House Republicans have introduced a 160-page legislative proposal that would significantly reshape Medicaid, proposing sweeping changes to eligibility rules, work requirements, and federal funding structures. The bill is part of a broader effort to realign major health care programs with conservative fiscal priorities, drawing both internal dissent and Democratic opposition.
According to NBC Washington, the legislation includes provisions that tighten access to Medicaid through stricter screenings and documentation standards. The proposed changes have quickly become a focal point of political tension on Capitol Hill, as lawmakers prepare for a crucial markup session set for Tuesday afternoon in the House Energy and Commerce Committee.
Proposed Changes Include Work Requirements and State Funding Reductions
The legislation, released Sunday evening by the House Energy and Commerce Committee, seeks to enforce work requirements for able-bodied adults aged 19 to 64 without dependents. Recipients would need to complete at least 80 hours per month of employment, community service, or other qualifying programs.
Pregnant women and individuals facing temporary hardship would be exempt. It also introduces stricter eligibility verification, mandates citizenship checks, and imposes tighter screening on providers receiving Medicaid reimbursements. States that offer Medicaid to undocumented residents would face cuts to federal funding.
As Rep. Brett Guthrie, R-Ky., stated in a Wall Street Journal op-ed:
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.
He added that the billPreserves and strengthens Medicaid for children, mothers, people with disabilities and the elderly, for whom the program was designed,” while anticipating “fear-mongering” responses from opponents.
Some Provisions Omitted to Ease Party Tensions
Notably, the bill excludes two of the more controversial ideas floated by Republican leaders in recent years: per capita caps on Medicaid spending and shifting financial responsibility for Affordable Care Act (ACA) expansion populations to the states.
These omissions appear to be aimed at moderates and politically vulnerable Republicans. Still, they have provoked criticism from hardline conservatives. Rep. Chip Roy, R-Texas, wrote on X:
Does the bill offer ANY transformative changes on Medicaid or otherwise? Currently — NO — it ignores the policy changes that matter.
He continued:
This bill embraces… $20 Trillion more debt… Obamacare expansion accepted by Republicans… extension of green new deal subsidies by Republicans… among MANY problems.
Roy also criticized the bill for failing to meet the $2 trillion savings target demanded by fiscal conservatives.
CBO Projects Major Coverage Losses and Spending Cuts
A preliminary analysis from the Congressional Budget Office (CBO) estimates that the health care section of the bill would cut federal spending by $715 billion and would
Reduce the number of people with health insurance by at least 8.6 million in 2034.
Democrats have seized on these findings to accuse Republicans of concealing the bill’s implications. Rep. Frank Pallone, D-N.J., the committee’s ranking Democrat, stated:
Trump and Republicans have been lying when they claim they aren’t going to cut Medicaid and take away people’s health care. Let’s be clear, Republican leadership released this bill under cover of night because they don’t want people to know their true intentions.
Pallone warned of widespread loss of access to care:
This is not trimming fat from around the edges, it’s cutting to the bone. The overwhelming majority of the savings in this bill will come from taking health care away from millions of Americans. Nowhere in the bill are they cutting ‘waste, fraud, and abuse’ — they’re cutting people’s health care and using that money to give tax breaks to billionaires.
Senators From Both Parties Signal Concern
The bill now heads to markup and could be amended before any floor vote. Passage in the narrowly divided House would require near-total Republican support before heading to the Senate.
Opposition has already emerged from Sen. Ron Wyden, D-Ore., who warned:
The largest Medicaid cut in history.
He added:
These cuts are going to do nothing to tackle waste, fraud and abuse — they are simply going to harm American kids, seniors, those with disabilities, and working families. This bill must not pass.
Sen. Josh Hawley, R-Mo., also voiced concern in a New York Times op-ed, highlighting local impacts:
If Congress cuts funding for Medicaid benefits, Missouri workers and their children will lose their health care. And hospitals will close. It’s that simple. And that pattern will replicate in states across the country.
