Article Summary –
At a campaign event in 2023, President Trump promised not to cut funding for Social Security, Medicare, or Medicaid, yet a GOP-endorsed budget plan proposes reducing Medicaid funding by $880 billion, framing these cuts as necessary reforms. Despite assurances that Medicaid cuts would target waste and fraud without affecting benefits, health policy experts warn these reductions would strip coverage from millions, shift costs to states, and harm rural healthcare access. Proposed measures like implementing work requirements, site-neutral payments, reducing federal reimbursement rates, and eliminating provider taxes are criticized for potentially leaving millions uninsured, closing rural hospitals, and financially straining states.
At a June 25, 2023, campaign event in Novi, Michigan, President Donald Trump promised voters that if he returned to the White House, “We’re not going to play around with Social Security, and we’re not going to play around with Medicare, Medicaid.” Despite this assurance, Trump and House Republicans endorsed a budget plan cutting up to $880 billion from Medicaid, framed by three influential Republican representatives as essential reforms.
In a March 10 Fox News op-ed, House Freedom Caucus chair Andy Harris (R-MD) and members Eric Burlison (R-MO) and Chip Roy (R-TX) urged fellow Republicans to back Medicaid reforms. They argued: “For lawmakers committed to cutting waste, fraud, and abuse, this is crucial. Implementing the $880 billion in savings is vital.” The Freedom Caucus includes some of the most right-wing House Republicans.
Health policy experts warn these reforms could devastate Medicaid, stripping coverage from low-income Americans, shifting costs to states, and threatening rural healthcare access.
Who is covered by Medicaid?
Medicaid offers free or low-cost health insurance to over 72 million Americans. States operate the program, with the federal government covering at least half the cost per person to ensure coverage for those who can’t afford it. Medicaid funds approximately 42% of U.S. births and over 60% of nursing home care. More than 2.3 million Michiganders were enrolled as of October 2024.
The 2010 Affordable Care Act, or Obamacare, expanded Medicaid to cover households slightly above the federal poverty line, with the federal government paying 90% of costs. Forty-one states, including Michigan, participated in this expansion.
What have Republicans promised about safety net programs?
On March 11, 2025, the White House stated in an article: “The Trump Administration will not cut Social Security, Medicare, or Medicaid benefits. President Trump has repeatedly said it.” On Feb. 26, Speaker of the House Mike Johnson (R-LA) told CNN: “The White House committed to not touching Social Security, Medicare, or Medicaid. We will target fraud, waste, and abuse instead.”
What was in the House budget resolution?
On Feb. 25, the House passed a 10-year budget resolution by 217-215, with every Democrat and Republican Thomas Massie of Kentucky voting no. Massie said the resolution failed to sufficiently reduce the deficit. The plan required the Committee on Energy and Commerce to cut at least $880 billion over a decade from programs it oversees, including Medicare, Medicaid, and CHIP. Trump endorsed it, stating it implements his full America First Agenda.
The Congressional Budget Office’s analysis showed even if the committee cut all other programs, savings would only total $135 billion. Eliminating CHIP would save just $201 billion. Yet, House Republican leaders suggested the budget did not cut Medicaid beyond reducing waste. “Do a word search for yourself. It doesn’t even mention Medicaid in the bill,” Johnson told reporters.
Natasha Murphy of the Center for American Progress said the op-ed admits cuts must come from Medicaid or CHIP to meet the $880 billion target. A KFF Health poll found only 17% of Americans want Medicaid funding decreased, 42% support increasing it, and 40% want it maintained.
What would be the impact of the House Freedom Caucus leaders’ proposed cuts?
The op-ed suggests ways to save Medicaid costs.
Implement work requirements to “save roughly $120 billion over 10 years and put more workers back in our economy”
The op-ed claims “able-bodied, working-capable adults are on course to become the largest subgroup on Medicaid” and proposes work requirements. A KFF report refutes this, stating 92% of Medicaid adults already work or face valid barriers. Anne Shoup from Protect Our Care noted past implementations, like in Arkansas, resulted in thousands losing coverage.
Matthew Cortland of Data for Progress highlighted challenges for those with health issues, questioning who decides work capability without healthcare access.
Site neutrality to “save over $471 billion”
Medicaid reimbursement varies by service location, with hospitals often costlier than private practices. Site-neutral payment proposals would pay the same rate regardless of location, which the American Hospital Association warns could financially endanger hospitals. Cortland said cuts could close rural hospitals, forcing long travel for care and causing a healthcare provider brain-drain from rural areas.
Lower the federal reimbursement rate for those covered under Medicaid to “save nearly $600 billion”
The Freedom Caucus proposes lowering the federal reimbursement from 90% to as low as 50%. An Urban Institute report indicates states would need to find $44.3 billion or cut programs, with nine states having trigger laws ending Medicaid expansion if contributions fall. Shoup emphasized Medicaid expansion’s success and deep integration into society.
Eliminate Medicaid provider taxes to “save the taxpayer $612 billion over 10 years”
Many states tax Medicaid-funded providers to offset costs. Cortland noted the Congressional Budget Office reported barring these taxes would reduce Medicaid spending, leading to significant program cuts. “The state has less money to spend on Medicaid,” he explained, reducing federal matching funds and overall spending.
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