A new Republican-led tax and spending package could slash Medicaid by more than $700 billion over the next decade, raising alarms from patient advocates, state leaders, and healthcare experts. The White House says the changes will only impact those “who shouldn’t have had coverage to begin with,” but analysts warn that millions of low-income Americans could lose access to health care.
$723 billion in cuts, 10.3 million could lose coverage
The Congressional Budget Office (CBO) estimates the legislation — officially titled the One Big Beautiful Bill Act — would reduce federal Medicaid spending by $723 billion over 10 years. The cuts are projected to increase the number of uninsured by 7.6 million and reduce Medicaid enrollment by 10.3 million by 2034.
Major cost-cutting provisions include:
- Work requirements for ACA expansion enrollees – $280B
- Repeal of simplified Medicaid eligibility rules – $167B
- Moratorium on new/increased provider taxes – $89B
- Changes to state-directed payment limits – $73B
- Frequent eligibility redeterminations – $53B
These five provisions alone account for 85% of all Medicaid-related savings in the House’s reconciliation bill.
Who is most affected?
Despite White House claims that only “undocumented immigrants” and “able-bodied non-workers” will be removed, the reality is more complex. Experts say the bureaucratic burden of work requirements and redetermination cycles will likely knock qualified Americans off the rolls — including:
- Low-income parents
- Individuals with disabilities who struggle with paperwork
- Rural residents with limited access to tech or government offices
KFF (Kaiser Family Foundation) estimates that the states hit hardest by these changes could see Medicaid enrollment decline by more than 20%, especially in Washington and Virginia.
States bracing for major funding losses
KFF’s state-level breakdown shows wide variation in projected Medicaid losses, with states like Louisiana and Illinois facing up to a 15% cut in their federal Medicaid funding. Even traditionally conservative states such as Alabama and Wyoming could see 5% funding drops — jeopardizing access in areas that heavily depend on the program.
| State | Projected Funding Loss | Enrollment Decline |
|---|---|---|
| Washington | 13–15% | ~25% |
| Virginia | 10–13% | ~20% |
| Louisiana, Illinois | 13–15% | ~15% |
| Alabama, Wyoming | 5–7% | ~8% |
White House message: “This isn’t a cut”
The Trump administration is adamant the plan isn’t a cut. Officials, including Medicaid chief Mehmet Oz and OMB Director Russ Vought, claim that those removed “shouldn’t have been on Medicaid in the first place.” The White House frames the bill as an effort to preserve Medicaid for the truly deserving: seniors, children, low-income families, and people with disabilities.
“We’re not cutting Medicaid — we’re future-proofing it,” Oz said in a recent interview.
Critics counter that framing. “If no one loses coverage, how are you saving $723 billion?” asked GOP pollster Whit Ayres.
What happens next?
The Senate is expected to take up its version of the bill later this month. While some Republicans — like Sen. Josh Hawley — say they’ve received assurances that there will be “no Medicaid benefit cuts,” others, including Sen. Susan Collins and Sen. Lisa Murkowski, have raised concerns about the impact of work requirements.
The final bill could hinge on whether Senate Republicans accept the White House’s reframing of the issue — or force policy concessions to protect Medicaid in their states.
More coverage
FingerLakes1.com is the region’s leading all-digital news publication. The company was founded in 1998 and has been keeping residents informed for more than two decades. Have a lead? Send it to news@fingerlakes1.com.