More Information about the Medicaid Provisions in the Budget Reconciliation Bill 

It took 27 hours last week for the House Energy and Commerce Committee to “mark up” their version of the budget reconciliation proposal that includes Medicaid changes projected to reduce the deficit by $715 billion over ten years and increase the number of people without health insurance by 8.7 million. They worked through the night, and advanced their portion of the reconciliation bill May 14.

In the weeks leading up to the emergence of the House Medicaid cuts proposal on May 12 – the first time the selected cuts were revealed to the public -  leaders changed the outline of the targeted reductions multiple times. An original concept to focus mostly on Medicaid expansion states and populations was modified significantly. A proposal for per capita Medicaid limits had been widely predicted, but was not included. Democrats criticized the rush to push the bill through by working through the night, arguing that the debate showed many members did not understand the changes.

The work of the House Energy and Commerce Committee was taken up by the House Budget Committee and combined to create the Big Beautiful Bill promoted by the White House to extend tax cuts and reduce spending across many programs. On Friday, a motion to move the full bill failed – with four Republicans joining 16 Democrats voting no. Those Republicans were ultimately convinced to vote “present” on Sunday, to allow the bill to pass 17-16.

The cuts to Medicaid mostly focus on states with Medicaid Expansion and those that use state funds to cover immigrants, but include many provisions that will impact non-expansion states as well – including work requirements, capped provider taxes, increased administrative burdens, increased state cost sharing, limiting the lookback period (retroactive coverage) to one month, limiting inpatient hospital and nursing home rates to the Medicare rate, prohibiting implementation of the minimum staffing rule for long term care facilities and eliminating enhanced match for states that choose to expand Medicaid in the future. 

The following includes a full summary of the Medicaid provisions included in the legislation approved by the Energy and Commerce Committee compared to current law.  Please view this table – it is the best list I have found thus far.

Tracking the Medicaid Provisions in the 2025 Reconciliation Bill | KFF

There are significant additional reductions above and beyond Medicaid that will impact Kansans including:

SNAP: Food benefits reductions more than $290 billion over ten years – pushing major portions of SNAP costs to states. An amended cost-sharing formula would be connected to payment error rates. SNAP would also see additional work documentation requirements.

ACA: Reduce access to federal subsidies that help people pay for health insurance through the Health Insurance Marketplace (Affordable Care Act). Participants would face stricter minimum work requirements or lose their subsidies.

The bill will now go to the House Rules Committee to set parameters for floor debate before it can go to the House floor for a vote. The lack of unanimity amongst Republicans in the Budget Committee vote suggests changes will need to be made in the Rules Committee to get the votes necessary to pass on the House floor. 

President Trump met with Republicans Tuesday morning to attempt to gather the votes necessary to keep the Budget Reconciliation Bill moving, but there is a group of conservatives pushing for deeper cuts. The House Rules Committee already released revisions that include cuts to federal employee benefits. Rumors suggest those changes might include expediting the work requirements – currently delayed until 2029.

Because the House Budget Committee vote took place in the middle of the night, the 48 hour rule means the House Rules Committee is scheduled to begin its work at 1:00 a.m. Wednesday (tonight). They hope to have a vote in the House Thursday. Speaker Johnson says Congress will work into the holiday weekend if necessary.

Please note that due to the changing nature of the activities in Washington D.C., there may be further changes as the legislation moves through the process.

Contact:  Amy Campbell - email