House Republicans Propose Deep Medicaid Cuts in Tax Bill

Republicans are advancing significant Medicaid reforms as part of a broader legislative effort to reduce federal spending, with a young think tank, Paragon Health Institute, playing a central role in shaping these proposals. The House Energy and Commerce Committee released a detailed budget reconciliation text outlining cuts that could reduce Medicaid spending by up to $880 billion over the next decade, potentially leaving millions without coverage through measures like rolling back enhanced federal matches for ACA expansion adults and eliminating state provider tax programs. The package includes work requirements for most healthy adults, more frequent eligibility verifications, and changes to how states raise their share of Medicaid funding, though more controversial proposals, such as capping federal spending per enrollee, were excluded to avoid alienating moderate Republicans. Critics warn these cuts would disproportionately harm vulnerable populations, including children, seniors, and people with disabilities, and fear the reforms are framed as targeting waste and fraud but would effectively reduce access to care. Meanwhile, internal GOP conflicts and accusations of undermining Trump’s Medicaid promises highlight the political sensitivity surrounding these reforms. The debate is intensifying as Republicans prepare to finalize the legislation, balancing fiscal goals with the political risks of cutting a program relied upon by over 70 million Americans.