UPDATED: 5:50 p.m. ET on June 5
As senators seek a path forward for President Trump's "big beautiful bill," Medicare cuts are reportedly on the table.
Politico reported that Republicans in the Senate are looking at provisions around Medicare as they look to make the bill's math work, and seek to appease the more hawkish wing of the party. The outlet reported that some GOP legislators believe that President Donald Trump would be on board with cuts to Medicare as long as they are within the confines of "fraud, waste and abuse."
These changes could come in the form of policy updates in Medicare Advantage, according to the report. The program has taken heat for practices that may overcharge the government.
Taking aim at Medicare is a politically fraught route for Republicans to take, and making significant overalls in MA would draw major pushback from the insurance industry.
The version of the bill that passed through the House would make substantial changes to Medicaid, including instituting work requirements in the program.
PUBLISHED: May 21 at 10:30 a.m. ET
GOP passes megabill, imposing strict Medicaid work requirements
At long last, the “one big, beautiful bill” has passed through the House of Representatives, sending an all-encompassing reconciliation package to the Senate.
The amended legislation (PDF), supported only by Republican lawmakers and the Trump administration, was passed in the early morning hours May 22 after another all-nighter by congressional lawmakers. By a vote of 215-214—with one Republican voting present, two voting against and zero Democrats joining the other side of the aisle—the bill extends trillions of dollars in tax breaks from Trump’s first term and raises the debt ceiling by $4 trillion. The bill also includes provisions banning taxes on tips or overtime.
Healthcare provisions in the bill were the thorniest for members. Moderate lawmakers were hesitant to see Medicaid bear the brunt of programmatic changes, while hardliners in the conference didn’t feel the bill went far enough.
Once the dust settled, the bill took a tougher approach on work requirements. Instead of work requirements taking effect in January 2029, they would start Dec. 31, 2026. It would be the first time work requirements are a federal requirement. They apply to able-bodied adults and mandate 80 hours of work per month.
“Today, the House has passed generational, nation-shaping legislation that reduces spending, permanently lowers taxes for families and job creators, secures the border, unleashes American energy dominance, restores peace through strength, and makes government work more efficiently and effectively for all Americans,” said Speaker of the House Mike Johnson, R-La., in a statement. “House Democrats voted against all of it—which clearly proves they want tax hikes on their constituents, open borders, and Medicaid for illegal immigrants.”
As part of the changes, states can begin Medicaid eligibility checks every six months starting at the end of 2026.
The original bill banned Medicaid from covering gender-affirming care for minors. But, now, the proposal passed by the House prohibits coverage for all individuals.
Republicans made changes to state-directed payments, allowing states that have not expanded Medicaid to make larger payments. It also includes a new section on cost-sharing reductions (CSRs). Eligibility for CSRs were already expected to be limited.
Millions of Americans are expected to lose their health coverage as a result of this bill, according to the Congressional Budget Office.
“They admit this is one of the most consequential pieces of legislation in a generation, but they voted without getting a full analysis of the proposal or a single hearing on the impacts of the biggest cut to Medicaid ever,” said Families USA Executive Director Anthony Wright in a statement. “Even without a full accounting yet, we know enough to know that the consequences will be devastating, from millions more uninsured, to increased premiums and co-pays and more bureaucratic barriers to get on and stay on both public and private coverage, to reduced benefits and scaled back services resulting from cuts to the hospitals, clinics and other providers on which we all rely.”
Patients For Affordable Drugs Now slammed the inclusion of the ORPHAN Cures Act in the package. This provision widens the types of drugs excluded from the drug price negotiation program under 2022's Inflation Reduction Act.
“By letting high-cost drugs with multiple orphan uses avoid negotiation and extending the timeline before negotiation for other medications, lawmakers have handed pharmaceutical corporations a new and unnecessary way to protect monopoly pricing—all while one in three Americans can't afford their medications,” said Merith Basey, executive director of the organization.
In a statement, Susan Dentzer, President and Chief Executive Officer of America’s Physician Groups, said the Medicaid cuts in the bill will mainly cause disenrollment and loss of coverage for millions of people, "with serious negative consequences for them as well as for physician groups, hospitals, and the entire stressed U.S. health care system."
Dentzer also slammed lawmakers for failing to extend enhanced premium tax credits for Affordable Care Act (ACA) marketplace coverage, which, along with "other damaging ACA marketplace changes in the package," will also cause major losses in coverage and further harm, she said.
"The SNAP cuts and loss of food assistance will imperil the ability of millions to obtain healthful food and lead to adverse health effects down the road," Dentzer said. "The fact that all these cuts in health care and social programs are being used to finance tax cuts that will primarily benefit the highest income taxpayers is inexcusable."
The American College of Emergency Physicians (ACEP) said in a statement that it is deeply concerned that drastic changes to Medicaid under consideration will disproportionately affect emergency departments that are already under significant strain, leaving emergency physicians with fewer resources to respond to patient needs and threatening patient access to lifesaving emergency care.
“Emergency departments are one of the few settings where patients are treated 24/7/365, regardless of their insurance status or ability to pay,” said Alison Haddock, M.D., president of ACEP. “The impact of policies that will leave millions of people without any health coverage falls squarely onto emergency physicians and patients. Patients with unmet health care needs will delay treatment and their conditions will worsen, leaving them with no other option than the emergency department. This creates avoidable health risks and threatens the viability of an already strained health care safety net.”
Groups representing the nation's health systems like the Federation of American Hospitals, the Catholic Health Association and America’s Essential Hospitals also opposed the bill in its current form.
Attention will now turn to the Senate. Like in the House, there are vocal Republican Senators who appear skeptical, or even opposed, to the bill. President Donald Trump inserted himself more prominently into negotiations this week, turning the screws on members who seemed ready to holdout for a better deal. Those efforts were not entirely successful, but the bill advanced regardless.