain on policies that can garner bipartisan support, such as imposing work requirements and tightening eligibility checks for Medicaid recipients. "We just keep bringing the conversation back to those three," said Ciscomani, referring to work requirements, eligibility checks, and removing undocumented individuals from the Medicaid rolls.
However, these moderate-backed initiatives are unlikely to meet the House's target of $880 billion in Medicaid savings. The CBO has estimated that limiting provider taxes could save $668 billion but would also result in 3.9 million people losing coverage. Similarly, increasing the frequency of eligibility checks could save $162 billion but lead to 600,000 more uninsured individuals.
Despite the push from moderates, conservative factions within the party, particularly the House Freedom Caucus, continue to advocate for more aggressive cuts. They argue that failing to address Medicaid spending could exacerbate the national debt and deficits, which are already a concern for the GOP. "Not addressing 'FMAP' is DC talk for continuing the Obamacare policy of discriminating against the people Medicaid is supposed to serve," the Freedom Caucus stated in a recent post on social media.
The stakes are high for Johnson and the GOP as they approach a self-imposed deadline to pass the bill by Memorial Day. With a slim majority in the House, Johnson can afford to lose only a handful of votes, making the need for consensus critical.
Moreover, the political ramifications of Medicaid cuts are significant. An April poll from KFF revealed that approximately 76% of the public opposes major cuts to Medicaid, reflecting widespread concern over the potential impact on vulnerable populations. This sentiment is echoed by lawmakers from both parties, who emphasize the importance of preserving coverage for low-income individuals, children, pregnant women, and people with disabilities.
Representative Jeff Hurd, R-Colo., who represents a district where nearly one-in-three residents rely on Medicaid, has been vocal about the need to protect the program's original purpose. He stated that while reforms are necessary, they should not jeopardize coverage for those who depend on it. "We need to preserve the original purpose of Medicaid," Hurd said, advocating for targeted reforms that focus on reducing waste and ensuring that benefits reach those who truly need them.
As negotiations continue, the GOP faces the challenge of balancing the demands of both moderate and conservative members. The party's internal divisions underscore the complexity of reforming a program that serves as a lifeline for millions of Americans. With the deadline approaching, the outcome of these discussions will have lasting implications for Medicaid and the individuals it serves.
Looking ahead, the markup for the reconciliation bill is scheduled for the week beginning May 12, 2025. As the House prepares to debate these critical issues, the fate of Medicaid hangs in the balance, reflecting broader tensions within the GOP and the ongoing struggle to navigate the political landscape.
