Changes a U.S. House bill makes to the federal program known as FoodShare in Wisconsin would increase costs for the state, the state Department of Health Services (DHS) reports. (Getty Images Creative)

Food and nutrition cuts in the reconciliation bill that passed the U.S. House early Thursday would cost Wisconsin taxpayers at least $314 million if they are signed into law, a state health official said Thursday.

A requirement for the state to pick up some of the costs of the federal Supplemental Nutrition Assistance Program benefits, a provision penalizing the state for errors in distributing benefits, expanded work requirements for recipients and the elimination of a nutrition education program will all contribute to that cost, said Bill Hanna, Medicaid director at the Department of Health Services (DHS) in a briefing for reporters Thursday afternoon.

The SNAP program is known as FoodShare in Wisconsin and administered by DHS.

SNAP currently includes a work requirement for adults ages 18 to 54 without children to receive benefits. The legislation would raise the upper age to 65 and add the requirement to adults with children who are 7 or older.

Wisconsin has an employment and training program to help FoodShare recipients meet the existing work requirement. With the increase in people who would have to meet the requirement, “We estimate that would cost another $44 million a year,” Hanna said.

Currently the federal government funds 100% of the food benefits under SNAP. The new bill requires states to pick up a portion of the cost, which is tied to a state’s error rate, Hanna said. Errors include the payment of more benefits than a person qualifies for or the payment of fewer benefits than they qualify for.

“When errors are identified, we correct them, meaning if there was an overpayment to a member, that is recouped on future benefits, or if there’s an underpayment, we fix that and back pay those payments,” Hanna said.

Wisconsin’s error rate is low enough to require the state to submit only a 5% match for SNAP funds under the House Republican proposal, he said. But another change — which would allow zero tolerance even for errors that in the past have not counted against state programs — would boost the state’s required match to 15%.

DHS estimates based on the proposed new requirements the state would have to pay about $207 million a year in benefit costs, he said. If the state is able to reduce its error rate to qualify for the 5% match, it would still need to pay $69 million a year.

A higher state share of administrative costs in the bill would add $51 million to the state’s costs for SNAP, Hanna said.

The state would also lose the $12 million it receives for SNAP-Ed, a program that provides education to SNAP participants on healthier food choices.

GET THE MORNING HEADLINES.

SUBSCRIBE

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.”

GET THE MORNING HEADLINES.

SUBSCRIBE

Reading Time: 2 minutes

Last week, our newsroom was intrigued by data in this Economist article showing that Wisconsin stands out nationally when it comes to its low vaccination rates for measles. It prompted a discussion about the many reasons for vaccine hesitancy and the complex challenges of maintaining trust in public health. 

One thing is clear: Measles is a very infectious disease, and it’s spreading nationwide. 

As of May 15 officials had confirmed 1,024 measles cases — including more than 100 hospitalizations — across 31 states, according to the U.S. Centers for Disease Control. 

Officials in 2025 have tracked almost as many measles outbreaks (defined as three or more related cases) as they did in all of 2024. Three deaths this year have been linked to measles. They included two unvaccinated school-aged children in Texas and an unvaccinated adult in New Mexico. 

The outbreaks come as vaccination rates decline nationwide, particularly in Wisconsin. The measles, mumps and rubella vaccine rate for Wisconsin kindergartners has plunged since 2019. But even before the COVID-19 pandemic, no county in Wisconsin had more than a 90% vaccination rate, which is traditionally associated with “herd immunity.” 

Wisconsin, The Economist article noted, “is among the most permissive states for vaccine exceptions in schools, allowing opt-out for personal-conviction reasons (along with medical and religious exemptions, which most states have); parents only have to submit a written note.”

Still, Wisconsin has yet to see a measles outbreak this year. As we consider how to report on this issue, let us know what you think. 

Do you have questions about measles, its vaccine or how to keep your family safe? Or do you have perspectives to share about prevention efforts in your community? 

If so, fill out this brief form. Your submissions will shape the direction of our reporting and will not be shared publicly. 

Help Wisconsin Watch report on measles prevention is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

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.

GET THE MORNING HEADLINES.

SUBSCRIBE

SEIU Wisconsin and UnityPoint Health-Meriter hospital will meet May 29 to resume contract talks covering 950 nurses. But the hospital management and the union have given conflicting accounts about plans for earlier negotiations. (Wisconsin Examiner photo)

SEIU Wisconsin and Meriter hospital management confirmed Wednesday plans to meet on Thursday, May 29 to resume negotiation on a new contract covering about 950 nurses.

Talks ended Monday without an agreement, and the union said it would go forward on Tuesday, May 27, with a five-day strike.

On Wednesday, however, the two parties gave contradictory accounts of the conclusion of their talks and the prospect of further negotiations before the walkout begins.

In Meriter’s initial statement on Tuesday after the strike was announced, the hospital reported that a bargaining session was scheduled for Monday, May 26.

In a statement Wednesday, however, the union bargaining committee said they had never scheduled talks for that day.

UnityPoint Health-Meriter issued an updated statement Wednesday asserting that “SEIU Wisconsin notified Meriter on Tuesday that they are no longer available to meet on May 26 and are now offering May 29 as their first available date to resume negotiations.”

The management statement quoted Meriter’s vice president of human resources Shana Wuebben: “SEIU Wisconsin has declined the bargaining session previously set for Monday, May 26 and has rescheduled bargaining sessions to Thursday, May 29 near the end of the 5-day strike period,” Wuebben said.

The bargaining committee flatly disputed the characterization that the Monday date had been agreed to.

“There was no agreement between the parties to meet on Monday May 26,” the committee’s statement said.

In the hospital’s statement, Wuebben said, “Meriter is listening. We have made great strides in our proposals and tentative agreements to date.  And we are ready to continue bargaining.”  

The union, however, charged that management — not the union — was responsible for ending the talks Monday.

“At our last bargaining session on Monday May 19, the union bargaining committee offered to stay as late as needed to reach an agreement,” the bargaining committee statement said.

“The union was clear that management needed to make movement on our core priorities — priorities we have been crystal clear about since Day 1 — in order to avoid a strike,” the committee said. “Instead of engaging in discussions about our priority issues, management chose to end the bargaining session.”

Wuebben reiterated that Meriter’s management negotiators are “ready to return to the bargaining table at any time.” 

The union statement said bargaining team members are also ready to return to the table, but said they would need to see evidence that management was willing to move on their issues relating to staffing ratios, stronger hospital security and compensation.

“The union bargaining team has consistently made themselves available to meet with Meriter management, and we will continue to do so,” the union statement said. “If Meriter management would commit to make meaningful movement on our priority issues before the strike, we would consider scheduling a meeting with them before Tuesday May 27.”

GET THE MORNING HEADLINES.

SUBSCRIBE

Reading Time: < 1 minute

Transgender people – those who have a gender identity that differs from the sex assigned to them at birth – are not considered by medical authorities to have mental illness simply because they are transgender.

In 2013, the American Psychiatric Association revised its mental disorders manual and no longer listed being transgender as a mental disorder. 

“Gender identity disorder” was eliminated and replaced with “gender dysphoria.”

Gender dysphoria is a diagnosis for the distress experienced by some whose gender identity conflicts with their sex assigned at birth.

Numerous medical groups, including the World Health Organization, have stated that being trans is not a mental disorder.

U.S. Rep. Nancy Mace, R-S.C., suggested May 17 at the Wisconsin Republican Party convention that being trans is a mental illness. She said “women shouldn’t be forced to share” facilities such as bathrooms “with mentally ill men.” 

Her campaign spokesperson did not provide information to support Mace’s reference to mental illness.

This fact brief is responsive to conversations such as this one.

Sources

• Mayo Clinic: Transgender facts
• NBC News: Being transgender no longer a 'mental disorder': APA
• American Psychiatric Association: Gender Dysphoria Diagnosis
• Wisconsin Watch: What gender-affirming care means to these Wisconsin families
• World Health Organization: Gender incongruence and transgender health in the ICD
• PolitiFact: Vivek Ramaswamy got it wrong; being trans isn’t a mental health disorder
• WisconsinEye: 2025 Republican Party of Wisconsin State Convention

Is being transgender classified as a mental illness? is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

Pat Raes, a Meriter hospital nurse and president of SEIU Wisconsin, addresses union nurses and their supporters at a rally April 8, 2025. On Tuesday the union announced it would strike starting May 27. (Photo by Erik Gunn/Wisconsin Examiner)

Nurses at Madison’s Meriter hospital plan to walk off the job for five days starting Tuesday, May 27, after negotiations on a new union contract ended Monday night without an agreement.

The hospital management and Service Employees International Union (SEIU) Wisconsin, which represents about 950 nurses at the hospital, are divided over pay, security provisions and whether the hospital should commit to specific ratios of how many patients are under a nurse’s care.

If the strike goes forward, it is scheduled to last for five days, with union members returning on Sunday, June 1.

Update: In a statement Tuesday, Meriter said there was a bargaining session scheduled for Monday, May 26, the day before the strike is scheduled to start. An SEIU Wisconsin spokesperson said Wednesday that the union never agreed to that session, and that a bargaining date has been scheduled for Thursday, May 29.

In order to allow hospitals to secure temporary replacement staff or move patients, federal law requires hospital workers to give at least 10 days notice before striking, which SEIU Wisconsin gave May 9. The union also opted for a fixed duration for the walkout.

“We don’t take going on strike lightly, but we truly feel in order to make the changes that are necessary we’re willing to fight to make things safe for our patients,” said Pat Raes, a long-time Meriter nurse and also president of SEIU Wisconsin, in an interview May 14.

“We’ve called a five-day strike because our goal isn’t to walk away from the table — it’s to make UnityPoint Meriter finally hear the voices of nurses,” Raes said Tuesday. “This timeline reflects the urgency of our demands while giving the hospital every opportunity to return to negotiations in good faith.”

She said the five-day window was chosen to match the standard five-day contract used by health care staffing agencies, such as would be called to cover the striking nurses, “to send a strong, clear message without unnecessary disruption to patient care. We hope Meriter uses these five days to come back with real solutions.”

The hospital, UnityPoint Health-Meriter, is one of 17 regional hospitals in the large, Iowa-centered nonprofit health care chain, UnityPoint Health.   

“We’ve been in a union environment for decades and know that a strike could happen. We always work very, very hard to avoid that,” said Sherry Casali, market chief nursing officer for the hospital, in a statement released to the press Tuesday. “I think both parties would prefer not to have a strike.”

The hospital statement said Meriter’s management was disappointed there were not more talks prior to Monday. “Meriter leadership will remain available throughout this week to return to the table and we encourage SEIU to do the same,” the statement said.

In past years, the union and the hospital have worked with federal mediators during contract talks. This year federal mediation wasn’t available after President Donald Trump issued an executive order in March gutting the Federal Mediation and Conciliation Service (FMCS), nursesan independent federal agency.

Although that order was blocked by a federal judge May 6, the union and hospital turned instead to the Wisconsin Employment Relations Commission.

Defined patient-nurse ratios have been a longtime goal for union nurses. California and Massachusetts both have state laws setting certain minimum ratios, according to  NurseJournal.org. A limited number of other states require hospitals to publish their nurse-to-staff ratios.

“The more patients you take care of once you get above that ratio puts every patient that you’re taking care of at higher risk for complications and higher risk for mortality,” Raes said.

The statement the hospital issued Tuesday acknowledged that “both parties agree on the importance of safe and effective staffing,” but said that mandated ratios “limit flexibility” and could make it more difficult “to adjust to patient needs and staff availability in real time.”

The hospital statement said the facility relies on its charge nurses, who “are key to staffing and have clear avenues to discuss any patient care needs throughout each shift.”

There are limits to flexibility, however, according to the members of the nursing staff. Flexibility “sometimes works and sometimes doesn’t,” said Amanda Husk, a postpartum nurse. “We just know there’s always a base need for nurses to make sure patients are safe.”

Husk said ensuring that the ratio of nurses is always sufficient “also prevents burnout and turnover of nurses. That’s a big deal.”

Raes said nurses also wanted stronger security measures — including metal detectors — in light of violent incidents at hospitals across the country that have led to injuries or deaths of health care workers.

The hospital’s statement said its security staff regularly updates security measures and plans additional unspecified changes this summer.

On pay, Raes said that while nurses in their first 12 years have had significant raises, those at the upper end of the scale for pay and longevity don’t see their pay keeping up.

The shift to a 401(k) retirement plan from a standard pension has diminished the incentive for more experienced nurses to stick around, said Raes, while the original pension plan encouraged longevity on the job.

Meriter’s statement said the hospital’s most recent pay offer would keep its nurses “some of the best-paid nurses in Wisconsin” as well as in Madison. 

This report was updated Wednesday with new information about when upcoming bargaining is to take place. 

GET THE MORNING HEADLINES.

SUBSCRIBE

Reading Time: 8 minutes

This story was originally published by The 19th.

Jolene Baxter’s daughter, Marlee, has overcome immense challenges in her first eight years of life.

Marlee, who was born with a heart defect, has undergone four open-heart surgeries — suffering a stroke after the third. The stroke affected Marlee’s cognitive abilities — she’s in the second grade, but she cannot read yet. A mainstream class with neurotypical students felt overwhelming, so Marlee mostly attends classes with kids who also have disabilities. Her care includes physical, occupational and speech therapies.

For years, Baxter has relied on Medicaid to cover Marlee’s medical expenses while advocating for her daughter’s right to an equal education. Medicaid — which covers therapies, surgeries and medication for Marlee — and disability protections under the Department of Education have been a critical safety net for Baxter, a single mom in Oklahoma City. Now Baxter fears that proposed cuts to Medicaid and those already underway at the Department of Education, which President Donald Trump has effectively gutted, will have a disastrous impact on her daughter. 

As the Trump administration overhauls federal agencies with budget cuts, layoffs and inexperienced leadership, parents of children with complex medical needs and disabilities told The 19th they are navigating uncertainty over how the federal government plans to maintain key pillars of their kids’ lives.

Baxter, who fostered and, later, adopted Marlee, fought to give her life-saving medical treatment when the child was an infant. Since Marlee was both an abandoned child and is Kiowa, the officials overseeing her welfare weren’t invested in getting her the care she needed to survive, Baxter believes. Cuts to Medicaid would be yet another obstacle for the Baxters to overcome.  Just getting Marlee enrolled in local public schools that tried to turn her away was a battle, Baxter said. Now, the mom is gravely concerned that her daughter will be left behind due to the restructuring of the Department of Education.

“I’ll do everything I can at home, but she’ll just fall through all the cracks, and she won’t get the education that she deserves,” Baxter said.

In March, Trump signed an executive order to close the Department of Education. The Republican-controlled Congress is also considering massive funding cuts to Medicaid, the federal-state program that provides health insurance to millions of low-income Americans and is a key safety net for Americans with disabilities.

“It is 50 plus years of work to get these protections for people with disabilities that we could potentially see — maybe not fully diminished — but very deeply eroded, in a very short period of time,” said Robyn Linscott, director of education and family policy at The Arc, an organization that advocates for people with intellectual and developmental disabilities.

The Department of Education’s primary duty has been to ensure that all students have equal access to education, and it is equipped with an Office for Civil Rights to investigate schools accused of discrimination. In March, the Department of Education cut nearly half of its staff, with workers who enforce students’ civil rights hit particularly hard. Advocates worry how this could potentially impact students with disabilities, and a lawsuit filed in March began to paint a picture: newly closed regional offices, frozen investigations and new alleged politically based cases. 

The Trump administration claims that the nation’s most vulnerable will be spared from his plans for federal downsizing. 

The White House has tentative plans to assign oversight of special education to the Department of Health and Human Services. Conservative groups are calling for the Trump administration to refer civil rights complaints to the Department of Justice, an agency that has had an exodus of staff departures since Trump returned to office and changed its mission. 

Nicole Jorwic, chief program officer at Caring Across Generations, a national caregiver advocacy organization, said the Education Department’s Office for Civil Rights receives about 20,000 complaints annually. She worries about the impact of staffing cuts on handling these complaints on the families of children with disabilities.

“Some of those staff were the ones who were looking into those complaints,” she said.

It’s not just OCR complaints, she added. When she was a practicing special education attorney, Jorwic turned to reports and guidance issued by the agency. That helped local school districts, superintendents and special educators know how to implement different laws or changes.

“The lack of that federal agency to provide that clarity is also important, as well as something that we’re really worried about,” she said.

Parents and advocates are doubtful that students with disabilities won’t be impacted. Before the Department of Education was created in 1979, schools often denied these children a right to education with impunity. Dissolving it, families fear, could see a return to the period when states and schools failed to prioritize special education. 

Baxter’s daughter, Marlee, is guaranteed the right to free and appropriate schooling by the Individuals with Disabilities Education Act (IDEA) of 1975, which is enforced by the Department of Education. This federal law mandates that children like Marlee attend classes suited to their cognitive and physical abilities and that they get the services needed, such as speech, physical and occupational therapy, to attend school . Ninety-five percent of students with disabilities attend public schools, a higher share than the 90% of students overall who do — and that’s largely because of the services federal policy requires public schools to provide.

Kim Crawley, a mother to a teenager with medically complex needs, has a 25-year career as a special education teacher. As part of her training, she learned about the history of education, including how five decades ago, schools were not obligated to accommodate students’ special needs. The agency never took power away from the states, she said, but stepped in to ensure that they educated all students equitably. 

“We learn about this for a reason because we don’t want to repeat it,” Crawley said. “We don’t want to have to start over again. To think of losing everything we have gained through the Department of Education over these years is scaring not only parents but teachers. Teachers are scared because we don’t know where this is going to end up for those kids. And that’s why we go to work every day.”

Critics of closing the department and redirecting disabled children’s needs to other agencies say that it will create a bureaucratic nightmare for parents. Instead of one federal agency overseeing research on students with disabilities, state funding for special education or discrimination claims, multiple departments would be involved. Families might not know which agency to reach out to with questions and concerns.

As it is, families are sometimes unaware of the services legally available to them — a reality that has cost them time and energy in the past and could be even more complicated in the future.

Baxter, for one, pulled Marlee out of class for two years to homeschool her after the child’s kindergarten teacher retired and subsequent teachers did not know how to educate her properly, she said. It was not Baxter’s first choice to homeschool Marlee, an option unavailable to most working parents, but one she made after multiple public schools said they could not accommodate her child. 

“Our special needs are full,” Baxter said they told her. “We don’t have room for her.”

When an acquaintance told her that public schools could not lawfully refuse to enroll Marlee, Baxter finally got a local public school to admit her. But after her ordeal last year, she has no faith that the federal government will hold schools that discriminate against children with disabilities accountable if the education department is disbanded. 

“We have enough stuff to worry about (with) making sure that she gets taken care of as far as medical care,” Baxter said of parents like herself. “We don’t need to worry about what we’re going to do as far as their education.”

---

For some families, the potential Medicaid cuts could unravel both a child’s well-being and their family’s finances.

In Philadelphia, Meghann Luczkowski has three kids with varying levels of specialized health care needs, including a 10-year-old son who spent his first year of life in a hospital intensive care unit.

“His ability to grow and thrive and be part of our family and part of this community is dependent upon significant health care support at home,” said the former special education teacher, who now works in public health.

Luczkowski said her husband has robust health insurance for the family, but it does not cover a lot of her son’s home-based medical needs — a reality for many families whose children are on Medicaid for care related to a disability. Private insurance never paid for his ventilator to breathe, or home health nurses who allow family caregivers to sleep at night.

“It doesn’t pay for the nurse to go to school with him, to make sure that he can be at school, accessing his education with his peers,” she said. “That’s all been provided through Medicaid.”

In the first months of his second term, Trump has mostly indicated support for Medicaid when asked about his budgetary plans for other popular programs like Social Security and Medicare. But the president has also said he supports cutting fraud and waste — a description that health policy experts warn could be used to defend more expansive cuts. Congress is considering hundreds of billions of dollars in Medicaid cuts, a dollar figure that goes way beyond known cases of fraud.   

Among the considerations are work requirements and a cap on Medicaid enrollee spending. Such restrictions could have ripple effects on state education budgets and subsequent reductions in services for students with disabilities. Medicaid is one of the largest providers of funds to public school districts. It is the responsibility of school districts and states to find funding if Medicaid reimbursements are insufficient. Trump has not addressed general concerns about how such spending cuts could impact disabled children and adults.

“We know that before 1975 and the passage of IDEA, 50% of kids with disabilities were not educated at all. So we know that this is a crucial piece of legislation, and that mandate to find funding for these is really important,” said Linscott, who previously worked as a special education teacher in New York City. “But we also recognize that school districts and state budgets are so limited, which is why we want Medicaid to be able to provide as robust funding and reimbursement as they possibly can for students and for these services.”

Jorwic said federal funding for special education services is crucial, and local governments cannot make up for the lost funds. The federal government currently spends more than $15 billion annually on special education services, and Medicaid funding accounts for about $7.5 billion annually in school-based services.

Jorwic said Medicaid cuts could also translate into higher taxes on a local or state level. This month, the Democratic Kansas governor said she had asked the state’s congressional lawmakers not to cut Medicaid in large part because of the ramifications on services. 

“There’s no state, even the wealthiest states, that could afford cuts to those programs, either when it comes to education or when it comes to providing home and community-based services,” Jorwic said.

Rachael Brown is the mom of a medically complex second grader in Washington, D.C., who receives special education services and multiple therapies at his public school. 

Brown’s son, who has autism and cerebral palsy, has a rare vascular anomaly in his brain that has required multiple surgeries. He receives extensive support from Medicaid and IDEA, which are crucial for his care and education. Brown is concerned about how cuts to Medicaid would impact her son’s care and her family’s personal finances. She noted that pediatric hospitals are heavily reliant on Medicaid. If the rate of that reimbursement is cut, those hospitals’ operational costs would be on the line — impacting everything from how many doctors and other health care providers are hired to what therapies are covered for her son.

“There’s just a ripple effect for our whole community,” she said, adding: “We are relatively privileged. There’s a lot of families who aren’t. It would be much worse for families for whom Medicaid is their only insurance.” 

Brown said she lives in fear and worry about what happens next, and it’s exhausting. While she and other advocates have some experience fighting for health care rights given previous political battles, “this time, everything feels a little more cruel.”

Luczkowski planned to travel to D.C. — taking a day off from work and rearranging child care needs — to advocate for Medicaid as part of a multi-organization advocacy day. She said parents of kids with medically complex needs and disabilities often aren’t able to get out and advocate as much as they would like to, in part because of the needs of their families.

“Despite the fact that it’s an incredible hardship on my family for me to be in D.C. talking to legislators and being at rallies on the Capitol steps, that’s what me and a great number of families are doing — because our kids’ lives depend on it,” she said. “We’re hopeful that our voices will be valued, and our children will be valued.”

This story was originally reported by Barbara Rodriguez and Nadra Nittle of The 19th. Meet Barbara and Nadra and read more of their reporting on gender, politics and policy.

‘She’ll fall through the cracks’: Parents of kids with disabilities brace for new reality is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

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

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

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

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

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

Speedier work requirements

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

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

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

“We have to fix this,” he said.

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

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

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

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

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

‘A wrecking ball to Medicaid’

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

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

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

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

Republican-only bill

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

‘They’re going to lose coverage’

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

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

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

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

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

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

Attempts to ax work requirement

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Planned Parenthood debate

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

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

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

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

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

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

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

Other organizations said to be affected

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

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

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

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

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

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

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

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

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

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

Harshbarger spoke against the amendment, saying it was unnecessary. 

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.

Reading Time: 6 minutes

Rennie Glasgow, who has served 15 years at the Social Security Administration, is seeing something new on the job: dead people.

They’re not really dead, of course. In four instances over the past few weeks, he told KFF Health News, his Schenectady, New York, office has seen people come in for whom “there is no information on the record, just that they are dead.” So employees have to “resurrect” them — affirm that they’re living, so they can receive their benefits.

Revivals were “sporadic” before, and there’s been an uptick in such cases across upstate New York, said Glasgow. He is also an official with the American Federation of Government Employees, the union that represented 42,000 Social Security employees just before the start of President Donald Trump’s second term.

Martin O’Malley, who led the Social Security Administration toward the end of the Joe Biden administration, said in an interview that he had heard similar stories during a recent town hall in Racine, Wisconsin. “In that room of 200 people, two people raised their hands and said they each had a friend who was wrongly marked as deceased when they’re very much alive,” he said.

It’s more than just an inconvenience because other institutions rely on Social Security numbers to do business, Glasgow said. Being declared dead “impacts their bank account. This impacts their insurance. This impacts their ability to work. This impacts their ability to get anything done in society.”

“They are terminating people’s financial lives,” O’Malley said.

Though it’s just one of the things advocates and lawyers worry about, these erroneous deaths come after a pair of initiatives from new leadership at the SSA to alter or update its databases of the living and the dead.

Holders of millions of Social Security numbers have been marked as deceased. Separately, according to The Washington Post and The New York Times, thousands of numbers belonging to immigrants have been purged, cutting them off from banks and commerce, in an effort to encourage these people to “self-deport.”

‘They are terminating people’s financial lives.’

Martin O’Malley, who led the Social Security Administration toward the end of the Joe Biden administration

Glasgow said SSA employees received an agency email in April about the purge, instructing them how to resurrect beneficiaries wrongly marked dead. “Why don’t you just do due diligence to make sure what you’re doing in the first place is correct?” he said.

The incorrectly marked deaths are just a piece of the Trump administration’s crash program purporting to root out fraud, modernize technology and secure the program’s future.

But KFF Health News’ interviews with more than a dozen beneficiaries, advocates, lawyers, current and former employees, and lawmakers suggest the overhaul is making the agency worse at its primary job: sending checks to seniors, orphans, widows, and those with disabilities.

Philadelphian Lisa Seda, who has cancer, has been struggling for weeks to sort out her 24-year-old niece’s difficulties with Social Security’s disability insurance program. There are two problems: first, trying to change her niece’s address; second, trying to figure out why the program is deducting roughly $400 a month for Medicare premiums, when her disability lawyer — whose firm has a policy against speaking on the record — believes they could be zero.

Since March, sometimes Social Security has direct-deposited payments to her niece’s bank account and other times mailed checks to her old address. Attempting to sort that out has been a morass of long phone calls on hold and in-person trips seeking an appointment.

Before 2025, getting the agency to process changes was usually straightforward, her lawyer said. Not anymore.

The need is dire. If the agency halts the niece’s disability payments, “then she will be homeless,” Seda recalled telling an agency employee. “I don’t know if I’m going to survive this cancer or not, but there is nobody else to help her.”

Some of the problems are technological. According to whistleblower information provided to Democrats on the House Oversight Committee, the agency’s efforts to process certain data have been failing more frequently. When that happens, “it can delay or even stop payments to Social Security recipients,” the committee recently told the agency’s inspector general.

While tech experts and former Social Security officials warn about the potential for a complete system crash, day-to-day decay can be an insidious and serious problem, said Kathleen Romig, formerly of the Social Security Administration and its advisory board and currently the director of Social Security and disability policy at the Center on Budget and Policy Priorities. Beneficiaries could struggle to get appointments or the money they’re owed, she said.

For its more than 70 million beneficiaries nationwide, Social Security is crucial. More than a third of recipients said they wouldn’t be able to afford necessities if the checks stopped coming, according to National Academy of Social Insurance survey results published in January.

Advocates and lawyers say lately Social Security is failing to deliver, to a degree that’s nearly unprecedented in their experience.

Carolyn Villers, executive director of the Massachusetts Senior Action Council, said two of her members’ March payments were several days late. “For one member that meant not being able to pay rent on time,” she said. “The delayed payment is not something I’ve heard in the last 20 years.”

When KFF Health News presented the agency with questions, Social Security officials passed them off to the White House. White House spokesperson Elizabeth Huston referred to Trump’s “resounding mandate” to make government more efficient.

“He has promised to protect social security, and every recipient will continue to receive their benefits,” Huston said in an email. She did not provide specific, on-the-record responses to questions.

Complaints about missed payments are mushrooming. The Arizona attorney general’s office had received approximately 40 complaints related to delayed or disrupted payments by early April, spokesperson Richie Taylor told KFF Health News.

A Connecticut agency assisting people on Medicare said complaints related to Social Security — which often helps administer payments and enroll patients in the government insurance program primarily for those over age 65 — had nearly doubled in March compared with last year.

Lawyers representing beneficiaries say that, while the historically underfunded agency has always had its share of errors and inefficiencies, it’s getting worse as experienced employees have been let go.

“We’re seeing more mistakes being made,” said James Ratchford, a lawyer in West Virginia with 17 years’ experience representing Social Security beneficiaries. “We’re seeing more things get dropped.”

What gets dropped, sometimes, are records of basic transactions. Kim Beavers of Independence, Missouri, tried to complete a periodic ritual in February: filling out a disability update form saying she remains unable to work. But her scheduled payments in March and April didn’t show.

She got an in-person appointment to untangle the problem — only to be told there was no record of her submission, despite her showing printouts of the relevant documents to the agency representative. Beavers has a new appointment scheduled for May, she said.

Social Security employees frequently cite missing records to explain their inability to solve problems when they meet with lawyers and beneficiaries. A disability lawyer whose firm’s policy does not allow them to be named had a particularly puzzling case: One client, a longtime Social Security disability recipient, had her benefits reassessed. After winning on appeal, the lawyer went back to the agency to have the payments restored — the recipient had been going without since February. But there was nothing there.

“To be told they’ve never been paid benefits before is just chaos, right? Unconditional chaos,” the lawyer said.

Researchers and lawyers say they have a suspicion about what’s behind the problems at Social Security: the Elon Musk-led effort to revamp the agency.

Some 7,000 SSA employees have reportedly been let go; O’Malley has estimated that 3,000 more would leave the agency. “As the workloads go up, the demoralization becomes deeper, and people burn out and leave,” he predicted in an April hearing held by House Democrats. “It’s going to mean that if you go to a field office, you’re going to see a heck of a lot more empty, closed windows.”

The departures have hit the agency’s regional payment centers hard. These centers help process and adjudicate some cases. It’s the type of behind-the-scenes work in which “the problems surface first,” Romig said. But if the staff doesn’t have enough time, “those things languish.”

Languishing can mean, in some cases, getting dropped by important programs like Medicare. Social Security often automatically deducts premiums, or otherwise administers payments, for the health program.

Lately, Melanie Lambert, a senior advocate at the Center for Medicare Advocacy, has seen an increasing number of cases in which the agency determines beneficiaries owe money to Medicare. The cash is sent to the payment centers, she said. And the checks “just sit there.”

Beneficiaries lose Medicare, and “those terminations also tend to happen sooner than they should, based on Social Security’s own rules,” putting people into a bureaucratic maze, Lambert said.

Employees’ technology is more often on the fritz. “There’s issues every single day with our system. Every day, at a certain time, our system would go down automatically,” said Glasgow, of Social Security’s Schenectady office. Those problems began in mid-March, he said.

The new problems leave Glasgow suspecting the worst. “It’s more work for less bodies, which will eventually hype up the inefficiency of our job and make us, make the agency, look as though it’s underperforming, and then a closer step to the privatization of the agency,” he said.

Jodie Fleischer of Cox Media Group contributed to this report.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — an independent source of health policy research, polling and journalism. Learn more about KFF.

This article first appeared on KFF Health News and is republished here under a Creative Commons license.

At Social Security, these are the days of the living dead is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

Kristen Payne, a member of Lead Safe Schools MKE. (Photo by Isiah Holmes/Wisconsin Examiner)

Update: The Milwaukee Health Department announced Thursday that 22 children were screened at the clinic, and two needed follow-up blood tests. The department said in a statement the turnout was lower than officials had hoped for, but that the department will host additional school-based screening clinics. The department also is advising families to visit pop-up clinics at Children’s Wisconsin hospital’s Next Door Clinic and the Sixteenth Street Health Center Community Outreach program.

As a lead screening clinic was being set up inside Milwaukee’s North Division High School Wednesday, a coalition of parents, teachers and locals gathered outside to voice their frustrations about the response to lead contamination in Milwaukee Public School’s (MPS). The group had gathered to “demand that lead contamination in our schools, our city and our state, be urgently and effectively addressed in a manner consistent with health science data,” said Kristen Payne, a member of Lead Safe Schools MKE, during a press conference outside the high school. 

The press conference brought together several groups including Lead Safe Schools MKE, Freshwater for Life Action Coalition, Get the Lead Out and Metcalfe Park Community Bridges. Inside North Division, the  Milwaukee Health Department set up a clinic in the cafeteria and prepared to screen up to 300 children. Concern over lead in MPS buildings has grown since January, after a student was reportedly poisoned. Just under 400 MPS students have been tested and several schools temporarily closed due to lead hazards so far this year.

“Testing our kids for lead poisoning is important, and it’s also not nearly enough,” Payne said. “Until the district, city and state work proactively to address root causes of lead exposure, these testing clinics will do little to prevent exposure of a harmful toxin.” Every year, more than 1,200 children in the city of Milwaukee test positive for lead poisoning, with an average age of 3 years old. With over 70,000 MPS students among the tens of thousands of children in the city, ensuring that enough children are getting tested can be challenging.

Katie Doss is the grandmother of one of those children who tested positive. “She was hospitalized,” said Doss, and  received a blood transfusion. The experience led  Doss to work with the Coalition on Lead Emergency (COLE) and city officials to help get as many children tested as possible. She eventually became a lead program coordinator. “Since then, I’ve got over 400 children tested,” said Doss.

Doss wasn’t alone. “I believe that my grandchildren have the right to go to school without the threat of exposure to lead,” said Maria Beltran, a local resident, grandmother and member of Freshwater for Life Action Coalition. “Lead exposure in children, like my entire family and myself — I have seven kids, seven grandchildren, and married — lead exposure in children can damage the brain and nervous system, cause developmental delays, learning challenges, behavioral issues, [and] hearing loss. Also in adults, lead exposure and lead poisoning can cause high blood pressure, kidney damage, brain damage, miscarriage, and infertility that I have experienced in my entire family as well.”

The group of parents and residents that joined Payne expressed their feeling  that MPS and the Health Department have been more reactive than protective when it comes to addressing lead contamination. Some questioned why only elementary schools, and not middle and high schools, are the focus of current testing and remediation efforts. Others felt that they’d been left in the dark as to how lead poisoning affected their loved ones, or felt that school officials were sending out last-minute warnings to parents about lead hazards. Such notifications often came as emails, sent in the evening hours or  near weekend days, parents at the press conference said. 

The coalition demanded that MPS test all buildings for lead in dust, paint, water and soil. Additionally, the group called on the school district to follow the American Academy of Pediatrics recommendations for lead-in-water readings <1.0 (parts per billion), and for better lines of communication to be established between school officials and parents. The group further demanded that the MPS Board of Directors pass a recently introduced lead-safety resolution, that city departments implement more proactive measures and that Gov. Tony Evers and the Legislature help remediate lead in schools statewide. 

Melody McCurtis, deputy director and lead organizer of Metcalfe Park Community Bridges, said that city officials are concerned with “growing the city without repairing the past harm that the current residents in this city is facing, especially in terms of lead.” McCurtis added,  “This city is prioritizing policing in our schools, prioritizing more than half of our city budget going to the police, but not going to prevention of crises like the lead crisis. It is going to take more than the Milwaukee Public School, the Health Department, and the city elected officials to come together to not just treat the issue, but to prevent it from happening.”

Inside the high school’s cafeteria, Health Department Commissioner Mike Totoraitis and Deputy Commissioner of Environmental Health Tyler Weber were helping oversee the final preparations for the screening clinic. They said  lead dust and paint are a target and the city’s youngest children are being prioritized for lead testing. “That’s not to minimize that there are other hazards here at the schools and potentially in the homes,” said Totoraitis. 

Although older children and adults will need to be included in testing eventually, it’s unclear how long that might take. The city is still re-grouping after plans to send specialized lead teams from the Centers for Disease Control and Prevention (CDC) to Milwaukee were cancelled by the Trump Administration. The teams would have helped with blood screening analysis to detect trends and gather more information. Totoraitis said that the health department has monitored citywide data for screenings, and has not noticed any new trends. Milwaukee is  also working with partners in other states including Ohio and Michigan. More parents have been taking their children to pediatricians to get tested, which is encouraging, Totoratis said. “That is the best way for parents to know if their child has been poisoned,” he said.

MPS assumes that lead paint exists in any building built before 1978, and the school district has 54 schools built before 1950. Addressing the full scale of the problem will take creativity, dedicated effort and time, health officials say. Weber said that although it’s good that positive tests since January have been relatively low, many more children still need to be evaluated. 

“Oftentimes, the children that we see tested aren’t always the children that need to be,” said Tyler, noting that although more than 1,200 children test positive annually, only 40-50% of children are tested who need to be.

Doss told Wisconsin Examiner that it can be difficult to convince parents to get their children tested. “It’s extremely challenging,” said Doss. “There are a lot of parents that’s lost hope and faith in the community as far as getting the children tested. They want to know what’s going to happen on the reaction. If they get their child tested, will they be actually judged if the child comes back with lead and they don’t know where the lead is coming from?” 

Doss said some parents fear that a positive lead test will lead to their homes being visited by authorities, or even that their children could be taken away. “So that’s why it’s very important to let the parents know that it’s nothing that they did. It’s in our environment, it’s in our water, it’s in the paint…The only way that you can help your child is to get your child tested to know if your child has it. And you need to get your child tested once a year. It’s very important.”

The scale of the problem, and a lack of capacity within the health department, creates stubborn obstacles. “And our old housing stock, the red-lining that’s happened over time, the disinvestment in communities, and so it’s a lot for a single department to get to the point where we get ahead of this,” Weber said.  “‘Cause it is devastating to have to see every day the results that come in from different children, and respond to those.” 

Weber added that ideally lead levels in soil, homes, water and human bodies would be zero. “We’re an old city with a lot of deeply rooted challenges, and there’s a lot of work that we have to do collectively.”

GET THE MORNING HEADLINES.

SUBSCRIBE

 

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.” 

Democratic Rep. Chris Deluzio of Pennsylvania joins veterans protesting the Trump administration's proposed cuts to the Department of Veterans Affairs on Tuesday, May 6, 2025, outside the U.S. Capitol. (Photo by Ashley Murray/States Newsroom)

WASHINGTON — Veterans and Democratic lawmakers on Capitol Hill Tuesday protested the Trump administration’s planned cuts for the Department of Veterans Affairs that include slashing some 80,000 jobs, which many worry will affect the massive agency’s delivery of medical care and benefits.

The group rallied outside the U.S. Capitol shortly after VA Secretary Doug Collins finished lengthy questioning before the Senate Committee on Veterans Affairs, where he defended the cuts as necessary to improve the department’s efficiency.

Holding signs that read “Veterans Healthcare Not For Sale,” a crowd of former service members joined by senators and representatives decried that argument as “nonsensical,” as Sen. Richard Blumenthal, top Democrat on the Veterans Affairs Committee, put it.

“We’re not going to allow veterans to be betrayed by this administration,” Blumenthal, of Connecticut, said. “I’ve just come from a hearing with the VA secretary, and to say it was a disappointment is a huge understatement. That hearing was a disgrace.” 

‘Non-stop smear campaign’

Jose Vasquez, executive director of Common Defense, the advocacy group that organized the press conference, said, “They call this efficiency, but we call it betrayal.”

Vasquez, an Army veteran who recently received care from the VA in New York for a cancerous tumor on his pancreas, said, “Millions of veterans depend on VA every day — survivors of cancer, toxic exposure, traumatic brain injuries and post-traumatic stress.”

He contends the agency’s workers, many of whom are veterans, have been the target of a “non-stop smear campaign.”

“Why? Simple. Because a small group of greedy billionaires would rather get tax cuts than pay for the true cost of war,” Vasquez.

Trump’s temporary DOGE organization, led by top campaign donor Elon Musk, cut roughly 2,400 VA jobs in early March.

Collins, a former Georgia congressman who still serves in the Air Force Reserve, unveiled a plan in early March to return VA staffing to 2019 levels of 398,000, down from the current approximately 470,000 positions.

The lawmaker told senators Tuesday that he’s “conducting a thorough review of the department’s structure and staffing across the enterprise.”

“We’re going to maintain VA’s mission-essential jobs like doctors, nurses and claims processors, while phasing out non-mission-essential roles like interior designers and DEI officers. The savings we achieve will be redirected to veteran health care and benefits,” Collins said.

Collins drew pushback during the hearing, including from Sen. Elissa Slotkin of Michigan, who told the secretary “there’s no way that all those 80,000 are in those job fields,” referring to his comment about DEI and interior designers.

“I’m having a problem understanding how the veterans in Michigan are going to get the same or better care, which is what we want,” said Slotkin, who served three tours in Iraq as a CIA analyst.

GOP says VA must change

Many Republicans on the panel maintained the VA, as Sen. Thom Tillis of North Carolina said, “is not working.”

“If we just say everything has to stay the same and you just gotta add more money and more people, then you’re looking at it the wrong way,” Tillis said, adding that he’s “open to any suggestions” and will review the proposal for workforce reductions.

Collins criticized the increase in hiring under former President Joe Biden, who signed into law the PACT Act, the largest expansion of VA benefits in decades.

The law opened care to roughly 1 million veterans who developed certain conditions and cancers following exposure to burn pits in Iraq and Afghanistan as well as Vietnam vets exposed to Agent Orange.

Republican Sen. Kevin Cramer of North Dakota said Collins was being “battered” about the possible 80,000 cuts. “Correct me if I’m wrong, but I believe there were 52,000 new positions added between 2021 and 2024. … That 52,000, has that saved the day for our veterans?

“I don’t think so,” Collins responded.

But at the rally afterward, Democratic Rep. Chris Deluzio, a former Navy officer who served in Iraq, defended the PACT Act expansion.

“At this moment when so many toxic-exposed veterans of my generation, Agent Orange-exposed veterans from the Vietnam era, are finally getting the benefits they’ve earned because of the PACT Act, we should be investing in the resources for the VA, and Donald Trump and his team are doing the opposite,” said Deluzio, who represents Pennsylvania.

Robert F. Kennedy Jr., the secretary of Health and Human Services, testifies during his Senate Finance Committee confirmation hearing at the Dirksen Senate Office Building on Jan. 29, 2025, in Washington, D.C. (Photo by Win McNamee/Getty Images)

WASHINGTON — Less than half of Americans have confidence in federal public health agencies’ ability to regulate prescriptions, approve vaccines and respond to outbreaks, according to a poll released Tuesday by the nonpartisan health research organization KFF.

The survey shows that just 46% of the people questioned have at least some confidence in federal agencies ensuring the safety and effectiveness of prescription drugs.

Even fewer, 45%, have confidence in the safety and effectiveness of vaccines and only 42% said they have confidence federal health agencies to respond to infectious disease outbreaks, like bird flu and measles.

An especially low percentage of those polled, 32%, had either some confidence or a lot of confidence in federal health agencies acting independently without interference from outside interests.

“There are remarkably low levels of trust in the nation’s scientific agencies, shaped by partisan perspectives, and that presents a real danger for the country if and when another pandemic hits,” KFF President and CEO Drew Altman wrote in a statement accompanying the poll.

Confidence in agencies sags or rises by party affiliation

The percentage of people overall who hold confidence in the U.S. Food and Drug Administration and the Centers for Disease Control and Prevention to provide reliable information about vaccines has dropped since a similar survey in September 2023, though party affiliation shows differing trends.

Democrats with a fair amount or great deal of trust in the FDA’s vaccine information has decreased from 86% to 67%, while trust among Republicans has increased from 42% to 52%.

When combined with independents, overall trust in the FDA’s information about vaccines has decreased, from 61% to 57%.

Confidence in the CDC providing reliable information about vaccines has also shifted based on party affiliation.

During the Biden administration, 88% of Democrats had a fair amount or great deal of trust in the CDC, though that has since dropped to 70%. Republicans have started to come back around to the CDC’s vaccine information, with their level of trust increasing from 40% to 51%.

Altogether, trust in CDC has dropped from 63% to 59%, according to the survey.

“The overall level of trust in each case is similar to where it stood in September 2023, though the poll reveals significant partisan shifts as the second Trump administration and Health and Human Services Secretary Robert F. Kennedy Jr. have started to change vaccine policies and messaging,” the poll states.

Local sources trusted

Health care providers and local public health departments are overwhelmingly looked to as trusted sources for reliable information on vaccines, according to the survey.

Eighty-two percent of respondents said they either have a great deal or a fair amount of trust in doctors and health care providers to give them reliable information about vaccines.

Eighty-one percent said they trust their child’s pediatrician, 66% responded they have confidence in their local public health department, 59% believe in the CDC, 57% trust the FDA and 51% have confidence in pharmaceutical companies to provide factual information about vaccines.

Those polled held less trust in politicians, with 41% believing Kennedy’s comments about vaccines and 37% trusting President Donald Trump “to provide reliable information about vaccines,” according to the poll.

A majority of those surveyed, however, are somewhat or very confident in the safety of several vaccines, including 83% for measles, mumps and rubella, or the MMR vaccine; 82% for pneumonia; 79% for shingles; 74% for the flu; and 56% for COVID-19.

The poll included 1,380 U.S. adults contacted online or via telephone from April 8-15, for a margin of error of plus or minus 3 percentage points. 

A worker applies an adhesive bandage to a child at a vaccination clinic in Minneapolis’ Corcoran Park in August 2023. Minneapolis is among the cities forced to cancel vaccinations after cutoffs in federal funding. (Courtesy of City of Minneapolis)

The number of measles cases is approaching 1,000 across 29 states, according to newly released federal statistics. Even as the outbreaks grow, more local governments are complaining that their efforts to combat measles with vaccination clinics have been shut down by abrupt federal funding cuts.

As of May 1, a total of 935 confirmed cases had been reported, according to the federal Centers for Disease Control and Prevention. They were in Alaska, Arkansas, California, Colorado, Florida, Georgia, Hawaii, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maryland, Michigan, Minnesota, Missouri, Montana, New Jersey, New Mexico, New York, Ohio, Oklahoma, Pennsylvania, Rhode Island, Tennessee, Texas, Vermont, Virginia and Washington.

There have been three confirmed deaths, two children in Texas and one adult in New Mexico, all unvaccinated.

Metro Nashville, the combined county and city government in Tennessee, and three other local governments sued on April 24 over reductions in federal public health funding, saying the abrupt $11 billion in cuts nationwide forced Nashville to cancel vaccination clinics needed to combat this year’s measles outbreak. Colorado and a group of other states sued earlier in April, mentioning the impact of cuts on their ability to control measles, flu and other vaccine-preventable illnesses.

Others joining the April 24 lawsuit: Harris County, Texas, where Houston is located; Columbus, Ohio; Kansas City, Missouri; and the American Federation of State, County and Municipal Employees union. They called the cuts “a massive blow… at a time where state and local public health departments need to address burgeoning infectious diseases and chronic illnesses, like the measles, bird flu, and mpox.”

The funding cuts also forced Minneapolis to shut down clinics in March that had been scheduled to run through June, said Luisa Pessoa-Brandão, director of health initiatives for the city’s health department.

Last year the city’s clinics served 501 patients with 1,475 vaccination shots, including against measles, she said. About 30% of children in the city are not fully vaccinated, much too high to ensure unvaccinated children won’t fall victim to measles outbreaks like the current one, she added.

“There’s fear and hesitancy about the vaccine, based on some of the misinformation out there,” Pessoa-Brandão said. “There are other factors — access [to medical care] and the COVID pandemic, which delayed people getting vaccinations. We’re playing catch-up the last few years.”

Stateline reporter Tim Henderson can be reached at thenderson@stateline.org.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org.