13.7 Million at Risk of Losing Coverage Under GOP Medicaid Plan, CBO Warns

Republicans Push Medicaid Work Mandate, Sidestep Federal Funding Cuts

DECK
GOP's sweeping domestic proposal revives Medicaid work requirements without slashing federal aid—but risks 13.7 million losing health coverage, CBO warns.

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KEY FACTS

What: House Republicans unveil Medicaid overhaul within broader domestic policy bill.
Where: U.S. House of Representatives; key developments from the Energy and Commerce Committee.
When: Legislative text released this week; committee markup scheduled for Tuesday.
Who: GOP lawmakers, led by Speaker Mike Johnson and Rep. Chip Roy, drive reforms.
Why: To meet budget targets and reshape Medicaid amid conservative pressure.

Impact: CBO estimates 13.7 million people could lose health insurance.

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SITUATION SNAPSHOT
On Capitol Hill, House Republicans rolled out the legislative language for a sweeping Medicaid overhaul, rekindling debate over work mandates and health equity. The proposal forms part of what President Donald Trump has dubbed the "one big, beautiful bill"—a sprawling effort to reshape social policy while advancing tax and spending goals.

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WHAT WE KNOW
The new legislation would resurrect work requirements for certain Medicaid enrollees, specifically targeting adults without dependents who are considered able-bodied. These individuals must complete 80 hours per month of work, community service, or educational activities—or a combination—to retain their coverage.

People under 19, over 64, pregnant women, individuals with disabilities, foster youth (including those aged out up to 26), Native American tribal members, and those already meeting work requirements under welfare or food assistance programs would be exempt.

States would also be compelled to implement stricter address verification protocols and conduct eligibility reassessments every six months for both Medicaid and the Children’s Health Insurance Program (CHIP).

The proposal delays Biden-era rules aimed at boosting staff in long-term care facilities and explicitly bars Medicaid funds from being used for gender-affirming care for transgender individuals under 18.

Crucially, while the legislation imposes significant policy shifts, it avoids reducing federal funding for Medicaid—a relief to Republican lawmakers from Medicaid expansion states under the Affordable Care Act.

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WHAT’S NEXT
The House Energy and Commerce Committee is set to begin markup proceedings Tuesday afternoon. Broader negotiations are expected to continue over tax cuts, immigration enforcement funding, and energy production spending. Meanwhile, Democrats and health care advocates are expected to mount sharp opposition to the Medicaid changes, especially with millions of Americans at risk of losing coverage.

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VOICES ON THE GROUND
"I sure hope House & Senate leadership are coming up with a backup plan," said Rep. Chip Roy of Texas. "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.”

House Speaker Mike Johnson echoed support for the work requirement, saying “29-year-old males sitting on their couches playing video games” should be working, not receiving Medicaid.

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CONTEXT
Republican budget plans have long targeted Medicaid as a key area for spending restraint. A resolution passed earlier this year required $1.5 trillion in spending cuts to offset $4.5 trillion in planned tax breaks. The Energy and Commerce Committee was tasked with delivering $880 billion in savings. However, a subsequent adoption of the Senate’s softer budget version reduced the urgency of deep cuts—though conservative factions remain determined.

Under the ACA, the federal government covers up to 90% of Medicaid costs for individuals earning up to 138% of the federal poverty level. Any federal retrenchment risks triggering automatic reductions in state funding levels across numerous jurisdictions, per the Kaiser Family Foundation.

The Congressional Budget Office has projected that the combined impact of Medicaid policy changes, expiration of enhanced ACA tax credits, and related provisions would result in 13.7 million more people without health insurance.

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REPORTER INSIGHT
The Medicaid fight marks a pivotal test of the GOP's balancing act—satisfying fiscal conservatives while avoiding backlash from states that expanded coverage under Obamacare. On the surface, the proposal stops short of a federal funding rollback, but beneath it lies a complex web of bureaucratic hurdles that could dramatically shift who gets care—and who doesn't.