The U.S. House Budget Committee votes on Friday, May 16, 2025 on a massive reconciliation package. The vote failed, 16-21. (Screenshot from House webcast)

WASHINGTON — Republicans suffered a major setback to their “big, beautiful bill” on Friday, when amid conservative objections the U.S. House Budget Committee failed to approve the measure, a crucial step in the process.

In a 16-21 vote, Reps. Andrew Clyde of Georgia, Josh Brecheen of Oklahoma, Ralph Norman of South Carolina, Chip Roy of Texas and Lloyd Smucker of Pennsylvania broke from their GOP colleagues to block the bill from moving toward the floor, demanding changes to several provisions.

The breakdown over the 1,116-page bill marks an escalation in the long-running feud between centrist Republicans, who have been cautious about hundreds of billions in spending cuts to safety net programs, and far-right members of the party, who argue the changes are not enough.

The committee is scheduled to reconvene Sunday at 10 p.m. Eastern. House Speaker Mike Johnson of Louisiana has said he wants the package on the floor prior to the Memorial Day recess.

Speedier work requirements

Norman said he remains a “hard no” until new work requirements for Medicaid recipients phase in more quickly. As the bill is written, the requirements won’t begin until 2029.

“To phase this in for four years — We’re telling a healthy-bodied, a healthy American that you got four years to get a job. No, your payment stops now,” Norman said.

Brecheen criticized the bill for not going far enough to repeal wind and solar energy tax credits, which he contends are “undermining natural gas jobs.”

“We have to fix this,” he said.

Clyde denounced the measure for not adhering to President Donald Trump’s promise of “right-sizing government,” as Clyde described it. The Georgia Republican also pleaded for lower taxes on firearms and stronger cuts that would put Medicaid on a “sustainable path.”

“Unfortunately, the current version falls short of these goals and fails to deliver the transformative change that Americans were promised,” Clyde said.

Smucker initially voted ‘yes,’ but then joined his four colleagues to oppose the measure.

Trump wrote on his social media platform shortly before the committee voted that “Republicans MUST UNITE behind, ‘THE ONE, BIG BEAUTIFUL BILL!’”

“We don’t need ‘GRANDSTANDERS’ in the Republican Party. STOP TALKING, AND GET IT DONE! It is time to fix the MESS that Biden and the Democrats gave us. Thank you for your attention to this matter!”

‘A wrecking ball to Medicaid’

Democrats, who as expected unified in voting no against the bill, slammed it as “ugly,” “cruel” and a “betrayal.”

“This bill takes a wrecking ball to Medicaid, on which 1 in 5 Americans and 3 million Ohioans depend for medical care — children, seniors in nursing homes,” said Rep. Marcy Kaptur, who represents northern Ohio. “Please come with me to visit the nursing homes. … Perhaps too many on the other side of the aisle have not had to endure a life that has major challenges.”

Rep. Ilhan Omar of Minnesota said the proposed cuts to safety net programs would be “devastating.”

“Their changes will kick millions of Americans off their health care and nutrition assistance. That means more untreated illnesses, more hungry children, more preventable deaths,” she said.

Republican-only bill

Republicans are using the complex reconciliation process to move the package through Congress with simple majority votes in each chamber, avoiding the Senate’s 60-vote legislative filibuster, which would otherwise require bipartisanship. 

Reconciliation measures must address federal revenue, spending, or the debt limit in a way not deemed “merely incidental” by the Senate parliamentarian. That means the GOP proposals must carry some sort of price tag and cannot focus simply on changing federal policy.

Republicans are using the package to extend the 2017 tax law, increase spending on border security and defense by hundreds of billions of dollars, overhaul American energy production, restructure higher education aid and cut spending.

The 11 House committees tasked with drafting pieces of the legislation have all debated and approved their measures along party lines.

The Agriculture Committee, Energy and Commerce Committee and Ways and Means Committee all completed their work earlier this week, amid strong objections from Democrats.

Proposed changes to the Supplemental Nutrition Assistance Program, or SNAP, could shift considerable cost-sharing onto states for the first time, presenting challenges for red-state lawmakers who need to explain the bill back home.

More than $600 billion in federal spending cuts to Medicaid during the next decade could also cause some difficulties for moderate Republicans, some of whose constituents are likely to be among the millions of Americans expected to lose their health insurance.

Republicans also have yet to reach an agreement on the state and local tax deduction or SALT, a priority for GOP lawmakers from blue states like California, New Jersey and New York.

The Budget Committee’s role in the process was to package together all of the bills and then send the one massive bill to the Rules Committee, the last stop before floor debate for major legislation.

That won’t be able to happen until after GOP leaders get nearly all the Republican lawmakers on the panel to support the package. 

House Committee on Energy and Commerce Chairman Brett Guthrie, R-Ky., left, and ranking member Frank Pallone, D-N.J., right, speak during a markup with the committee on Capitol Hill on May 13, 2025 in Washington, DC. . (Photo by Anna Moneymaker/Getty Images)

WASHINGTON — The U.S. House panel in charge of overhauling Medicaid by cutting hundreds of billions in federal spending wrapped up debate on its bill Wednesday, following a 25-hour session.

The Energy and Commerce Committee voted 30-24 along party lines to sign off on the legislation, sending it to the Budget panel, which is expected to bundle it together with the other 10 measures Friday to create Republicans’ “big, beautiful bill.”

The full House is set to vote on that package next week, though GOP leaders need to make sure nearly all of the chamber’s 220 Republicans support the overall bill in order for it to pass.

The legislation, should it gain that backing, will then head to the Senate, where GOP lawmakers are expected to rewrite or eliminate numerous sections of the bill. 

Analysis from the nonpartisan Congressional Budget Office, shared with States Newsroom by Republican staff on the Energy and Commerce Committee, shows the Medicaid changes would cut $625 billion in federal spending during the next decade.

About 10.3 million people would lose access to Medicaid or the Children’s Health Insurance Program, with 7.6 million people becoming uninsured during the 10-year budget window, according to the CBO analysis, which has yet to be released publicly.

House committee debate on the bill, which began Tuesday and continued overnight, largely centered around Democrats saying the legislation would lead millions of vulnerable people to lose access to Medicaid, while Republicans contended their overhaul would protect “the integrity” of the health care program for lower income Americans and some people with disabilities.

Democrats proposed dozens of amendments trying to change the bill’s various sections, including the Medicaid provisions, but Republicans on the committee blocked their adoption.

‘They’re going to lose coverage’

Just after the sun rose over Capitol Hill on Wednesday morning, Ohio Democratic Rep. Greg Landsman said Republican claims about people not being kicked off Medicaid due to federal spending cuts were going “off the rails.”

“They’re going to lose coverage in part because of the red tape and the paperwork. We know that because we’ve seen it in other states,” Landsman said. “And these are people who are eligible or deserving — people who need it.”

Washington Democratic Sen. Kim Schrier later in the day raised concerns that people who lose access to Medicaid would put off getting routine care from primary care doctors, only to end up in emergency departments.

“Those kicked off Medicaid will still get care, of course, but they will be sicker, they’ll be treated in the emergency room, the care will be more complicated, more expensive,” Schrier said. “And since they can’t pay for it, all of us will make up that difference. So our insurance rates will go up.”

Florida Rep. Laurel Lee argued the GOP changes to Medicaid are common sense improvements, like “restoring work requirements for able-bodied adults without dependents, modernizing systems to prevent fraud and abuse, and ending misdirected payments to those who are deceased or who are not eligible for the program.”

“These reforms are not about taking something away; they are about protecting the integrity of the program so that the people we represent — those who truly need this support — can count on it to be there, now and in the future,” Lee said. “Our reforms are about restoring integrity to the system and ensuring that it works for the long haul.”

Attempts to ax work requirement

Democrats proposed numerous amendments during debate on the health care section of the bill, including some that would have eliminated the work requirements.

New Jersey Democratic Rep. Frank Pallone, ranking member on the committee, said those requirements often cause people to lose access to Medicaid due to “red tape” and paperwork.

Pallone said when Georgia implemented work requirements, fewer than 7,000 of the 400,000 people eligible for Medicaid were able to prove to the government they met the standards.

“It’s not that they weren’t eligible, it’s that the state of Georgia put too many barriers in the way of them being able to qualify,” Pallone said. “And that’s what I think is happening here today with this bill.”

He further criticized the GOP for including a provision in the bill saying that if people are not eligible for Medicaid then “they’re not eligible for any kind of subsidy under the Affordable Care Act.”

“So they don’t have that option as well, which is, of course, also the basis for the CBO saying so many people get kicked off Medicaid,” Pallone said. “They assumed that if you didn’t have Medicaid, you would go to the ACA, and that would have probably eliminated most of your savings. But instead, now you say they can’t go to the ACA because they still haven’t filled out the paperwork for Medicaid, so we’re not going to let them go to the ACA and get any kind of subsidized care. And it goes on and on.”

‘We don’t want to repeat the Arkansas law’

Energy and Commerce Chairman Brett Guthrie, R-Ky., said the GOP proposals for work requirements sought to avoid the issues experienced in Arkansas and Georgia, when those states implemented their work requirements for Medicaid.

“We don’t want to repeat the Arkansas law,” Guthrie said. “We agree that was the wrong way to do it.”

Arkansas’ experiment with work requirements and monthly checks was “overly cumbersome,” but Guthrie said this legislation would “only require a beneficiary to have to verify work at the time of enrollment or during a redetermined position of their eligibility. This allows states and beneficiaries to take advantage of existing processing and paperwork that they already go through.”

The GOP bill includes several exceptions to the requirement that people enrolled in Medicaid between the ages of 19 and 65 work, participate in community service, or attend an educational program at least 80 hours a month.

Those exclusions include pregnant people, parents of dependent children, people who have complex medical conditions, tribal community members, people in the foster system, people who were in the foster system who are below the age of 26 and people released from incarceration in the last 90 days, among others.

CBO estimates the work requirements would save the federal government $300 billion during the next decade. That savings wouldn’t begin until after the provision takes effect on Jan. 1, 2029.

GOP lawmakers not on the committee have expressed frustration with the delayed implementation, including South Carolina Republican Rep. Ralph Norman.

“Delaying work requirements for able-bodied adults on Medicaid to 2029 isn’t ‘progress,’” Norman wrote in a social media post. “It’s fiscally irresponsible and another sad excuse for the swamp!!”

Texas Republican Rep. Chip Roy, wrote in a four-page letter, that Congress must “significantly amend” several of the bill’s Medicaid provisions, including immediately implementing the work requirements.

“Republicans are in control now and should not let out-of-year savings be compromised by a future Democratic trifecta,” Roy wrote.

Planned Parenthood debate

Texas Democratic Rep. Lizzie Fletcher sought to remove the provision that would block Medicaid funding from going to Planned Parenthood, though GOP lawmakers ultimately voted to keep the language in the measure. 

Federal law for decades has prevented taxpayer dollars from going to abortion services with exceptions for rape, incest, or the life of the pregnant patient. But the provision in the GOP bill would block all Medicaid funding for Planned Parenthood, including for preventive care and regular health check-ups.

Medicaid enrollees who go to Planned Parenthood for wellness checks, birth control, lab work, cancer screenings and other services would have to find a different provider, or go without care.

“To make up the gap, federally qualified health centers would need to increase their capacity by an additional 1 million clients,” Fletcher said. “This is just another way people will lose access to health care. Defunding Planned Parenthood is an assault on the health, dignity and freedom of women across this country.”

Fletcher later pointed out that Planned Parenthood clinics and their affiliates in states with abortion bans would be cut off from federal funding, even though they don’t provide abortions.

She listed the Houston, Texas, Planned Parenthood as one example of a facility that doesn’t perform abortions but would lose federal funding.

The Planned Parenthood language would increase federal deficits by about $300 million during the next decade, according to the Congressional Budget Office. It is the only provision in the health care section of the bill that would not reduce federal spending.

Other organizations said to be affected

Virginia Republican Rep. Morgan Griffith said he was told by CBO that other health organizations in addition to Planned Parenthood would be impacted by the provision, but he was unable to name those health care organizations.

The provision would apply to “providers that are nonprofit organizations, that are essential community providers that are primarily engaged in family planning services or reproductive services, provide for abortions other than for Hyde Amendment exceptions, and which received $1,000,000 or more (to either the provider or the provider’s affiliates) in payments from Medicaid payments in 2024,” according to a summary of the GOP bill. It would take effect as soon as the bill becomes law and last for a decade.

Republican staff on the Energy and Commerce Committee did not immediately respond to a request from States Newsroom for the list that Griffith referenced.

Legal staff said the secretary of Health and Human Services would determine what organizations meet that definition and would therefore lose federal Medicaid funding.

Tennessee Republican Rep. Diana Harshbarger opposed the amendment, saying that it was well past time for Congress to cut off all federal funding for Planned Parenthood.

“This bill does not change the availability of funds for women’s health. It simply establishes a safeguard so that the nation’s largest abortion providers are not the one providing services through Medicaid,” Harshbarger said. “Should these entities stop participating in abortion services, they would again be eligible to receive funding.”

Republicans also blocked an amendment from Illinois Democratic Rep. Robin Kelly that would have required Medicaid to cover a full year of postpartum coverage for enrollees.

The vast majority of states already cover postpartum care for a year under an expansion Democrats approved in the American Rescue Plan, the $1.9 trillion coronavirus relief bill they enacted in 2021. That was later made permanent in a 2022 appropriations law.  

But Kelly said she was worried that would change if states had to make tough budget choices due to a drop-off in federal funding for the program.

“Medicaid covers almost half of all births in this country and covers more than half of all births in rural communities,” Kelly said. “When we talk about cutting funding, you are cutting into the care that supports moms and babies during the most vulnerable time of their lives.”

Harshbarger spoke against the amendment, saying it was unnecessary. 

The U.S. House will begin debate in committee this week on a bill that would cut Medicaid spending. (Getty Images)

WASHINGTON — U.S. House Republicans plan to debate and approve the three final pieces of their “big, beautiful bill” in committee this week, including the tax measure, major spending cuts to Medicaid that will change how states run the program and an agriculture bill.

At least $880 billion over the next 10 years would be slashed under the piece of the bill that covers energy and health care, including from Medicaid. Republicans would add new Medicaid work requirements for some able-bodied adults; seek to penalize the dozen states that allow immigrants living in the U.S. without legal status in the program; and require states to more frequently check Medicaid enrollees’ eligibility, among other changes.

An estimate was not yet available for exactly how much that would save in Medicaid spending or how many people enrolled might lose coverage. Earlier projections of various other scenarios by the Congressional Budget Office had placed the numbers of displaced enrollees in the millions, and Democrats predicted the same effect from the newest plan.

House panels have already signed off on eight of the 11 bills that will make up the sweeping reconciliation legislation. And if all goes according to plan, that chamber should approve the entire package before the end of the month.

Debate is expected to begin Tuesday in each of the panels and last hours, possibly into Wednesday. Democrats will offer dozens of amendments seeking to change the bills and highlighting their disagreement with GOP policy goals.

Internal Republican disputes between centrists and far-right lawmakers over numerous tax proposals and funding changes to Medicaid will also likely lead to debate on GOP amendments.

With paper-thin majorities in the House and Senate, nearly every Republican needs to support the overall package for it to move through both chambers and to President Donald Trump.

If Republicans fail to reach agreement during the next couple months, it would put nearly every aspect of their agenda in jeopardy. GOP leaders would also need to negotiate a bipartisan debt limit agreement before the August recess, should the reconciliation package fall apart, since they plan to include debt limit language as well.

GOP divided over Medicaid cuts

Kentucky Republican Rep. Brett Guthrie, chairman of the committee that oversees energy and Medicaid, wrote in a statement last week announcing the markup that his panel’s measure would “end wasteful government spending, unleash American energy and innovation, and strengthen Medicaid for mothers, children, individuals with disabilities, and the elderly.”

But the bill released this weekend might not have support from far-right members in the House and seems to be running into opposition from some GOP senators as well. 

Texas Republican Rep. Chip Roy, of the hard right, wrote on social media that he hoped “House & Senate leadership are coming up with a backup plan…. ….. because I’m not here to rack up an additional $20 trillion in debt over 10 years or to subsidize healthy, able-bodied adults, corrupt blue states, and monopoly hospital ceos…”

Missouri Republican Sen. Josh Hawley, who has voiced concern for months about potential cuts to Medicaid, wrote an op-ed published in The New York Times on Monday highly critical of a “contingent of corporatist Republicans” who support lower federal spending on the program.”

“This wing of the party wants Republicans to build our big, beautiful bill around slashing health insurance for the working poor,” Hawley wrote. “But that argument is both morally wrong and politically suicidal.”

The entire House package will be open to amendment if the legislation makes it to the Senate, where several GOP lawmakers are expected to rework or even eliminate entire sections.

Work requirements

The Energy and Commerce Committee’s bill is the one that would cut federal spending by at least $880 billion during the next decade including on Medicaid, the state-federal health program for lower income people.

The legislation would institute work requirements nationwide for able-bodied adults between the ages of 19 and 65, with several exceptions, including for pregnant people, enrollees with certain disabilities or serious medical conditions, and parents of dependent children.

People not exempted from the requirements would need to work, engage in community service, or enroll in an education program for at least 80 hours a month.

A staffer on the panel told reporters during a background briefing Monday that Republicans tried to learn from challenges certain states had in the past when they implemented work requirements.

After discussions with current and former state Medicaid directors, the staffer said the committee wrote a bill that they are confident “states will be able to implement effectively.”

The work requirements take into account various unexpected circumstances, like if someone were to be hit by a bus and unable to complete the 80-hours-per-month requirement on time because they were hospitalized, the staffer said.

“We did try to be very thoughtful about any kind of circumstance that could happen,” they said.

Immigrant coverage, eligibility checks

The Medicaid legislation also seeks to encourage states who include undocumented immigrants in their program to stop doing so or lose some federal funding.

The federal government currently pays 90% of the cost of covering enrollees who are eligible for Medicaid under the 2010 Affordable Care Act expansion. That would decrease to 80% for the expanded population if states choose to keep covering undocumented immigrants.

The committee staffer said this would impact California, Colorado, Connecticut, the District of Columbia, Illinois, Maine, Massachusetts, New Jersey, New York, Oregon, Utah, Vermont and Washington states if they don’t change their policies regarding undocumented immigrants.

Additionally, states would need to check eligibility for all of their Medicaid enrollees every six months, instead of once a year for the expanded population. This likely would lead to some people being kicked out of the program.

Committee staff members were unable to share exactly how each of the Medicaid provisions would affect the federal budget or how many people could lose access to the program if Congress were to implement the legislation as written.

But the nonpartisan Congressional Budget Office wrote in a letter Monday that it estimates the Energy and Commerce Committee met its target of cutting at least $880 billion in spending “over the 2025-2034 period and would not increase on-budget deficits in any year after 2034.”

Staff on the committee said they don’t expect to have the full CBO score before the markup begins Tuesday and didn’t have an estimate for when that information will be out.

Energy and Commerce Committee Ranking Member Frank Pallone, D-N.J., wrote in a statement the GOP bill would lead to millions of people losing access to Medicaid.

“This is not trimming fat from around the edges, it’s cutting to the bone,” Pallone wrote. “The overwhelming majority of the savings in this bill will come from taking health care away from millions of Americans. No where in the bill are they cutting ‘waste, fraud, and abuse’—they’re cutting people’s health care and using that money to give tax breaks to billionaires.”

Repealing clean-energy funds

The Republican proposal would repeal more than a dozen sections of Democrats’ 2022 reconciliation law related to energy and environment programs.

The law, known as the Inflation Reduction Act, included hundreds of billions in tax credits for renewable energy and energy-efficiency measures. It was considered the largest investment by the United States in tackling climate change.

The House bill would repeal sections including the $27 billion Greenhouse Gas Reduction Fund, which helps finance clean-energy projects, and a $40 billion Department of Energy loan program meant to stimulate production of clean-energy infrastructure.

Sections targeting carbon emissions, air pollution, offshore wind transmission, and other programs would also rescind any unspent funds for those purposes appropriated in the Biden-era law.

The measure would allow pipeline builders to pay fees to bypass environmental review. Natural gas pipelines could pay $10 million to access an expedited approval process and liquified natural gas exports could pay $1 million for the Energy Department to deem them “in the public interest.”

Rep. Kathy Castor, the ranking member on the Energy and Commerce Energy Subcommittee, said the proposal would sabotage efforts to drive down prices for consumers.

“Cleaner, cheaper energy for consumers gets left behind,” the Florida Democrat wrote in a statement. “Dismantling our landmark Inflation Reduction Act will kill jobs, hurt businesses, and drive-up Americans’ energy costs.”

Tax cuts

The Ways and Means Committee released its 28-page starter bill late last week and the full 389-page version Monday afternoon, but Republicans on the panel could add to it during the Tuesday markup.

House GOP tax writers propose making permanent the underlying 2017 tax law provisions while temporarily expanding several of them, including the child tax credit and standard deduction.

The child tax credit would increase to $2,500, up from $2,000, until 2028. The refundable amount of the tax credit per child — meaning how much taxpayers could get back — would now reach up to $1,400. Taxpayers claiming the credit would now have to provide a Social Security number, as well as the SSN of a spouse.

The standard deduction for single and married joint filers would temporarily increase until 2029 up to $2,000, depending on filing status.

Trump’s campaign promises, including no tax on tips, also made it into the proposal, though only until 2028. Those claiming the tax break on tips will also need to provide a Social Security number as well as the SSN of their spouse, if married.

Trump’s promise to eliminate taxes on car loan interest, also set to expire in 2028, would not apply to any vehicle that was not finally assembled in the U.S.

Tax writers increased but ultimately left a cap on the amount of state and local taxes, commonly referred to as SALT, that households can deduct, an incredibly contentious issue for lawmakers with constituents in high tax areas like New York and California. GOP lawmakers increased the SALT cap to $30,000, up from $10,000.

That level, however, might not have the support needed among Republicans’ extremely thin majorities and will likely lead to heated debate during markup, or on the floor.

Republicans from higher-tax states have repeatedly said they will not vote for the entire package unless they feel their constituents will benefit from raising the SALT cap.

The dispute has spilled over several times already, including in a statement last week from four New York Republicans, who wrote, “The Speaker and the House Ways and Means Committee unilaterally proposed a flat $30,000 SALT cap — an amount they already knew would fall short of earning our support.”

“It’s not just insulting—it risks derailing President Trump’s One Big Beautiful Bill,” they wrote. “New Yorkers already send far more to Washington than we get back—unlike many so-called ‘low-tax’ states that depend heavily on federal largesse.

“A higher SALT cap isn’t a luxury. It’s a matter of fairness.”

New York Republican Rep. Nick LaLota wrote on social media Monday afternoon: “Still a hell no.”

How much the tax proposal will cost has not yet been released, but government deficit watchdogs estimated a wholesale extension of the 2017 Tax Cuts and Jobs Act, without the enhancements, would cost north of $4 trillion over the next decade.

Erica York, vice president of federal tax policy at the Tax Foundation, said the proposal provides some certainty to individual taxpayers but it also adds complexity in many areas.

“You can clearly see the thinking here was probably just a straight-up extension (of the 2017 law), people wouldn’t feel like they got a tax cut because it’s just continuing. So they had to do something to make it feel like there’s a larger tax cut,” York said.

Ag cuts remain a mystery

The House Agriculture Committee, led by Pennsylvania Republican Glenn ‘GT’ Thompson, hadn’t released its bill as of Monday afternoon but was scheduled to begin the markup on Tuesday evening.

That panel is supposed to cut at least $230 billion in federal spending during the next decade, some of which will likely come from reworking elements of the Supplemental Nutrition Assistance Program, or SNAP.

Committee leaders are also planning to include elements of the much overdue farm bill, though those provisions could run into issues in the Senate if they don’t have a significant impact on federal revenue or spending.

Republicans are using the complex reconciliation process to move the package through Congress with simple majority votes in each chamber, avoiding the Senate’s 60-vote legislative filibuster, which would otherwise require bipartisanship. 

Reconciliation measures must address federal revenue, spending, or the debt limit in a way not deemed “merely incidental” by the Senate parliamentarian. That means the GOP proposals must carry some sort of price tag and cannot focus simply on changing federal policy.

Jacob Fischler and Ashley Murray contributed to this report.