House Republicans Propose Medicaid Changes, Including Work Requirements and Eligibility Checks

House Republicans unveiled their much-anticipated plan for revamping Medicaid with a proposal that calls for establishing work requirements, tightening rules for establishing eligibility for Medicaid, and freezing provider taxes.

The GOP plan steers clear of some more drastic changes to the Medicaid program that some Republicans and conservative health policy experts had floated, such as a per capita limit on federal Medicaid spending or sharply curtailing the Federal Medical Assistance Percentage, the federal government's share of Medicaid funding.

Even so, some Medicaid experts said the Republican plan is far from a minor tweak that would result in millions of people in the U.S. losing health insurance coverage and force states to make significant cuts or change how they fund healthcare for some of their vulnerable populations.

Larry Levitt, executive vice president for health policy for KFF, wrote on X that the combination of this Medicaid plan from Republicans on the House Committee on Energy and Commerce and changes to the Affordable Care Act (ACA) proposed by the White House would increase the number of people in the U.S. without health insurance by 13.7 million. "That would take us back to close to pre-ACA levels," wrote Levitt.

In a brief statement issued last night, the Congressional Budget Office (CBO) estimated that the healthcare-oriented portions of the committee's plan would reduce the number of people in U.S. with health insurance by at least 8.6 million. The CBO statement also said that the plan would reduce the deficit by at least $715 billion from 2025 to 2034.

Rep. Brett Guthrie

In an opinion article published by the Wall Street Journal yesterday, Rep. Brett Guthrie, a Kentucky Republican and chairman of the House Energy and Commerce Committee, argued that the Republican plan would implement “sensible work requirements."

"Half of all Americans get insurance through work, seniors on Medicare get coverage because they paid into the trust fund and veterans earned their care through their service to our country," Guthrie wrote.

Guthrie said the Medicaid plan is in keeping with the Trump administration’s immigration and deportation policies. Guthrie said that Democrat-run states such as California use Medicaid funds to subsidize health insurance for people living in the country without legal permission.

The House Republicans' proposal for Medicaid is part of a broader effort by congressional Republicans and the White House to extend major tax cuts enacted during the first Trump administration while offsetting them with approximately $1.5 trillion in federal spending cuts. President Donald Trump has also called for eliminating the federal income tax on tips, overtime and Social Security.

Guthrie has scheduled a public hearing on the committee's spending plan, which also includes provisions that would rollback green energy programs, for tomorrow at 2 p.m. A livestream will be available here.

The Republican plan would freeze state provider taxes at current levels and prohibit the implementation of new taxes, a measure critics warn could strain state budgets.

Darbin Wofford, deputy healthcare director at the center-left think tank Third Way, told the Journal that weakening provider taxes "ties the hands of states and prevents them from addressing their individual needs."

The proposal will also introduce a new cost-sharing requirement for some beneficiaries, capping their out-of-pocket expenses at 5% of their income.