A newly released report from the Congressional Budget Office (CBO) reveals that sweeping cuts to Medicaid proposed by Republican lawmakers would strip health insurance from millions of Americans, directly contradicting public claims made by GOP leaders that only “fraud, waste, and abuse” would be targeted. The report confirms that efforts to reduce Medicaid funding by hundreds of billions of dollars to help offset $5 trillion in tax cuts would result in significant harm to current beneficiaries.
Medicaid, which provides healthcare coverage for over 70 million low-income individuals in the United States, is jointly funded by the federal government and the states. Under current Republican budget proposals, $880 billion in federal Medicaid spending would be slashed—more than half of the total $1.5 trillion in mandatory program savings sought by House GOP negotiators.
The CBO report, published Wednesday, makes clear that these cuts would not be limited to abstract accounting measures. If implemented, the proposed reductions would result in approximately 5.5 million people losing Medicaid coverage—equal to about one in every 13 current enrollees. Of those, the CBO found that around half would be left with no other health insurance options after being removed from the program.
Democratic lawmakers responded swiftly, accusing Republicans of misleading the public and pushing a reckless policy that would devastate low-income families, seniors, children, and people with disabilities.
“Trump has repeatedly claimed Republicans are not cutting health care, but CBO’s independent analysis confirms the proposals under consideration will result in catastrophic benefit cuts and people losing their health care,” said Rep. Frank Pallone Jr. (D-New Jersey), ranking member of the House Energy and Commerce Committee.
Sen. Ron Wyden (D-Oregon), ranking Democrat on the Senate Finance Committee, echoed that assessment. “This analysis from the non-partisan, independent CBO is straightforward: the Republican plan for health care means benefit cuts and terminated health insurance for millions of Americans who count on Medicaid,” Wyden said. “Republicans continue to use smoke and mirrors to try to trick Americans into thinking they aren’t going to hurt anybody when they proceed with this reckless plan, but fighting reality is an uphill battle. The bottom line is that the Republican bill is going to cut health care for kids, seniors, Americans with disabilities and working families.”
The CBO examined several of the Medicaid-related proposals under consideration by House Republicans as part of their broader reconciliation bill. Among the scenarios analyzed:
- Placing a cap on Medicaid spending for the expansion population (enrollees made eligible under the Affordable Care Act) would save $225 billion but result in 1.5 million people becoming uninsured by 2034.
- Limiting the ability of states to tax healthcare providers—a method used by nearly every state to boost their share of Medicaid funding—would save $668 billion but would cause an additional 3.9 million people to lose coverage.
While the CBO assumed that states would try to offset some of the lost federal funding, the report notes that most states would only be able to replace about half of the reductions. As a result, they would likely reduce payments to healthcare providers, eliminate optional benefits, restrict enrollment, or raise taxes and cut funding for public programs like education or law enforcement.
These numbers do not include the effects of work requirements, which were not part of this specific CBO analysis. However, a 2023 CBO report found that imposing “community engagement” rules—such as work or volunteer hour minimums—on Medicaid enrollees aged 19–55 would save $109 billion over ten years while leaving 600,000 people uninsured, and shifting $65 billion in costs to state governments.
Despite these findings, Republican leaders have continued to claim that their proposals would not affect current beneficiaries. “We have to root out fraud, waste and abuse,” Speaker of the House Mike Johnson (R-Louisiana) said in a recent interview with Fox News.
House Republicans have tasked the Energy and Commerce Committee with finding $880 billion in Medicaid savings, a goal the CBO has already indicated would be impossible to achieve without reducing benefits or coverage.
Even some Republicans have raised concerns about the scale of the proposed cuts. Rep. Juan Ciscomani (R-Arizona), whose constituents include many Medicaid recipients, told reporters, “My neighbors, people my kids go to school with” depend on the program.
Rep. Don Bacon (R-Nebraska), who represents parts of Omaha, also expressed hesitancy about the hardline proposal. While he opposed the full $880 billion in reductions demanded by party leadership, he suggested he might support cuts in the range of $500 billion, along with added eligibility checks and new work requirements.
Getting the bill through both chambers of Congress could prove difficult. In the House, Republicans can afford to lose no more than four votes. Even if they use the reconciliation process in the Senate to bypass a filibuster, they would still need near-unanimous support within their caucus to advance the bill.
Meanwhile, public opinion continues to lean heavily against any cuts to Medicaid. A KFF poll released earlier this month found that 76 percent of Americans oppose cutting Medicaid, including majorities across party lines. In a separate March survey, 82 percent of Americans said they wanted Medicaid spending to either increase or remain the same, while only 17 percent favored reductions. Even among that small minority, only half wanted “major” cuts.
As Republicans seek to reconcile massive tax breaks with a shrinking federal revenue base, Medicaid has emerged as one of their primary targets for spending reductions. But the CBO’s analysis suggests that such cuts will come at a steep cost—both to the millions of people who depend on the program and to the lawmakers who may face political backlash for voting to dismantle it.
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