The U.S. Capitol building in Washington, D.C., is pictured on Wednesday, May 7, 2025. (Photo by Jennifer Shutt/States Newsroom)

This report has been updated.

WASHINGTON — The U.S. House early Thursday approved the “big, beautiful bill” that Republican leaders spent months negotiating with centrists and far-right members of the party — two distinct factions that hold vastly different policy goals — over intense opposition from Democrats.

The 215-214 vote ships the package to the Senate, where GOP lawmakers are expected to rewrite much of it, before sending it back across the Capitol for final approval, a process likely to stretch through the summer.

President Donald Trump, who said he backed the House version, would then need to sign the legislation, which under the complicated process being used by Republicans can pass with just a majority vote in the GOP-controlled Senate.

Trump called on the Senate to pass the legislation as quickly as possible, writing in a social media post that “(t)here is no time to waste” and that the bill is “arguably the most significant piece of Legislation that will ever be signed in the History of our Country!”

Speaker Mike Johnson said minutes before the vote that he expects lawmakers to give the measure final approval before the Fourth of July.

“Now, look, we’re accomplishing a big thing here today, but we know this isn’t the end of the road just yet,” Johnson, R-La., said. “We’ve been working closely with Leader (John) Thune and our Senate colleagues, the Senate Republicans, to get this done and delivered to the president’s desk by our Independence Day. That’s July 4. Today proves that we can do that, and we will do that.”

House Democratic Leader Hakeem Jeffries, D-N.Y., argued against the legislation, saying it “undermines reproductive freedom, undermines the progress that we have made in combating the climate crisis, undermines gun safety, undermines the rule of law and the independence of the federal judiciary. It even undermines the ability of hard-working and law-abiding immigrant families to provide remittances to their loved ones, who may just happen to live abroad.”

Jeffries raised concerns with how the proposals in the bill would impact the economy and the federal government’s financial stability.

“Costs aren’t going down. They’re going up. Inflation is out of control. Insurance rates remain stubbornly high,” Jeffries said. “Our Moody’s rating, our credit rating, has been downgraded, and you’ve got people losing confidence in this economy. Republicans are crashing this economy in real time and driving us toward a recession.”

Ohio’s Warren Davidson and Kentucky’s Thomas Massie were the only Republicans to vote against passing the bill, which members debated throughout the night prior to the vote just after daylight in the nation’s capital. All Democrats, who dubbed it “one big ugly bill,” were opposed. Maryland GOP Rep. Andy Harris, chairman of the Freedom Caucus, voted “present.”

Massie spoke against the bill overnight, calling it “a debt bomb ticking.”

“I’d love to stand here and tell the American people: We can cut your taxes and we can increase spending, and everything’s going to be just fine. But I can’t do that because I’m here to deliver a dose of reality,” Massie said. “This bill dramatically increases deficits in the near term, but promises our government will be fiscally responsible five years from now. Where have we heard that before? How do you bind a future Congress to these promises?”

White House press secretary Karoline Leavitt said during a briefing later in the day that Trump wants Davidson and Massie to face primary challenges next year during the midterm elections.

“I believe he does,” Leavitt said. “And I don’t think he likes to see grandstanders in Congress.” 

In the works for weeks

The 1,116-page package combines 11 bills that GOP lawmakers debated and reported out of committee during the last several weeks.

The legislation would:

• Extend the 2017 tax law, including tax cuts for businesses and individuals;
• Bolster spending on border security and defense by hundreds of billions of dollars;
• Rework energy permitting;
• Restructure higher education aid such as student loans and Pell Grants;
• Shift some of the cost of the Supplemental Nutrition Assistance Program food aid program for low-income Americans to state governments; and
• Overhaul Medicaid, the nation’s program for health care for low-income people and some people with disabilities.

The bill would make deep cuts to Medicaid spending, reducing the program by $625 billion over 10 years under the latest estimate by the Congressional Budget Office.

The budget measure would also raise the debt limit by $4 trillion.

A new Congressional Budget Office analysis released late Tuesday showed the package tilted toward the wealthy, projecting it would decrease resources for low-income families over the next decade while increasing resources for top earners.

Republicans hold especially thin majorities in the House and Senate, meaning that nearly every GOP lawmaker — ranging from centrists who barely won their general elections to far-right members who are more at risk of losing a primary challenge — needed to support the bill.

Balancing the demands of hundreds of lawmakers led to nearly constant talks during the last few days as Johnson struggled to secure the votes to pass the bill before his Memorial Day deadline.

Any deal Johnson made with far-right members of the party risked alienating centrist GOP lawmakers and vice versa.

An agreement finally came together Wednesday evening when GOP leaders released a 42-page amendment that made changes to various sections of the package, including the state and local tax deduction, or SALT, and Medicaid work requirements and nixed the potential sale of some public lands.

Tax cuts

House debate on the package fell largely along party lines, with Democrats contending it would benefit the wealthy at the expense of lower-income Americans, including millions who would lose access to Medicaid.

Republicans argued the legislation is necessary to avoid a tax hike at the end of the year, when the 2017 GOP law expires, and to curb government spending in the years ahead.

Ways and Means Chairman Jason Smith, R-Mo., said the tax section of the package would halt a tax increase for many that would have taken place after the vast majority of the provisions in that law expire at the end of this year.

“Working families, farmers and small businesses win with this bill,” Smith said. “We expand and make permanent the small business deduction and increase the child tax credit, the standard deduction and the death tax exemption.”

The legislation would increase the tax rate for colleges and universities with substantial endowments, which would match the corporate tax rate, he said.

Massachusetts Democratic Rep. Richard Neal, ranking member on that tax-writing committee, said the legislation would lead the United States to “borrow $4 trillion and with interest payments over the next 10 years, $5 trillion, to justify a tax cut for the billionaire class.”

Neal said that the wealthy would see a greater benefit from the GOP tax provisions than working-class Americans.

“If you made a million dollars last year, you’re going to get $81,000 of tax relief. If you made less than $50,000 Guess what? Not quite so lucky,” Neal said. “But you know what? $1 a day goes a long way, because that’s where the numbers land.”

Neal said Democrats would have worked with Republicans to extend the 2017 tax cuts if the GOP had capped them for those making less than $400,000 a year, with people making more than that going back to the higher rate. 

Child tax credit

The child tax credit will increase to $2,500, up from the $2,000 enacted under the 2017 tax law. The refundability portion of the credit, or the amount parents could receive in a refund check after paying their tax liability, will remain capped but will increase with inflation by $100 annually. As of now, the amount a parent could receive back per child stands at $1,700.

While Republicans hailed the increase as a win for families, critics say it continues to leave out the poorest families as the refund amount is dependent on how much a parent earns. The credit phases in at 15 cents per income dollar, one child at a time.

“The Republican bill will leave out 17 million American children who are in families that don’t earn enough to receive the full child tax credit,” Rep. Suzan DelBene of Washington said Wednesday in the House Committee on Rules. Her amendment to make the tax credit fully refundable was rejected.

On the House floor Thursday morning, DelBene criticized the bill as a “big, broken promise.”

SALT

Republicans from high-tax blue states declared victory on the increase in the SALT cap, or the amount of state and local taxes that can be deducted from federal taxable income. After long, drawn-out disagreement, Republicans representing districts in California, New Jersey and New York secured a bump to $40,000, up from the $10,000 cap enacted under Trump’s 2017 tax law.

However, the cap comes with an income limit of $500,000, after which it phases down. Both the $40,000 cap and the $500,000 income threshold will increase annually at 1% until hitting a ceiling of $44,000 and $552,000.

Rep. Mike Lawler of New York said during debate that he “would never support a tax bill that did not adequately lift the cap on SALT.”

“This bill does that. It increases the cap on SALT by 300%,” Lawler said. “And I would remind my Democratic colleagues, when they had full control in Washington, they lifted the cap on SALT by exactly $0, zilch, zip, nada.”

Medicaid work requirements 

Energy and Commerce Chairman Brett Guthrie, R-Ky., said his panel’s bill would ensure Medicaid coverage continued for low-income families, individuals who are disabled and seniors through new work requirements and other changes.

“This bill protects coverage for those individuals by ensuring ineligible recipients do not cut the line in front of our most vulnerable Americans,” Guthrie said. “The decision by left-leaning state governments to spend taxpayer dollars on people who are ineligible for the program is indefensible. Medicaid should not cover illegal immigrants, deceased or duplicative beneficiaries, or able-bodied adults without dependents who choose not to work.”

The policy change would require those who rely on the state-federal health program, and who are between the ages of 19 and 65, to work, participate in community service, or attend an educational program at least 80 hours a month.

The language has numerous exceptions, including for pregnant people, parents of dependent children, people who have complex medical conditions, tribal community members, those in the foster care system, people who were in foster care who are below the age of 26 and individuals released from incarceration in the last 90 days, among others.

New Jersey Democratic Rep. Frank Pallone, ranking member on the committee that oversees major health care programs, said the Republican bill would not only cut funding for Medicaid, but also for Medicare, the program relied on by seniors and some younger people with disabilities.

“Republicans are stripping health care away from people by putting all sorts of burdensome and time-consuming road blocks in the way of people just trying to get by,” Pallone said. “The vast majority of people on Medicaid are already working. This is not about work. It’s about burying people in so much paperwork that they fall behind and lose their health coverage, and if someone loses their health coverage through Medicaid, this GOP tax scam also bans them from getting coverage through the ACA marketplace.”

While the GOP bill doesn’t directly address Medicare, he said, a federal budget law, known as the Pay-As-You-Go Act, would force spending cuts called sequestration to that health program.

“The Medicare cuts will lead to reduced access to care for seniors, longer wait times for appointments, and increased costs,” Pallone said.

States to share in food aid costs

House Agriculture Committee Chairman Glenn “GT” Thompson, R-Pa., pressed for support for his piece of the legislation, saying changes to the Supplemental Nutrition Assistance Program, or SNAP, are needed.

“SNAP is the only state-administered welfare program that does not have a cost-share component, and while the federal government funds 100% of the benefit, states are tasked with operating it,” Thompson said. “The only problem: They aren’t operating it well.”

He also cheered several of the package’s tax provisions, saying they would benefit farmers.

“The one big, beautiful bill makes permanent and expands the Trump tax cuts. It also prevents the death tax from hitting over 2 million family farms,” Thompson said. “It locks in the small business deduction, helping 98% of American farms stay afloat.”

Minnesota Democratic Rep. Angie Craig, ranking member on the panel, wrote in a statement that the proposed changes would “make America hungrier, poorer and sicker.”

“At a time when grocery prices are going up and retirement accounts are going down, we must protect the basic needs programs that help people afford food and health care,” Craig wrote. “As a mother and someone who needed food assistance at periods in my own childhood, I condemn this attempt to snatch food off our children’s plates to fund tax breaks for large corporations.”

Border security, air traffic control, EV fees

House Transportation and Infrastructure Chairman Sam Graves, R-Mo., said his piece of the package would combine “critical investments in border security, national defense and modernization of America’s air traffic control system, while eliminating wasteful spending and other deficit reduction measures.”

“Specifically, this bill addresses long overdue needs in the United States Coast Guard, which for over two decades has received less than half of the capital investment necessary to effectively carry out its critical missions,” Graves said.

The transportation section of the package, he said, includes $21 billion for the Coast Guard and $12.5 billion to modernize the air traffic control systems while establishing a $250 annual fee for electric vehicles and a $100 annual fee for hybrid vehicles that would go toward the Highway Trust Fund. That account has traditionally been funded through a gas tax. 

Washington Democratic Rep. Rick Larsen, ranking member on the transportation panel, said he wanted “to continue historic funding for transportation, infrastructure, and stronger and healthier communities.”

“Unfortunately, this reconciliation package leaves very little room for those investments,”  Larsen said.

“This bill causes immediate harm by yanking money from locally selected projects that our constituents in Republican and Democratic districts alike are counting on,” he added. “And for what? To help pay for the tax cuts for the richest Americans and largest and largest corporations.”

Student loan overhaul, medical research

House Education and Workforce Committee ranking member Bobby Scott, D-Va., urged opposition to what he called the “big, bad billionaires bill,” saying it would lead to a massive reshaping of higher education aid.

“The bill not only can increase the deficit, it has 4 million students who will lose their Pell Grants, 18 million children could potentially lose their free school lunch, 13.7 million people are set to lose their health care and everybody loses when the National Institutes of Health research is cut,” Scott said.

Natural Resources Committee Chairman Bruce Westerman, R-Ark., said his portion of the legislation would “generate over $20 billion in savings and new revenue for the federal government, primarily by direct royalty and lease fees from the sale of oil, gas, timber and mine resources, while curbing wasteful spending.”

“Our title reinstates onshore and offshore oil and gas lease sales, holds annual geothermal lease sales and ensures a fair process for critical mineral development nationwide,” Westerman said. “We’ve also directed the Forest Service and the Bureau of Land Management to utilize long-term timber sale contracts.”

The Trump administration released a Statement of Administration Policy on Wednesday urging GOP lawmakers to approve the legislation, when it still appeared several members of the party might delay or even block the bill in the House. 

“The One Big Beautiful Bill Act reflects the shared priorities of both Congress and the Administration,” the SAP states. “Therefore, the House of Representatives should immediately pass this bill to show the American people that they are serious about ‘promises made, promises kept.’

“President Trump is committed to keeping his promises, and failure to pass this bill would be the ultimate betrayal.”

From left, parents Jessica Seawright and Brooke Wampole talk with Sen. Tammy Baldwin about their concerns over the impact of Medicaid cuts on families with children such as theirs who have disabilities. (Screenshot/Zoom)

As members of Congress continue to debate the Republican budget reconciliation bill that includes hundreds of billions of dollars in cuts to Medicaid, Jessica Seawright ponders what that could mean for her young son.

Seawright is a social worker in Southeast Wisconsin. She’s also the mother of a 9-year-old boy with complex medical needs resulting from a genetic condition.

She and her husband — a college professor — have medical coverage through work, but with her son’s condition, which includes cerebral palsy, their health plans could never cover the degree of care he requires.

Medicaid has made the difference, Seawright said Wednesday. It’s helped through the Katie Beckett  program, which enables children with disabilities to have Medicaid coverage while living at home instead of being in an institution; the Medicaid children’s long-term support coverage; and Medicaid support that public schools receive to cover certain services that students with disabilities require.

Her son has been able to thrive living with her and her husband, Seawright said — but worry clouds the future.

“We look toward his adulthood, knowing that disability and aging programs that would support him staying in the community — where we, our family and our community, know he belongs — are being dismantled and defunded,” Seawright said. “Forcing us and others like us into medical bankruptcy is not a solution.”

Seawright was one of two parents who said Wednesday that their lives and their children’s lives could be profoundly upended by the Medicaid reductions that are included in the budget reconciliation proposal.

They spoke during a webinar conducted by Sen. Tammy Baldwin (D-Wisconsin), who has been an outspoken critic of the budget bill’s Medicaid cuts.

“Our neighbors, our friends and our colleagues at work who rely on Medicaid and are scared, really scared,” Baldwin said. She cited estimates produced by Democrats on the Joint Economic Committee that with cuts to Medicaid as well as to the Affordable Care Act, the legislation could reduce health care for nearly  14 million Americans, including almost 230,000 Wisconsin residents.

The money saved, she added, would be used to extend and expand tax cuts enacted in 2017, during the first Trump administration. The Center on Budget and Policy Priorities has said the tax cuts primarily favor the wealthy and corporations.

“It’s giveaways for their wealthy friends at the cost of Americans’ health and lives,” Baldwin said. “That’s the deal.”

Baldwin said the choice that U.S. House Republicans made to advance the bill in committee in the early hours of Wednesday morning was a sign that “Republicans know what they’re doing is deeply unpopular.”

She dismissed claims that the objective of the bill’s authors was to address waste, fraud or abuse in Medicaid and other safety net programs.

“I would be happy to come to the table to write a bill that truly gets at fraud and abuse,” Baldwin said. “We want that out of Medicaid. We want that out of Medicare. But that is not what this bill does. This bill terminates health care for Wisconsin families.”

Besides being a mother of a child who has been helped by Medicaid’s programs, Seawright has experienced Medicaid through two other lenses.

When she and her sister were growing up, their mother was relying on Medicaid for the family’s health care. That helped give the family stability so that her mom could go to community college, become a medical assistant and get full-time work in health care with insurance through her employer, Seawright said.

In her own job as a social worker, she added, some of the clients she works with have Medicaid.

Both her childhood experience and her role as a mental health provider have made her critical of proposals to cut Medicaid, Seawright said — especially one to add work requirements as a condition for adults considered “able-bodied” to enroll in Medicaid.  

“Creating more barriers for people to access the care they need … individuals losing their primary care providers and their specialists, from my perspective, is just a cruel response that is steeped in distrust of those of us who are doing the work day to day,” Seawright said.

Also on the webinar was Brooke Wampole, who lives in northern Wisconsin. She and her husband have a 4-year-old son who was found to have long delays in his development.

About two years ago he was screened and qualified for services and therapies covered by Medicaid programs for children with disabilities, and over time, his clinicians helped him first to “exist, to self-regulate, to see the world around him and not find it to be a threat,” Wampole said.

The family’s regular health insurance “could never cover the cost” those treatments required. “ Medicaid programs “have been absolutely instrumental in our lives.”

In the last year, her son has begun speaking one-syllable words. “My favorites or Mommy and Dada,” Wampole said, then added with a smile, “however, he is pretty partial to talking about trapezoids. And raisins.”

The thought of losing Medicaid coverage “is terrifying,” Wampole said — both because of the loss of services for her son, but also because of its impact on other families.

“I worry what our world looks like without Medicaid,” Wampole said. “Other families, they could be way worse off … and cutting Medicaid could hurt them even more than my family. I don’t want to be part of a system that contributes to that.”

Carol Chapin's son joins a protest in Madison to oppose cuts to the Medicaid program. (Photo courtesy of Carol Chapin)

This week, the U.S. House of Representatives and Wisconsin’s Republican members — U.S. Reps. Bryan Steil, Derrick Van Orden, Glenn Grothman, Scott Fitzgerald, Tony Wied and Tom Tiffany — are supporting a budget that would slash federal Medicaid funding by $790 billion, according to the latest Congressional Budget Office estimate. 

For my family, this isn’t just a number on a budget sheet somewhere in Washington. For us, it is deeply personal. These cuts have the potential to devastate our lives.

My son Liam lives with a developmental disability. Thanks to Medicaid — and more specifically, a category known as Home and Community-Based Services (HCBS) — he’s able to live independently in his own apartment. He receives support each day to help him manage meals, take his medications, and safely get to his two part-time jobs using paratransit.

He volunteers at a local food pantry. He makes art. He participates in community programs for people with disabilities. He takes community college courses and continuing education classes, and his goal is an associate’s degree in architectural technology. He’s proud to call Madison’s Eastmoreland neighborhood home.

All of this is possible because of Medicaid. But the Home and Community-Based Services that make his life possible are considered “optional” under federal Medicaid law. They’re on the chopping block if Congress moves forward with the proposed cuts.

If the federal government cuts its share of Medicaid funding, our state will face a painful decision. We will either use more state dollars to fill the gap, or make cuts — fewer people covered, fewer services, lower provider pay. For Liam and others, that means less support, fewer community programs and a greater risk of institutionalization. 

Even with Medicaid, it took our family years to find a supportive care agency with an opening. These services are already stretched to the limit. Some Republican members of Congress are advocating for hard caps on Medicaid costs which would further degrade these essential programs.

Medicaid is not just an insurance program. It is the infrastructure that makes independent living possible for people with disabilities. And it is already under strain. Here in Wisconsin, some disability advocacy organizations have gone months without federal funding due to administrative budget cuts. The signs are all around us: The safety net is fraying. 

If Congress ultimately cuts federal Medicaid spending, we will witness the unraveling of vital support systems: most critically, Home and Community-Based Services. For thousands of people like Liam, this would mean being forced from their homes, with many facing the possibility of institutionalization.

Keeping people in their homes has been a bipartisan issue for decades. Home and Community-Based Services are both significantly cheaper and more empowering for our community-members with disabilities. 

I urge our elected officials — especially those who have said they want to protect “the vulnerable” — to stop these irresponsible cuts to Medicaid. Liam’s life, and the lives of so many others in Wisconsin, depend on it.

The U.S. Capitol building in Washington, D.C., on May 7, 2025. (Photo by Jennifer Shutt/States Newsroom)

WASHINGTON — As House Republicans continue to wrangle over the “one big beautiful bill,” a new analysis released late Tuesday projects the massive reconciliation package would decrease resources for low-income families over the next decade while increasing resources for top earners.

The nonpartisan Congressional Budget Office estimates that the lowest-earning households in the United States would see incomes decrease 2% in 2027, moving to a 4% loss in 2033, as a result of spending cuts to nutrition assistance and Medicaid, the health insurance program for low-income individuals and those with disabilities.

The CBO projects resources would meanwhile increase by 4% for the highest-earning Americans in 2027, moving down to a 2% increase by 2033, according to the latest analysis.

The CBO score could change as hardline conservatives press Republican leadership for increased spending cuts to federal safety net programs as a way to pay for, at least in part, the extension and expansion of 2017 tax cuts that come with a price tag of $3.8 trillion.

Rep. Brendan Boyle, ranking member on the House Committee on the Budget, said in a statement late Tuesday that “Donald Trump and House Republicans are selling out the middle class to make the ultra-rich even richer.”

“This is what Republicans are fighting for—lining the pockets of their billionaire donors while children go hungry and families get kicked off their health care,” said the Pennsylvania Democrat.

The bill as written now would slash roughly $800 billion from Medicaid and Affordable Care Act provisions, and $300 billion from the Supplemental Nutrition Assistance Program, or SNAP, according to the left-leaning Center on Budget and Policy Priorities.

Lawmakers on the House Committee on Rules — the final stop for the 1,116-page package bill before it reaches a House floor vote — have been debating the measure since 1 a.m. Eastern Wednesday, while House Speaker Mike Johnson huddled separately with far-right deficit hawks.

Far-right members of the House Freedom Caucus remained skeptical the bill could reach the House floor by Johnson’s goal of Wednesday.

The Louisiana Republican leader also faces opposition from GOP lawmakers who represent high-tax blue states who want an even higher ceiling for the amount of state and local taxes, or SALT, their constituents can deduct from federal taxable income.

Lifting the ceiling, which lawmakers already proposed boosting from $10,000 to $30,000 for married couples filing jointly, will increase the cost of the bill.

Johnson needs nearly every GOP lawmaker to support the bill once it hits the floor as House Republicans have an extremely thin 220-213 majority.

President Donald Trump arrives with Speaker of the House Mike Johnson, R-La., for a House Republican meeting at the U.S. Capitol on May 20, 2025 in Washington, D.C. (Photo by Kevin Dietsch/Getty Images)

WASHINGTON — The U.S. House Republicans who have yet to rally behind the party’s “big, beautiful bill” huddled in the speaker’s office Tuesday as different factions tried to hash out agreement on taxes, Medicaid and a few other outstanding issues.

Speaker Mike Johnson, R-La., told reporters before those meetings began there were “a number of loose ends to tie up” with deficit hawks and members from high-tax states, who are pressing to raise the state and local tax deduction, also known as SALT.

“We got some hours ahead of us to work this out, and I’m very confident we will,” Johnson said. “I’m going to have a series of meetings that will begin right now in my office to try to tie up the final loose ends. This is a 1,100-page piece of legislation. We’re down to a few provisions so we are very confident, very optimistic we can get this done and stay on our timetable.”

Johnson hopes to pass the legislation this week, though he didn’t appear to have the votes as of Tuesday afternoon.

Trump pays a House call

The smaller meetings followed a closed-door huddle between all the chamber’s GOP lawmakers and President Donald Trump earlier in the day that didn’t quite have the intended effect of immediately convincing holdouts to vote for the bill.

Trump, however, appeared to declare victory before leaving the Capitol.

“I think we have unbelievable unity. I think we’re going to get everything we want,” Trump said after the morning meeting. “And I think we’re going to have a great victory.”

House Republicans have an extremely thin 220-213 majority, requiring nearly every GOP lawmaker to support the 1,116-page package in order for it to reach the Senate.

Getting SALT-y

The reconciliation bill currently proposes lifting the SALT cap from $10,000 to $30,000 for married couples filing jointly, with a phase-down for those earning $400,000 or more, but that’s not enough for Republicans from states most impacted by the aspect of tax law.

New York Republican Rep. Nick LaLota told reporters in the early afternoon that he would likely lose reelection if he can’t secure a better SALT agreement than what was on the table.

“If I do a bad deal, I would expect my constituents to throw me out,” LaLota said. “If I did a deal at $30,000, my own mother wouldn’t vote for me.”

LaLota said Republicans leaders should prioritize a deal that benefits swing voters to avoid the party losing centrist members and possibly the House majority in the 2026 midterms.

“If we win that one issue, they’ll have a much easier November of 2026. And thus we’ll be able to keep the House and do other fiscally responsible things for the next couple of cycles here, if we get this one issue right,” LaLota said. “Conversely, you get this issue wrong — you vote for a bad bill and you keep the cap low — those folks are getting thrown out of office, we lose the majority, and then we have an open border, then we have an impeached president, and then we have all the other things that America voted against.”

LaLota said later Tuesday, after GOP leaders proposed different SALT cap numbers, that there was still “no accepted deal, yet the parties are talking a little more with an understanding of each other’s position.”

“Leadership understands better what our pain threshold is,” LaLota said. “We clearly rejected the $30,000 number that’s in the Ways and Means bill.” 

He declined to say if the SALT Caucus was prepping a counteroffer for leadership, but said that staff were conducting “some research on some of the mixes of income caps and what SALT cap there would be and how much that would be valued at relative to the entire $4 trillion package.”

‘Bad faith negotiation’

Rep. Mike Lawler, a staunch supporter of raising the SALT cap for his constituents north of New York City, would not comment to reporters outside the speaker’s office about a specific dollar amount but said there’s an “improved offer” on the table.

“We’re waiting on more details. We’ll have more to say later,” Lawler said.

Speaking to Fox News in the hallway, he said, “I’m not going to sacrifice my constituents and throw them under the bus in a bad faith negotiation, which is what this has been by leadership and Jason Smith,” he said referring to the chair of the House Committee on Ways and Means.

“We need to come to an agreement. We need to provide real and lasting tax relief, and that’s what I’m fighting for, for my constituents. I respect the president … but I’ll respectfully disagree,” Lawler said.

Trump urged House Republicans Tuesday morning that raising the SALT cap benefits Democratic governors.

Conservatives still unhappy

Complicating negotiations, some far-right House Republicans remain opposed to the bill, saying it does not go far enough.

Rep. Chip Roy of Texas, who did not support the bill during a committee vote Sunday night, told States Newsroom Tuesday afternoon that his “concerns and problems still exist.”

Roy argues the massive reconciliation deal does not reduce deficit spending enough, particularly with respect to Medicaid and clean energy tax credits.

When asked whether lawmakers were approaching an agreement, Roy said “Not sure. We’re still talking. We’ve had literally like five meetings today already.”

Thune predictions

The House passing the package this week would only be one of many steps in the long, winding process.

Senate Majority Leader John Thune, R-S.D., said during a press conference Tuesday afternoon, just after Johnson spoke during a closed-door lunch, that changes to the package are expected in the upper chamber.

Thune said one of the major questions for GOP senators is whether the legislation holds “sufficient spending reforms to get us on a more sustainable fiscal path.”

“I think most of our members are in favor of a lot of the tax policy and particularly those portions of the tax policy that are stimulative, that are pro-growth, that will create greater growth in the economy,” Thune said. “But when it comes to the spending side of the equation: This is a unique moment in time and in history where we have the House and the Senate and the White House, and an opportunity to do something meaningful about government spending.”

Thune said that GOP senators would likely make “tweaks” to the tax provisions once the House sends over a package, especially around how long certain tax policy lasts.

“They have cliffs and some shorter-term timeframes when it comes to some of the tax policies,” Thune said. “We believe that permanence is the way to create economic certainty and thereby attract and incentive capital investment in this country that creates those good-paying jobs, and gets our economy growing and expanding, and generates more government revenue.”

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. 

A measure passed by the U.S. House Ways and Means Committee allows individual taxpayers such as waiters and waitresses to deduct qualifying tips earned throughout the year, a tax break that would end in 2028. (Getty Photos)

WASHINGTON — House Republicans advanced the tax portion of the “one big, beautiful” reconciliation package early Wednesday, a step forward in permanently extending, and in some cases expanding, the 2017 tax law and temporarily handing President Donald Trump a win on campaign promises like no tax on tips.

The House Committee on Ways and Means voted along party lines to pass the measure, 26-19, after nearly 18 hours of debate that went through the night. Republicans rejected numerous amendments offered by Democrats, including protecting tax credits meant to combat climate change enacted under Democrats’ own 2022 budget reconciliation law, the Inflation Reduction Act.

The marathon debate occurred as the House Committee on Energy and Commerce debated overnight and into Wednesday afternoon over deep budget cuts, including some to Medicaid assistance for low-income individuals, to pay for the cost of tax provisions.

As of now, the massive tax package is estimated to add $3.8 trillion to the budget deficit over 10 years, according to the nonpartisan Committee for a Responsible Federal Budget.

If any temporary expansions in the bill are eventually made permanent, it would add roughly $5.3 trillion to the deficit over the next decade, according to the CRFB. The official congressional budget score has not yet been released.

Overall the bill is “a very, very big tax cut,” said Howard Gleckman, senior fellow at the Tax Policy Center, part of the left-leaning Brookings Institution and Urban Institute. “Much of the benefit will go to higher income people.”

Tax brackets, business breaks would continue

The bill permanently extends the underlying tax provisions passed in 2017 under the GOP-backed bill titled the Tax Cuts and Jobs Act, which is set to expire in 2025.

This means:

• Individual taxpayers would remain in the same tax brackets that were lowered in 2017, and they would continue to see the doubled standard deduction — two of the most costly measures. Additionally, taxpayers will receive a boost up to $2,000 on the standard deduction through 2028.
• Individual brackets would remain at 10%, 12%, 22%, 24%, 32%, 35% and 37%, though the proposal would change how inflation adjustments are calculated, meaning income would be taxed less over time, except for those in the 37% bracket.
• The $2,000 child tax credit, per child, would remain permanent but temporarily increase to $2,500 through 2028. The refundable portion of the credit — meaning how much money taxpayers can get back — would be increased to $1,400, but the amount remains subject to income thresholds, meaning lower income households would receive less of a refund.
• The child tax credit would now only be accessible if the parent submits a Social Security number, as well as a spouse’s if legally married, in addition to the already required Social Security number of each qualifying child.
• On the business side, the corporate tax rate would stay at 21%.
• Business owners who run sole proprietorships, partnerships and S-corporations would see an increase, to 23% up from 20%, in the amount of business income they can deduct from their federal returns, otherwise referred to as the pass-through income deduction.
• Expensing for research and development would be restored through 2029, as well as deductions available to businesses for certain investments, including equipment purchases.

No tax on tips, but only for a few years

Trump promised on the campaign trail to eliminate taxes on tips, Social Security and car loan interest. House Republicans handed him a win in their bill, but only a limited one.

The bill allows individual taxpayers to deduct qualifying tips earned throughout the year, a tax break that would end in 2028. And like the new child tax credit requirement, taxpayers could only take advantage of the deduction by including a Social Security number on their federal tax return as well as their spouse’s SSN, if married.

No taxes on car loan interest would also go into effect through 2028, though taxpayers could only claim it for automobiles that received final assembly in the United States.

Senior citizens with incomes of $75,000 or less, or $150,000 for a married couple, would receive an extra $4,000 discount on taxable income, with the amount decreasing as incomes increase. The tax break would also expire in 2028. The bill does not specify an age for “seniors.”

Highly taxed states still unhappy 

House Republicans raised the cap on the amount of state and local taxes, or SALT, that can be deducted, but not enough to please both GOP and Democratic lawmakers who represent highly taxed states like New York and California.

Under the bill the committee advanced Wednesday morning, taxpayers could deduct up to $30,000 — three times the $10,000 ceiling in the 2017 law — from their federal taxable income. The full cap would apply to those making $400,000 or less in annual income but phases down for higher earners.

Raising the cap is costly and unpopular with lawmakers representing lower tax states.

Republican Reps. Mike Lawler and Nick LaLota of New York, and Rep. Young Kim of California, are threatening to vote no on the House floor if the cap isn’t raised. The House GOP cannot lose more than a handful of votes if all Republicans are present.

House Speaker Mike Johnson of Louisiana told reporters Wednesday he didn’t want to “handicap” negotiations by sharing details publicly and that he was talking to the SALT caucus until 1:30 a.m.

“But I will tell you I’m absolutely confident we’re going to be able to work out a compromise that everybody can live with,” he said.

A ‘tragic indifference’ for poor families

The committee’s party-line approval of the bill drew praise and criticism across organizations representing varying interests of Americans.

Kris Cox, director of federal tax policy for the left-leaning Center on Budget and Policy Priorities, wrote on social media that the temporary child tax credit bump does “zilch” for the roughly 17 million children whose parents do not earn enough money to receive a refund check from the credit.

“But it delivers an additional $500-per-kid to higher-income families,” Cox wrote.

The organization also slammed the bill for going “out of its way to take eligibility from 4.5 million US citizen kids who have at least one parent without an SSN.”

Kristen Crowell, executive director of the advocacy group Fair Share America, said in a statement Wednesday that the bill “shows a tragic indifference to the very real struggles of normal, working people.

“In order to save face in front of their constituents, Republicans are hiding behind misleading claims that everyone will see reductions in their taxes,” Crowell said.

The Natural Resources Defense Council, an environmental protection advocacy organization, estimates that phasing out and altogether eliminating clean energy tax credits would result in higher electricity bills in several states, including Ohio and Pennsylvania, according to an emailed statement.

‘Unshackle the economy’ for businesses

Groups representing businesses across the U.S. praised the House bill as a way to bolster investment and growth opportunities.

Former Republican Ways and Means Chair Kevin Brady of Texas released a statement Wednesday on behalf of the Alliance for Competitive Taxation praising the bill as a path to “unshackle the economy from burdensome taxes and unlock new growth.”

“The bill reported out by the House Ways and Means Committee is an encouraging step in that direction and, if implemented with its major pro-growth proposals intact, will help American businesses and workers compete at home and abroad,” Brady said.

The alliance hailed the extension of the 21% corporate tax rate and urged lawmakers to make permanent the research and development expensing, and capital investment deductions.

Kristen Silverberg, president and chief operating officer of the Business Roundtable, said her organization “applauds Chairman Smith and members of the House Ways and Means Committee for advancing a comprehensive, pro-growth tax bill,” referring to GOP Rep. Jason Smith of Missouri.

“Today’s vote is a critical step forward in securing a more competitive tax system for American businesses and workers,” said Silverberg, whose organization represents 200 CEOs of U.S.-based companies.

House Minority Leader Hakeem Jeffries holds a press conference May 13, 2025, at the U.S. Capitol in Washington, D.C. (Photo by Shauneen Miranda/States Newsroom)

WASHINGTON — Democrats Tuesday criticized House Republicans for their efforts to pass “one big, beautiful” bill to extend Trump-era tax cuts that would require potential cuts to food assistance and Medicaid.

“The American people do not support this extreme and toxic bill, and we’re going to hold every single House Republican who votes for it accountable,” said House Minority Leader Hakeem Jeffries, Democrat of New York, during a press conference.

As House Republicans push forward with the last three bills of their reconciliation package in committee this week, Democrats slammed the proposed work requirements for Medicaid, extending the 2017 tax cuts enacted during President Donald Trump’s first term and overhaul of the Supplemental Nutrition Assistance Program, or SNAP, in order to pay for the megabill.

The complex reconciliation process skirts the Senate filibuster and Republicans plan to pass the bill through a simple majority, meaning input from Democrats is not needed. 

Several House Democrats, such as Rep. Steven Horsford, Democrat of Nevada, called the legislation a “scam.”

Horsford, who sits on the Ways and Means Committee, said during a separate press conference with the advocacy group Popular Democracy that extending the 2017 Trump tax cuts would “gut Medicaid.”

Medicaid is the state-federal health care program for people with low incomes and certain people with disabilities, and has 71.3 million enrollees. 

“This would be the largest cut to health care in the history of our country,” Horsford said.

Rep. Judy Chu, Democrat of California, said only the ultra wealthy, such as billionaires, would benefit from reconciliation through tax cuts.

The cost of the tax proposal has not yet been released, but government deficit watchdogs estimated a wholesale extension would cost roughly $4 trillion over the next decade.

SNAP costs shifted in part to states

The House committees on Agriculture, Energy and Commerce and Ways and Means met Tuesday to debate and pass their bills.

The Agriculture panel seeks to hit as much as $290 billion in cuts by passing part of the costs of SNAP to states through a sliding pay scale, based on error rates.

States with the lowest error rates for SNAP benefits would only pay for 5%, while other states with higher rates could pay as much for 25% of food benefits. More than 42 million people rely on SNAP, which is currently completely funded by the federal government.

The Energy and Commerce bill would cut federal spending by $880 billion, such as by instituting work requirements for Medicaid for some able-bodied adults ages between 19 and 65.

House committees have already signed off on eight of the 11 bills that will make up the sweeping reconciliation legislation before the Budget Committee rolls the bills into one package. If all Republicans get on board, the House is on track to approve the entire package before the end of May.

Warnings of rising premiums, hospital closings

Senate Democrats slammed potential cuts and changes to Medicaid.

“Not only will millions of Americans lose coverage — for many others, their premiums will skyrocket,” Senate Minority Leader Chuck Schumer said at a press conference Tuesday.

“Hospitals — rural, urban and in between — will close,” the New York Democrat said. “Many, many people will lose their jobs, and many more will lose their health coverage. States will scramble with their budgets, and American families will be left out to dry.”

Oregon Democratic U.S. Sen. Ron Wyden also blasted the proposed cuts.

“What the Republicans do in their health care provisions in the reconciliation package is walk back health security for millions and millions of Americans,” he said.

“We’re for a tax code that gives everybody in America the chance to get ahead, that’s something that we’re going to battle for in this process,” said Wyden, the top Democrat on the U.S. Senate Committee on Finance.

Senate GOP

Some Republicans have also raised concerns about cuts to Medicaid, such as Missouri Sen. Josh Hawley, who wrote in an opinion piece in the New York Times that any cuts to Medicaid would be “both morally wrong and politically suicidal.”

But Senate Majority Leader, John Thune of South Dakota, said Tuesday that he feels “very good” about where House Republicans are on their bill and “where, ultimately, we are going to be on that bill as well.”

“We are coordinating very closely with our House counterparts at the committee level, at the leadership level, and we know they have to get 218 votes,” he said.

Thune said House Republicans will “do what it takes to get it done in the House, and when it comes over here, we will be prepared for various contingencies, obviously, one of which could be taking up the House bill and then offering a Senate substitute, but we’ll see what ultimately they’re able to get done.” 

Capitol Police remove a protester in a wheelchair from the House Energy And Commerce Committee hearing room during the committee markup of part of the budget reconciliation package on May 13, 2025 in Washington, D.C. (Photo by Jemal Countess/Getty Images for Protect Our Care)

WASHINGTON — The U.S. House committee tasked with overhauling energy policy and Medicaid to achieve $880 billion in spending cuts on Tuesday began what was expected to be a long, grueling session with debate on dozens of amendments.

Republicans on the panel argued during opening statements the proposed changes are necessary to realign several programs with President Donald Trump’s campaign promises and some long-standing GOP policy goals, primarily an extension of the 2017 tax cuts.

Democrats contend the legislation, one of 11 measures that will make up the GOP’s “big, beautiful bill,” would kick millions of people out of Medicaid, the state-federal program for lower income Americans, some people with disabilities and a considerable number of nursing home patients.

Energy and Commerce Committee Chairman Brett Guthrie, R-Ky., said the GOP bill is aimed at reducing waste, fraud and abuse within Medicaid “by beginning to rein in the loopholes, by ensuring states have the flexibility to remove ineligible recipients from their rolls and removing beneficiaries who enrolled in multiple states.”

“We make no apologies for prioritizing Americans in need over illegal immigrants and those who are capable but choose not to work,” Guthrie said. “Our priority remains the same: strengthen and sustain Medicaid for those whom the program was intended to serve — expectant mothers, children, people with disabilities and the elderly.”

Democratic New Jersey Rep. Frank Pallone, ranking member on the panel, rejected comments that the GOP bill was “moderate” and said it clearly was not aimed at addressing waste, fraud and abuse.

“Medicaid is a life-saving program that 80 million Americans count on every day,” Pallone said. “It provides health care to 1 in 3 Americans and nearly half of all children in the United States. It covers close to half of all births. And it’s the largest source of funding for long-term care for seniors and people living with disabilities. With this bill, Republicans are essentially telling millions of Americans, ‘Gotcha, no more health care for you.’”

Pallone added that Republican lawmakers were “intentionally taking health care away from millions of Americans, so they can give giant tax breaks to the ultra-rich, who frankly don’t need them.”

Just before Pallone spoke, several protesters in the room, including at least three people in wheelchairs, began chanting “No cuts to Medicaid” and were led out by U.S. Capitol Police, who charged 25 people with illegally demonstrating in the Rayburn House Office Building.

Photos of constituents

Democrats gave numerous opening statements at the start of the markup, each holding up a large photograph of one of their constituents on Medicaid and sharing stories of how the program helped them get or keep access to health care after complex diagnoses, like congestive heart failure, leukemia and cerebral palsy.

Democratic lawmakers expressed concern those people would lose access to the health care program if the GOP bill becomes law.

“You don’t just gut the largest insurer of low income Americans without real harm,” said Illinois Democratic Rep. Robin Kelly. “Call it what it is — abandonment, disinvestment and pure disregard for human life.”

Florida Republican Rep. Kat Cammack rebuked some of the Democrats’ comments, which she said sought to fearmonger and lie to people about what was in the GOP bill.

“The posters that our colleagues on the left have held up are touching. The stories, they’re very emotional. And I agree that we want to protect those most vulnerable,” Cammack said. “As a pregnant woman, I want to make sure that pregnant women, expectant mothers have access to resources around the country.”

Cammack added that “not a single person in those posters is going to be impacted by this legislation.”

Floor action as soon as next week

Republicans have already approved eight of the reconciliation bills in committee and are scheduled to wrap up work on the remaining three measures this week. The Ways and Means Committee began debating the tax bill shortly after Energy and Commerce began its markup, and the Agriculture panel was scheduled to begin its debate Tuesday evening.

Later this week, the House Budget Committee plans to bundle all 11 bills together and send the full package to the floor. The entire House is set to vote on the legislation before Memorial Day.

GOP leaders cannot afford much disagreement over the entire package, given their paper-thin majority in the House. If all of the current members are present at the vote, just three Republicans can oppose the package and still have it pass.

The same margin exists in the Senate, which is expected to make substantial changes to the package should the House approve the measure and send it across the Capitol.

$880 billion cut

The Energy and Commerce Committee’s bill up for debate Tuesday met the panel’s goal of cutting at least $880 billion in federal spending during the next decade, according to a letter from the nonpartisan Congressional Budget Office.

Congress’ official scorekeepers, however, hadn’t released their full analysis of the panel’s bill before the start of the debate and amendment process, known in Congress as a markup.

Once those details are made public, lawmakers and the voters who elected them will have a much more detailed look at how each of the proposed changes will affect federal revenue, spending and the number of people who could lose access to Medicaid.

Democrats released a CBO analysis last week showing the impact of various proposals, though Energy and Commerce GOP staff cautioned Monday during a background briefing that what they proposed in the actual bill didn’t completely align with those scenarios.

The bill would make considerable changes to Medicaid if the House and Senate approve the legislation as written, which seems highly unlikely, given objections from several GOP senators, including Missouri’s Josh Hawley.

The House legislation would require able-bodied people between the ages of 19 and 65 to work, participate in community service, or attend an education program for at least 80 hours a month. There would be exceptions for pregnant people, Medicaid enrollees with dependent children and people with complex medical issues, among other exclusions.

That provision would take effect on Jan. 1, 2029, according to an explainer on the bill from nonpartisan health research organization KFF.

States would be required to check eligibility for all Medicaid patients every six months, lowering the threshold from one year for people eligible for the program under the expansion in the 2010 Affordable Care Act. That would need to begin by Oct. 1, 2027.

Republicans are seeking to get the 12 states that allow immigrants without legal status into their Medicaid programs to change course by lowering the percent the federal government pays for those states’ expansion population enrollees from 90% to 80%. That would take effect Oct. 1, 2027.

The legislation seeks to block Medicaid funding for a narrow subset of health care providers who offer abortion services, which appeared to target Planned Parenthood.

The prohibition 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.

The Hyde Amendment allows federal funding for abortions that are the result of rape, or incest, or that endanger the life of the pregnant patient.

Planned Parenthood, SBA Pro-Life react

Planned Parenthood Action Fund President and CEO Alexis McGill wrote in a statement that defunding the organization and overhauling Medicaid would mean that “cancers will go undetected; it will be harder than ever to get birth control; the nation’s (sexually transmitted infection) crisis will worsen; Planned Parenthood health centers will close, making it significantly harder to get abortion care; and people across the country will suffer — all so the supremely wealthy can become even richer.”

SBA Pro-Life America President Marjorie Dannenfelser applauded the potential change to federal funding.

“It’s time to stop forcing taxpayers to fund the Big Abortion industry. Thanks to Speaker (Mike) Johnson and Energy and Commerce Committee Chairman Brett Guthrie, this year’s budget reconciliation bill contains the commonsense language to make that happen,” Dannenfelser wrote. “Taxpayers should never be mandated to prop up an industry that profits from ending lives and harming women and girls.”

More than 80 organizations, including the National Women’s Law Center and the Center for Reproductive Rights, wrote in a letter to congressional leaders that cutting off Medicaid funding for Planned Parenthood “would be catastrophic, shutting down health centers and stripping millions of patients across the country of access to essential and affordable health care.”

“In many communities, Planned Parenthood health centers are the only affordable provider with expertise in sexual and reproductive health,” the organizations wrote. “For those communities, the gap left by Planned Parenthood health centers would mean that many patients would have nowhere to turn for care.”

President of the American College of Obstetricians and Gynecologists Stella Dantas wrote in a statement the GOP’s changes to Medicaid might create challenges for pregnant patients seeking to access care and that some states may roll back their expansion of postpartum coverage from a full year.

“Pregnant patients who keep their coverage under Medicaid will still face challenges accessing care as labor and delivery unit closures escalate as a result of Medicaid cuts, leaving patients to travel longer distances to give birth,” Dantas wrote. “Ob-gyns are also concerned that the cuts will threaten the 12 months of postpartum coverage that we have fought so hard to achieve, and which will leave so many without access to medical care during the year after delivery when two-thirds of maternal deaths occur.

“Backsliding on our recent progress in increasing access to postpartum coverage puts lives at risk.”

American Public Health Association Executive Director Georges Benjamin wrote in a statement that House Republicans’ planned overhaul of Medicaid “does nothing to improve public health.”

“Instead, it would undermine much of the progress we have made to expand access to affordable, quality health insurance and implement other evidence-based measures to protect the public’s health,” Benjamin wrote. “We urge the House to reject this bill and instead work in a bipartisan manner on legislation to improve public health and expand access to health care for all Americans.”

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.

U.S. House Republicans are debating cutbacks to Medicaid, the health care program for lower-income Americans and some people with disabilities. (Photo by Thomas Barwick/Getty Images)

WASHINGTON — The Congressional Budget Office said Wednesday that potential major cuts and changes to Medicaid under consideration by Republicans could mean states would have to spend more of their own money on the program, reduce payments to health care providers, limit optional benefits and reduce enrollment.

The end result, under some scenarios, could be millions of Americans would be kicked off Medicaid and possibly left without health insurance, said the nonpartisan agency relied on by Congress for budget estimates.

The letter from CBO stemmed from a request by Senate Finance Committee ranking member Ron Wyden, D-Ore., and House Energy and Commerce ranking member Frank Pallone, D-N.J.

Both oppose GOP attempts to slash federal funding for the health care program for lower-income Americans and some people with disabilities. Republicans, who have not settled on an approach, say they are interested in ending waste, fraud and abuse in the program.

CBO Director Phillip Swagel wrote that possible Medicaid changes would likely lead to several outcomes in the states. The impact on states would occur because the federal government covers at least 50% of the cost of the program, with that share increasing in states with lower per capita incomes and those that expanded eligibility under the Affordable Care Act.

Wyden wrote in a statement the CBO letter showed “the Republican plan for health care means benefit cuts and terminated health insurance for millions of Americans who count on Medicaid.”

Pallone wrote in a statement of his own that reducing federal funding for the program by hundreds of billions of dollars would lead to “millions of people losing their health care.”

“(President Donald) Trump has repeatedly claimed Republicans are not cutting health care, but CBO’s independent analysis confirms the proposals under consideration will result in catastrophic benefit cuts and people losing their health care,” Pallone wrote. “It’s time for Republicans to stop lying to the American people about what they’re plotting behind closed doors in order to give giant tax breaks to billionaires and big corporations.”

The Medicaid changes would come as Republicans use the complex budget reconciliation process to move a sweeping legislative package through Congress with simple majority votes in each chamber, avoiding the Senate’s 60-vote filibuster, which would otherwise require bipartisanship. 

The House Energy and Commerce Committee, which is tasked with cutting at least $880 billion from the programs it oversees — including Medicaid — during the next decade, has yet to release its bill that if approved by the committee will become part of that package.

The panel, led by Kentucky Republican Rep. Brett Guthrie, is expected to debut its proposed changes next week before debating the legislation during a yet-to-be-scheduled markup.

Republicans plan to use the reconciliation package to permanently 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.

Five scenarios

CBO’s analysis looked at five specific Medicaid scenarios including:

• Congress reducing the federal match rate for the 40 states that expanded Medicaid eligibility under the Affordable Care Act, also known as Obamacare.
• Lawmakers eliminating a 6% threshold that exists for states that collect higher taxes from health care providers and then return that additional money in the form of higher Medicaid payments. CBO writes those “higher Medicaid payments increase the contributions from the federal government to states’ Medicaid programs.”
• Republicans creating a per-enrollee cap on federal spending.
• Congress establishing a cap on federal spending for Medicaid enrollees who became eligible for the program after their state expanded eligibility under the ACA.
• Lawmakers repealing two Biden-era rules that addressed the Medicare Savings Programs and standardized how states approached enrollment and renewals.

The analysis said states could raise taxes or cut spending on other programs to replace the lost federal revenue that would coincide with the first four scenarios, though CBO “expects that such steps would prove challenging for many states.”

“In CBO’s view, different states would make different choices regarding how much of the reduced Medicaid funds to replace,” the analysis states. “Instead of modeling separate responses for each state, the agency estimated state responses in the aggregate, accounting for a range of possible outcomes.”

Overall, CBO expects state governments would be able to replace about half of the lost federal revenue and that they would “reduce provider payment rates, reduce the scope or amount of optional services, and reduce Medicaid enrollment” to address the other half.

Alternatives studied

The first scenario, where lawmakers reduce the federal matching rate for expanded Medicaid populations, would save the government $710 billion during the next decade.

But in 2034, CBO expects that “2.4 million of the 5.5 million people who would no longer be enrolled in Medicaid under this option would be without health insurance.”

CBO wrote that in the second, third and fourth scenarios, “Medicaid enrollment would decrease and the number of people without health insurance would increase.”

The second scenario of limiting state taxes on health care providers would save the federal government $668 billion during the 10-year budget window. It would lead to 8.6 million people losing access to Medicaid with a 3.9 million increase in the uninsured population by 2034.

The third projection that looked at a federal cap on spending per enrollee would reduce federal spending by $682 billion during the next decade. A total of 5.8 million people would lose Medicaid coverage and 2.9 million would become uninsured under that proposal. 

And the fourth scenario, where Congress caps federal spending per enrollee in the expansion population, would cut the deficit by $225 billion during the next 10 years. More than 3 million people would lose Medicaid coverage and 1.5 million would become uninsured under this scenario.

Under the fifth scenario, where GOP lawmakers would change two Biden-era rules, CBO expects that the federal government would spend $162 billion less over the 2025–2034 window.

“CBO estimates that, in 2034, 2.3 million people would no longer be enrolled in Medicaid under this option,” the letter states. “Roughly 60 percent of the people who would lose Medicaid coverage would be dual-benefit enrollees who would retain their Medicare coverage.” 

From left, Megan Hufton, Laurel Burns and Abigail Tessman take part in a roundtable discussion about Medicaid with Sen. Tammy Baldwin, right. The discussion was held Friday, May 2, 2025, at Common Threads, a Madison agency that provides Medicaid-supported services for people with autism and people with disabilities. (Photo by Erik Gunn/Wisconsin Examiner)

Update: GOP leaders in Congress have postponed the release of their proposals for Medicaid, originally scheduled for the week of May 5. 

Ahead of action on Congressional legislation that could provide the first hard details on proposed cuts to Medicaid, Wisconsin lawmakers are urging constituents to push back against cutting health care coverage.

“One of the most powerful things we can do right now is to elevate stories and talk about how compelling a need there is for robust investment in the Medicaid program,” Sen. Tammy Baldwin told a group of Medicaid recipients at a roundtable discussion in Madison on Friday.

Republicans in Congress are trying to extend federal tax cuts enacted in 2017, during President Donald Trump’s first term. Unless renewed, the 2017 tax cuts will expire at the end of 2025.

Congressional Republicans want to offset $4.5 trillion that extending the 2017 tax cuts will add to the federal deficit over 10 years. Based on their original blueprint, Medicaid has been in the spotlight as a likely target, and this week GOP leaders in the U.S. House are expected to release their first concrete proposals.

Medicaid covers about 1.3 million Wisconsin residents — roughly one in five people in the state, according to the state Department of Health Services (DHS). Those include nearly 900,000 low-income people who have primary health care and hospital services though BadgerCare Plus.

More than 260,000 people who are elderly, blind, or have other disabilities have coverage through Medicaid, including for long-term care in nursing homes or in their own homes or the community. And another 244,000 Wisconsinites have Medicaid coverage through a variety of other special programs.

Extending the 2017 tax cuts will benefit the richest 1% of the population most, the Institute on Taxation and Economic Policy (ITEP) found.

“In order to give tax breaks for the rich, what do they want to cut? Medicaid. It’s one of the biggest targets,” Baldwin, a Democrat, told participants in the Madison roundtable. “So from the folks who are most vulnerable, to transfer money to those who are billionaires and millionaires and multi-millionaires — it is criminal in my mind. It’s immoral.”

Baldwin’s event was one of two held Friday to highlight Medicaid’s importance in Wisconsin. In Eau Claire, state Rep. Jodi Emerson (D-Eau Claire) convened a discussion that included providers and Medicaid recipients.

Emerson’s discussion was joined via Zoom by Chiquita Brooks-LaSure administrator of the Centers for Medicare & Medicaid Services (CMS) under former President Joe Biden

“These attacks on the Medicaid program can be devastating if they go through,” Brooks-LaSure told the Wisconsin Examiner in a phone interview. “Not just for the millions of low-income people who need help, not just for the millions of middle-class families who depend on Medicaid — particularly for nursing home care, care in the home to keep you out of the nursing home, and children with special needs, whether it be autism services, whether it be developmental disabilities or physical disabilities.”

The existence of Medicaid helps the overall health care economy in the long run, Brooks-LaSure said.

Under federal law, hospitals must ensure that patients who show up in their emergency rooms are stable before they leave. But if a person’s care isn’t covered, “the entire health care system pays for that.”

Medicaid recipients who met with Baldwin described their anxiety over the prospect of losing coverage.

For Laurel Burns, who was born with no arms, Medicaid has enabled her to have health care for herself and for her two sons, now teens, whom she’s raised as a single mother after their father left.

“Being disabled has been a struggle my whole life. It’s like every twist and turn is up a steep hill,” Burns told Baldwin. Medicaid support, however, has enabled her to have health care at home, including needed assistance with grocery shopping and housekeeping.

She has been able to get a college degree and landed a part-time job working for an insurance agent.

“I would love to work full time, but the job market and being disabled is really difficult to navigate,” Burns said. “With all these cuts and threats to the program, it’s really scary for somebody like me who doesn’t have a large family.”

Megan Hufton, the single mother of two teenage boys who have autism and don’t speak, said that in addition to the support Medicaid has provided her sons as part of the program’s disability services, schools get Medicaid support to help pay for services such as occupational therapy. “I’m very nervous about the future,” Hufton said.

Baldwin’s discussion was held at Common Threads, a Medicaid-funded agency in Madison that provides mental health, rehab and alternative education services.

Liv Lacayo, who works with Common Threads clients and their families, said Medicaid enables them to get routine care so they don’t have to use emergency services as they might have to otherwise.

Without Medicaid, she said, she worries that families would be struggling for support.

Brett Maki, who must use a motorized wheelchair to get around, said Medicaid has made it possible for him to live independently, getting daily help with cooking, cleaning and laundry — “all of the basic necessities that I would need to live my life to the fullest.”

Without that, “I don’t even want to think about what that means,” he said.

A poll released Thursday, May 1 showed 76% of Americans oppose cuts to Medicaid. (Photo via Getty Images)

WASHINGTON — A majority of Americans, including most Republicans, oppose major cuts in federal funding for Medicaid, according to a poll released Thursday by the nonpartisan health research organization KFF.

The survey shows that 76% of those questioned wouldn’t support  Congress slashing the amount of spending dedicated to the state-federal health program for lower-income Americans and some people with disabilities.

Democrats held the highest rate of opposition at 95%. A small majority of Republicans surveyed, 55%, said they don’t support substantial federal spending cuts for the program.

The breakdown was nearly even among respondents who identified as Make America Great Again supporters — President Donald Trump’s base — with 51% of that group saying they support less federal funding for Medicaid and 49% saying they oppose major cuts to the federal allocation.

The survey comes just days before House Republicans are expected to release a bill that will likely propose cutting hundreds of billions in federal funding for Medicaid.

That legislation, as well as bills from several other committees, is supposed to help Republicans offset some of the $4.5 trillion deficit impact that comes with extending the 2017 tax law.

The KFF poll also showed strong opposition to slashing federal funding to other health care programs — 74% were against cuts to states for mental health and addiction prevention services, 71% didn’t support reducing federal spending to track infectious disease outbreaks, 69% opposed limiting federal dollars for research at universities and medical centers, 65% were against cuts to HIV prevention program allocations and 65% didn’t support reducing federal funding to help people buy health insurance through the Affordable Care Act.

Polling of 1,380 U.S. adults took place from April 8 to April 15 via telephone and online. The margin of error is plus or minus 3 percentage points.

Senate GOP watching House action

Senate Republicans are closely watching how their House colleagues restructure federal funding for Medicaid, and will likely propose changes when the entire 11-bill package comes over from the House later this year.

Several GOP senators told reporters at the Capitol on Wednesday they will judge the package based on how changes to Medicaid will impact their constituents.

Missouri Sen. Josh Hawley said he’s unlikely to support any changes to Medicaid that “will result in cutting benefits or denying eligibility for people who are otherwise working.”

“I’m all for work requirements,” he said. “I don’t think you get any Republican objection to that.”

But Hawley said going beyond that might be pressing the issue too far to get his vote.

“I just met with the governor of my state this morning. He’s in town. We just sat down and we talked about this issue,” Hawley said, adding that Gov. Mike Kehoe, a Republican, was “very worried about” potential changes to federal Medicaid funding.

Maine Sen. Susan Collins said she’s planning to evaluate the House bill once it makes it through that chamber based on “the impact on low-income seniors who are dual eligible, families with children with disabilities, low-income families, our rural hospitals, healthcare providers.”

Dual eligibility refers to people who are on Medicare and Medicaid.

“I am open to carefully crafted work requirements for able-bodied adults who do not have preschool children,” Collins said. “But I have no idea what the package is going to contain at this point.”

Kansas Sen. Jerry Moran said he’s told his chamber’s Republican leadership that “Medicaid is an important issue” for him in determining whether he votes for the entire package once it’s on the floor.

“I’m going to look at overall how it impacts citizens, particularly people with disabilities, and how it impacts my state and the hospitals that provide services to people in Kansas,” Moran said.

North Dakota Sen. John Hoeven said “the challenge is going to be to find savings in line with what the president has described.”

“He said he doesn’t want any cuts to Medicaid,” Hoeven said. “But how do you make sure that you eliminate waste, fraud and abuse? And that the folks that should be getting it are getting it, rather than an able-bodied person who should be out there working and is able to do that and take care of themselves.”

Getty Images

Major cuts to Medicaid under discussion in Congress would harm patients, the health care system and the economy in Wisconsin, the state health department said in a report Monday, likely increasing health care costs in the long run rather than saving money.

Depending on what route the federal budget takes to reduce spending on the program, it could cost the state up to $16.8 billion over 10 years, according to the report from the Department of Health Services (DHS).

Medicaid — jointly  funded by the federal and state governments — provides health care coverage for low-income Wisconsinites as well as long-term care for elderly people and people with disabilities.

GOP leaders in the U.S. House of Representatives are looking for ways to cut $880 billion from programs under the supervision of the House Energy and Commerce Committee. The budget plan hasn’t taken formal shape. Because Medicaid is the single largest program in the committee’s budget portfolio, however, “substantial impacts to Medicaid and other health programs are unavoidable,” the report states.

In Wisconsin Medicaid covers about 1 million Wisconsin residents up to the age of 65 for primary health care through BadgerCare Plus. It also covers long-term care for people with disabilities and the elderly under a variety of different programs. Medicaid covers 20% of state residents and 40% of births, along with 38% of Wisconsin children and 60% of state residents in nursing homes.

“Medicaid is an important part of our health care infrastructure,” said Wisconsin Medicaid Director Bill Hanna at a DHS press conference Monday.

One possibility the report considers is a cap on federal coverage for each Medicaid patient.

Currently the federal share is 60% of the health care costs incurred by Wisconsin Medicaid recipients, with the state paying the remaining 40%. “This arrangement allows state budgets to cope with unforeseen circumstances, such as economic downturns or faster-than-expected medical cost growth,” the DHS report states.

The report states that a per-person ceiling on Medicaid costs, which Congress is reportedly considering, “would squeeze state budgets and put Wisconsin taxpayers on the hook if medical costs rise quickly, with cuts to benefits and cuts to provider payments.”

Hanna said that there remains “a lot of unknowns” in how Congress might structure a payment system with a ceiling. The report considers various scenarios under a cap, including low, medium and high increases in health care costs.

Over 10 years, Wisconsin could lose anywhere from $6.4 billion to $16.8 billion, DHS projects.

Other Congressional proposals include adding higher barriers to Medicaid coverage — primarily through a work requirement.

Work requirements have long been found to eliminate eligible people from Medicaid because of the additional burden to demonstrate that they are eligible.

“Adding an additional burden for this population will certainly result in fewer people making it through, even if they are working, just struggling with the paperwork pieces,” Hanna said.

According to the report, Wisconsin Medicaid enrolled about 191,000 childless adults per month in late 2024. Nearly half of them would be exempt from a work requirement.

“It is unknown how many people would lose coverage simply because it would be difficult to report their hours or wages,” the report states. It calculates that about 52,000 people “would be at the highest risk for losing eligibility.”

Reducing the Medicaid rolls through a work requirement, however, will carry other costs, the report argues.

“It’s not like these people disappear,” Hanna said.  “They still need care that now they just won’t have the insurance [to cover]. Meaning hospitals again will be picking up additional costs, which gets passed on to all health care consumers.”

A third approach Congress is said to be considering would reduce the federal government’s share of the cost to run Medicaid programs. That could cost Wisconsin up to $93 million, the report finds.

While congressional leaders have pointed to data on “improper payments” in Medicaid in defense of cuts and say they’re targeting “waste, fraud and abuse,” Hanna said members of Congress are  conflating two sharply different issues.

“Improper payments are not fraud, waste and abuse,” Hanna said. “Improper payments are often documentation errors that can be for any number of reasons.”

Wisconsin’s last Medicaid audit — required every three years — found an improper payment rate of 0.5%, which was due to clerical errors.

“In Wisconsin, you’re definitely not going to find significant savings” in the form of ineligible people getting covered, he said. “We have a very robust system in Wisconsin with very few errors.”

Facing substantial federal reductions, the state has four policy options, Hanna said: putting in more state funds to keep the program the same; restricting eligibility, so there are fewer Wisconsinites covered; cutting some services that Medicaid now pays for; or cutting what Medicaid pays to doctors, hospitals and other providers.

If the state pays more, then it will have to raise taxes or divert funds from other priorities. But each of the alternatives has other consequences, Hanna said.

Cutting provider rates “would have major impacts on our state’s health care system,” the DHS report states, with hospitals offsetting those by charging other payers more.

If fewer people are eligible for Medicaid, the rate of uninsured people in Wisconsin will increase, potentially driving up health care costs as well.

“Uninsured rates going up means more uncompensated care” for hospitals and other health care providers, Hanna said.

Reducing the services that Medicaid covers, however, would likely mean that people put off getting health care until an illness or condition gets worse, he said — “which ultimately means we end up spending more.”