House Panel’s Medicaid Reform Proposals Set Off Predictably Fierce Debate

The House Energy and Commerce Committee unveiled its proposals to revamp Medicaid on Sunday night, drawing the predictable cheers and jeers from Congress’ varying factions—establishment Republicans, Democrat Medicaid crusaders, and hard-line fiscal conservatives.

The debate over how to handle Medicaid has emerged as the most hot-button issue in Republicans’ rush to pass a budget reconciliation bill that would fulfill President Donald Trump’s promises on tax cuts and border security.

For months, Republican leaders in the House have promised to protect hardworking Americans’ Medicaid, while preventing it from being abused by illegal immigrants and the able-bodied—reforms meant to help reach a target of $880 billion in 10-year savings in the committee.

House Leadership: We’re Not Cutting Medicaid

“You don’t want able-bodied workers on a program that is intended, for example, for single mothers with two small children,” House Speaker Mike Johnson, R-La., said in February.

Sunday’s release of Energy and Commerce’s legislative text revealed multiple reforms, such as cutting federal funding for gender transition surgeries and for abortions unrelated to incest, rape, or protecting the life of the mother.

The text also requires that Medicaid enrollees have their immigration, income, and parenting status verified if they want to receive benefits.

The Congressional Budget Office, a nonpartisan watchdog that Congress relies on for scoring proposals, said in a statement Monday that the committee’s proposals would meet the target of $880 billion in cuts.

Additionally, the plan reduces the Federal Medical Assistance Percentage (FMAP) to Medicaid expansion states that provide health care coverage for illegal immigrants under state-run health programs.

In other words, if a state provides Medicaid to illegal immigrants, the federal government will not be footing as much of the bill.

Energy and Commerce Committee Chairman Rep. Brett Guthrie, R-Ky., described the reforms as a way to protect ordinary Americans’ benefits.

“When so many Americans who are truly in need rely on Medicaid for lifesaving services, Washington can’t afford to undermine the program further by subsidizing capable adults who choose not to work,” he wrote in a Wall Street Journal op-ed.

Democrats: Republicans Are Cutting Medicaid

Democrats were predictably quick to denounce the plan as an assault on Medicaid. 

“The House Republican budget will cause millions of Americans to lose their health care coverage,” House Minority Leader Hakeem Jeffries, D-N.Y., wrote on X on Monday. 

Rep. Frank Pallone, D-N.J., who serves as ranking member on the committee, called it a “reverse Robin Hood scheme.”

“Tomorrow, Energy & Commerce Committee Republicans will bring up their budget bill with devastating Medicaid cuts so billionaires can get another tax break,” he said on Monday.

Fiscal Hawks: Cut Deeper

The plan also lacks some provisions that fiscal hawks in the Republican Party wanted.

“I sure hope 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,” Rep. Chip Roy, R-Texas, wrote on X the morning after the legislative text was released.

Roy, a hard-liner on deficits, has pushed for reversing much of the Medicaid expansion made possible by President Barack Obama’s Affordable Care Act. 

Last week, he introduced a bill—first reported by The Daily Signal—which proposes allowing states to reduce Medicaid eligibility to those at or below the poverty line, as well as phasing down the rate at which the federal government matches state Medicaid payments. 

“Does the bill offer ANY transformative changes on Medicaid or otherwise? Currently – NO – it ignores the policy changes that matter,” Roy posted on X on Monday afternoon.

Another of the House’s fiscal hard-liners, Rep. Tim Burchett, R-Tenn., told The Daily Signal that he would like to see the federal government reduce its matching of state Medicaid payments.

“Yeah,” he said. “And of course, I want to see more verification that [Medicaid recipients] are American citizens. I just think everything should be on the table because we are broke, $36 trillion in debt. We have got to fix the problem.”

He told The Daily Signal that he supports the bill’s work requirements for Medicaid, but lamented that those would go into place only in late 2028.

That’s not to say Burchett wants Congress to slow down in its race to pass the budget bill.

“I think America is tired of waiting. They’re tired of the delays on DOGE, they’re tired of delays on everything. They want to see action.”

To be sure, the release of the legislative text is not the end of the story. Committee members will mark up the text Tuesday, in what is sure to be a vigorous debate.

Bradley Devlin contributed to this report.

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