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. 

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.”