House Republicans on the Energy and Commerce Committee this week unveiled a plan to cut more than $880 billion to pay for a significant portion of President Trump’s domestic agenda.
After months of wrangling over how deeply to cut Medicaid, committee Chair Brett Guthrie (R-Ky.) appears to have avoided the most politically controversial proposals while also saving more money than the committee needed.
An official score by the Congressional Budget Office hasn’t been released, though it acknowledged in a letter Monday that the committee’s recommendation would exceed the savings target laid out in the blueprint governing Trump’s “big beautiful bill” and wouldn’t increase the deficit after 2034.
But as the measure moves ahead in the House and gets to the Senate, GOP leaders are going to need to figure out how to keep both moderates and conservatives happy. The panel is scheduled to meet on Tuesday afternoon for a marathon session to debate and refine the package.
Here’s what you need to know about the proposal:
No structural changes to Medicaid
The plan caters more to the moderate wing of the Republican party by omitting two of the biggest and most politically controversial proposals discussed: a per-capita cap on people who get coverage from Medicaid expansion, and a direct lowering of the federal matching rate.
Instead, most of the savings come from policies that would cause Medicaid beneficiaries to pay more for doctors’ visits and complete more paperwork to prove eligibility. It would also impose a requirement for poor, childless adults, between the ages of 19 to 64, to prove they are working at least 80 hours a month.
All told, the Medicaid and health portions would save about $715 billion, according to the Congressional Budget Office. But it would also result in at least 8.6 million more Americans going uninsured.
Punts hard choices to states
One of the largest chunks of savings in the proposal comes from cracking down on the ability of states to levy taxes on providers like hospitals and nursing homes.
Provider taxes have been a lucrative loophole for states to get more federal Medicaid funding by taxing providers and then returning the money to them in the form of higher reimbursements for treatment. The proposal would freeze all state taxes at their current rates and prevent states from imposing additional taxes.
The plan doesn’t roll back current taxes, so some conservatives argue it could have gone further.
But the loss of the extra revenue will force states to reconsider how they fund their Medicaid programs. States will have to decide whether to cut benefits or raise taxes.
The new work requirements will be federally mandated, but enforcement will be up to the states. Under the proposal, states must enforce “community engagement” requirements on Medicaid enrollees beginning in 2029.
Community engagement is defined as 80 hours of work, community service or a work program each month. Other options include at least half-time enrollment in an educational program or a combination of the available options.
“This bill refocuses Medicaid on mothers, children, people with disabilities, and the elderly—not illegal immigrants and capable adults who choose not to work. It is reckless that my colleagues on the other side of the aisle claimed an artificially high number in alleged coverage loss just so they can fear monger and score political points,” Guthrie said in a statement.
The proposal would also penalize the handful of Democratic-led states which have used their own money to offer Medicaid to undocumented immigrants. It would reduce the federal match to 80 percent for the expansion population—down from the current 90 percent—if the states continued to subsidize such coverage.
The states that would be hit hardest are New York, Washington and California.
“Defunds” Planned Parenthood
The proposal includes a win for anti-abortion lawmakers; it would strip Medicaid funding from Planned Parenthood and its affiliates.
The proposal doesn’t mention Planned Parenthood by name, but it would prevent Medicaid from funding health providers that also offer abortion services. Abortions for cases of rape, incest or to save the mother from harm or death are exempted.
Medicaid is already banned from covering abortions, but proponents say Planned Parenthood shouldn’t get any federal funding, because women can go elsewhere for non-abortion care. The move may not save money, but is an important conservative message.
Moderate lawmakers had expressed concern about the possibility of such a provision being included, but anti-abortion groups are ratcheting up the pressure.
Kristan Hawkins, president of Students for Life, during a Monday web event called on grassroots activists to contact specific House and Senate lawmakers and urge them to support defunding Planned Parenthood.
The list included what Hawkins said were some “pro-choice” GOP moderates like Sen. Lisa Murkowski (R-Alaska) as well as longtime anti-abortion champions.
Conservatives want deeper cuts
Guthrie may have tried to thread the needle between moderates and conservatives, but it’s not clear if it will be enough to sell them on it.
“Does the bill offer ANY transformative changes on Medicaid or otherwise? Currently – NO,” conservative hardliner Rep. Chip Roy (R-Texas) wrote on X. He said the plan “ignores the policy changes that matter” such as lowering the enhanced federal match for expansion states.
“Even the changes it embraces are mainly codification of rules Trump would do anyway, leaving healthcare costs spiraling, fat cats still making lots of money while hard-working Americans are left behind,” Roy wrote. “We will need SIGNIFICANT additional changes to garner my support.”
But at the same time, Sen. Josh Hawley (R-Mo.) on Monday wrote a New York Times opinion article warning against efforts to cut Medicaid. He said funding the “big, beautiful bill” by slashing health insurance for the working poor is “morally wrong and politically suicidal.”
Hawley has carved himself a lane as a GOP populist, but his continued opposition to Medicaid cuts are likely a sign of trouble should legislation eventually reach the Senate.
