House budget plan advances, paving way for major Medicaid cuts

A House budget framework that calls for hundreds of billions of dollars in cuts to Medicaid has passed on the floor by a vote of 217-215.

The plan advanced out of the House Budget Committee Feb. 13 and received President Donald Trump’s seal of approval because he prefers “one big, beautiful bill” over the Senate’s two-bill backup strategy. Now, the Senate must pass an identical budget resolution.

Legislators spent the day debating the bill. Scheduled for 6 p.m. ET, the vote was delayed more than an hour to allow more time in persuading Republican holdouts to support the bill, Congressional reporters said. The bill was temporarily pulled from consideration for around 15 minutes before leadership called Republicans back to the floor to vote after all.

“Republicans tried to pull a fast one,” said Rep. Maxwell Frost, D-Fla., on X, accusing his counterparts of attempting to sneakily bring a vote without bringing attention to Democratic lawmakers. The bill passed on party lines, and calls for $4.5 trillion in tax cuts and increases the debt limit by $4 trillion.

Rep. Thomas Massie, R-W.V., voted no but every other holdout flipped to vote in favor of the bill including Reps. Warren Davidson, R-Ohio, Victoria Spartz, R-Ind. and Tim Burchett, R-Tenn.

Democratic lawmakers stressed the budget resolution slashes $880 billion over 10 years in spending from the House Energy and Commerce Committee. The bill’s text doesn’t explicitly say Medicaid will be cut, but the program would likely have to be fundamentally altered—beyond controversial but less extreme proposals like requiring work requirements—to cut spending at that scale.

Hospital groups, like the American Hospital Association and the Federation of American Hospitals (FAH), flatly oppose Medicaid cuts and urged the House to balk at today’s bill. FAH President and CEO Chip Kahn seemed to indicate Medicaid cuts may not be included in the final reconciliation law.

“Key Republican lawmakers—recognizing that so many constituents rely on Medicaid for critical care—made it clear that their vote today was based on an understanding the final reconciliation bill would not include devastating Medicaid cuts or changes,” said Kahn in a statement after the vote. “That is gratifying—it’s important that these members came to the same conclusion the President did: Medicaid cuts are off the table.”

Other groups were not so optimistic.

“This budget resolution will open the door to devastating Medicaid cuts that will impact millions of Americans, especially those middle-to-low-income working Americans in both rural and urban communities, who rely on Medicaid to access critical health care services,” said Bruce Siegel, M.D., president and CEO of America’s Essential Hospitals.

“This is an unfortunate and short-sighted decision by the House,” said Association for Community Plans CEO Margaret Murray. “Cuts of this magnitude to Medicaid funding go far beyond simply cleaning up fraud and waste, and will cut deeply into vital services for children, seniors, veterans, and workers with low incomes.”

Some Republican lawmakers are concerned the Medicaid cuts will negatively impact residents in their district and upend state budgets. In their home districts, some members faced vocal constituents worried about cuts to Medicaid and other programs at town halls.

“Nearly 30% of Medicaid enrollees are Hispanic Americans, and for many families across the country, Medicaid is their only access to healthcare,” said Republican members of the Congressional Hispanic Conference in a letter (PDF) last week. “Slashing Medicaid would have serious consequences, particularly in rural and predominantly Hispanic communities where hospitals and nursing homes are already struggling to keep their doors open. Moreover, the possibility of cutting Medicaid disproportionate share hospital (DSH) funding threatens hospitals that serve low-income and uninsured patients.”

Others expressed disappointment on the floor that there were not even greater spending restraints in the resolution, highlighting the difficulty for Speaker of the House Mike Johnson, R-La., to wrangle together the Republican coalition. Johnson could only lose one vote to advance the resolution. 

“Medicaid provides coverage for one in five individuals, funds 41% of all births nationwide, and is the largest payer for long-term care and behavioral health services,” said the Catholic Health Association, representing hospitals and clinics and long-term care facilities, in a letter (PDF) Feb. 20.

“Cuts of this magnitude would jeopardize both access to care for millions of Medicaid enrollees and the financial stability of providers who care for them,” added David Skorton, M.D., president and CEO of the Association of American Medical Colleges, in a statement ahead of the vote.

In order to pass reconciliation bills and advance major legislation on party lines, both the Senate and the House must pass identical budget resolutions first.