House Republicans have released a far-reaching budget proposal that would slash healthcare access for millions of low-income Americans while making permanent and expanding tax cuts heavily skewed toward the wealthiest individuals and corporations. The legislation, revealed late Sunday by the House Energy and Commerce Committee, is part of a sweeping reconciliation package Republicans hope to finalize by Memorial Day.
The bill’s Medicaid section would impose harsh new conditions on recipients and restrict eligibility in ways that disproportionately impact children, seniors, and people with disabilities. It includes work requirements mandating at least 80 hours of employment or community service each month, cost-sharing rules that force low-income adults to pay out-of-pocket for coverage, and stringent new screening procedures. Analysts warn these measures would create procedural barriers and confusion, pushing millions off the rolls.
A preliminary estimate from the nonpartisan Congressional Budget Office projects that the bill would cut Medicaid spending by at least $715 billion over the next decade and leave at least 8.6 million more people without health insurance.
“Many of the Medicaid proposals from House Republicans are technical and wonky, and will be difficult for the public to absorb,” said Larry Levitt, executive vice president for health policy at KFF. “What won’t be difficult to absorb: CBO’s estimate that the changes will increase the number of people without health insurance by at least 8.6 million.”
The proposal targets adults earning just over the poverty line—$15,650 for a single individual in 2025—who would be forced to pay premiums or additional fees to stay covered. In practice, this would mean substantial costs imposed on those with already limited resources. As Bobby Kogan, senior director of federal budget policy at the Center for American Progress, wrote in an analysis of the bill, “If you make $20,000, a state might slap $1,000 of fees onto your Medicaid. True sicko shit.” He added, “My heart aches for the people whose lives will be ruined if this becomes law. So it’s our job to stop it.”
Rep. Frank Pallone Jr. (D-N.J.), ranking member on the House Energy and Commerce Committee, condemned both the content of the bill and the secrecy surrounding its release.
“This bill confirms what we’ve been saying all along: Trump and Republicans have been lying when they claim they aren’t going to cut Medicaid and take away people’s healthcare,” Pallone said. “Let’s be clear, Republican leadership released this bill under cover of night because they don’t want people to know their true intentions. In no uncertain terms, millions of Americans will lose their healthcare coverage, hospitals will close, seniors will not be able to access the care they need, and premiums will rise for millions of people if this bill passes.”
The tax component of the reconciliation package, advanced by the House Ways and Means Committee and led by Rep. Jason Smith (R-Mo.), proposes to permanently extend several provisions from the 2017 Tax Cuts and Jobs Act. These include lower personal income tax rates, increased deductions for “pass-through” business income, and a larger estate tax exemption—raised from $13.99 million to $15 million per spouse, and indexed to inflation.
Amy Hanauer, executive director of the Institute on Taxation and Economic Policy (ITEP), criticized the structure and priorities of the package. “So far this costly bill appears to double down on trickle down, with huge tax cuts that will further enrich the rich and not much for the rest of us,” she said. “What’s more, many of the modest improvements for lower- and middle-income families are proposed to be temporary, whereas the benefits for the wealthiest are proposed to be permanent.”
ITEP flagged other components of the tax plan, including the expansion of the GILTI deduction, which would continue to let multinational corporations pay lower taxes on foreign profits compared to domestic earnings. The bill would also temporarily raise the standard deduction and increase the child tax credit to $2,500 per child for four years—but with a catch: 4.5 million U.S. citizen children would lose access because of a new requirement that both parents have Social Security numbers.
Chuck Marr, vice president of federal tax policy at the Center on Budget and Policy Priorities, outlined the combined impact of the healthcare and tax legislation across multiple House committees: “On Tuesday, House Republicans in one committee will be taking away people’s health insurance and in another taking away food assistance, while in a third they will be permanently increasing the amount the wealthiest heirs in the country can inherit tax-free.”
He also noted that Republicans are “repeating a brazen pattern from 2017: Make the provisions for rich people permanent (recall the 2017 massive corporate rate cut) while making the broader provisions temporary—backwards priorities.”
The reconciliation package appears crafted to fulfill two long-standing GOP objectives: reducing federal spending on social welfare programs and locking in tax preferences for high-income earners and large corporations. While Trump recently floated a symbolic increase in the top tax rate for the ultra-rich, his party’s legislation does not include any such measure. In fact, no portion of the new tax proposal raises taxes on any income group.
As Marr concluded, “So tonight we’ve learned—despite all the Trump bluster—House Republicans are proposing more tax cuts for the wealthy, increasing its already bloated costs, while harshly failing to deliver for millions of families he promised to help.”
The full reconciliation package remains in markup stages, but Democrats and advocacy groups are already mobilizing in opposition. With Medicaid and tax policy again at the center of a partisan economic agenda, millions of Americans stand to lose access to basic care while the nation’s wealthiest gain permanent tax advantages.
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