House Republicans push Medicaid cuts to fund tax breaks for billionaires

House Republicans are reportedly eyeing deep cuts to Medicaid to fund tax breaks for the rich and other far-right priorities.

Punchbowl News reported on Jan. 24 that House Republican committee chairs held a private meeting in which they identified between $2 trillion and $3.5 trillion of potential spending cuts. The cuts would help pay for an upcoming reconciliation bill.

Among the proposals was a per capita cap on Medicaid, which would limit the amount of federal funding provided to states to administer Medicaid. Work requirements for Medicaid were also discussed.

The Congressional Budget Office estimates that work requirements for Medicaid would result in approximately 600,000 Americans losing their health insurance. The impact of a per capita cap is harder to estimate, but the Kaiser Family Foundation predicts it will inevitably lead to less services.

More than 70 million Americans receive health insurance through Medicaid. About 12 million of those individuals also collect Medicare.

A reconciliation bill adjusts federal spending, taxes, or the debt limit to align with budgetary goals. The bill being negotiated now is expected to include a reauthorization of the 2017 Tax Cuts and Jobs Act, which disproportionately slashed taxes for high income earners and large corporations.

For some Republicans lawmakers, including President Donald Trump, cutting Medicaid would be a reversal of a campaign pledge.

“We’re not going to play around with Social Security, and we’re not going to play around with Medicare, Medicaid,” Trump said in June 2023. “I will always protect Medicare and Social Security for our great seniors.”

Trump made a similar promise during his 2016 campaign, but failed to keep it. 

In 2017, Trump endorsed a repeal of the Affordable Care Act that would have cut Medicaid by $880 billion. The repeal did not pass. 

In 2020, the Trump administration tried to empower states to implement work requirements for Medicaid. These efforts faced legal challenges and were ultimately reversed by the Biden administration.

Per capita caps and work requirements for Medicaid also appear in Project 2025, an executive policy agenda that was published by the far-right Heritage Foundation. Trump claims to have no association with Project 2025, despite it being authored by several of his close allies.

Trump nominated Russell Vought, one of Project 2025’s principal authors, to lead the Office of Management and Budget. Vought indicated during his Jan. 22 Senate confirmation hearing that he supports work requirements for Medicaid.