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****Bill Clark/CQ Roll Call via AP Images
**MAY 7, 2025**
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**** Medicaid Cuts in Republican Bill Would Charge Poor
People More for Coverage
The cost-sharing requirements on beneficiaries above the federal poverty line is the most notable item in a menu of Medicaid cuts seen by the Prospect.
By David Dayen
Medicaid recipients with earnings at or above the federal poverty line would have to pay significant out-of-pocket expenses for their health care coverage, and work requirements would be placed on the program, according to a menu of items in the emerging Republican budget reconciliation proposal seen by the
**Prospect**.
The Medicaid cuts, part of the giant tax and spending package Republicans are readying using the reconciliation process to avoid a Senate filibuster, would also roll back Biden-era rules that improved staffing at nursing homes. And they would alter a number of eligibility and enrollment provisions that would make Medicaid harder to navigate for its 71 million-plus enrollees
[link removed], a common tactic to reduce enrollment.
"A lot of these policies will add administrative costs for the states, burdens for people, the potential for more improper payments and errors in processing," said Allison Orris, director of Medicaid policy at the Center on Budget and Policy Priorities (CBPP). "All of this shifting of the ball can result in people losing coverage."
Sources told the
**Prospect** that the list of Medicaid cuts in the menu do not appear to reach the $880 billion over ten years required in budget reconciliation instructions for the House Energy and Commerce Committee. Even with proposed changes to the Affordable Care Act that could increase health care costs for millions of recipients, as well as unspecified cuts to the remnants of the traditional welfare program, known as Temporary Assistance for Needy Families (TANF), and the
Social Services Block Grant (SSBG), the total estimate of savings is about $600 billion. That would lower the amount of tax cuts available under reconciliation instructions, which hard-line Republicans might reject as insufficient.
But even if it doesn't reach the preferred level of cuts, many Medicaid beneficiaries, and the states that co-manage the program with the federal government, will feel a definitive and deep impact, experts said, particularly those earning above the poverty line, those with a sudden need for coverage, patients in nursing homes, and residents of Washington, D.C. And it would burden beneficiaries and cause drops in coverage, a red line for moderates claiming that they are only concerned with waste, fraud, and abuse.
The House Energy and Commerce Committee, led by Rep. Brett Guthrie (R-KY), did not respond to a request for comment.
Negotiations in the House are ongoing this week, and the markup in the Energy and Commerce Committee is not expected
until next week at the earliest. But sources tell the
**Prospect** that text of the Energy and Commerce section could be released Friday. Republicans are looking to hold all the most contentious markups-in the Energy and Commerce, Ways and Means (which handles the tax provisions) and Agriculture (which deals with the Supplemental Nutrition Assistance Program, or food stamps) committees-on the same day, to make it hard for the opposition to focus.
But Medicaid cuts have been a point of emphasis for Democrats all year, and now the details are dribbling out.
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