A budget bill championed by President Donald Trump cleared the House of Representatives on Thursday, setting the stage for significant alterations to the U.S. social safety net if it becomes law.
The proposed legislation would introduce work requirements for many low-income adults seeking Medicaid health insurance coverage and expand existing work requirements for food assistance programs. It also mandates hospitals to verify patients’ citizenship status and cuts federal funding for services, including birth control, provided by the nation’s largest abortion provider.
Supporters of the bill argue that these measures will generate cost savings, eliminate inefficiencies, and promote individual responsibility. However, a preliminary analysis by the nonpartisan Congressional Budget Office (CBO) estimates that the proposals would result in 8.6 million fewer Americans having health care coverage over the next decade.
The bill, which also incorporates tax cuts, passed the House by a narrow one-vote margin and is now headed to the Senate, where its provisions could undergo further revisions.
Key Potential Impacts:
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Medicaid Work Requirements: Starting next year, numerous “able-bodied” Medicaid enrollees would be required to demonstrate employment to maintain their health insurance coverage. While approximately 92% of current enrollees are estimated to meet this criterion, CBO projections for an earlier version of the bill suggest that roughly 5 million individuals could lose their coverage due to these new requirements. Healthcare system president Eduardo Conrado of Ascension cautioned that increased eligibility checks and bureaucratic hurdles associated with work requirements could lead to eligible individuals being wrongly removed from the program, potentially creating financial strain for rural hospitals. He argued that these requirements represent a fundamental shift away from the program’s core purpose. Only Arkansas has previously implemented a work requirement that led to coverage loss for non-compliance, with over 18,000 individuals losing coverage before federal courts blocked the program. Joan Alker, executive director of Georgetown University’s Center for Children and Families, asserted that work requirements do not increase employment rates but rather decrease health insurance coverage.
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Expanded SNAP Work Requirements: The Supplemental Nutrition Assistance Program (SNAP), formerly known as food stamps, already has work requirements for some of its approximately 42 million recipients. The House-passed bill would raise the age limit for these requirements from 54 to 65 and extend them to parents without children younger than age 7. Additionally, the legislation would limit the ability to waive work requirements in areas with unemployment rates significantly above the national average. The liberal-leaning Center on Budget and Policy Priorities estimates that these changes could put 6 million adults at risk of losing SNAP benefits. Similar to Medicaid work requirements, those for SNAP are projected to decrease program participation without a corresponding increase in employment, according to a Brookings Institution report.
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Federal Funding Cuts for Immigrant Healthcare: The bill proposes to penalize states that use their own funds to provide Medicaid-covered services to immigrants lacking legal status or offer subsidies to help them purchase health insurance. States providing such coverage, sometimes limited to children, would see their federal Medicaid expansion funding reduced from 90% to 80%. Georgetown’s Alker suggested this financial penalty could force states to withdraw such coverage. KFF reported that this provision could affect 14 states and Washington, D.C., that currently cover children regardless of immigration status. California Governor Gavin Newsom recently announced a freeze on new enrollments in state-funded healthcare for undocumented immigrants as a budget-balancing measure.
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Planned Parenthood Funding Restrictions: A provision in the bill would bar Planned Parenthood from receiving Medicaid funds, potentially leading to the closure of approximately one-third of its health centers, according to the organization. Planned Parenthood estimates that about 200 centers are at risk, primarily in states where abortion remains legal, potentially halving the number of their centers in those states. While federal funds are already prohibited from paying for abortions, some states use their own Medicaid funds for this purpose. Planned Parenthood President and CEO Alexis McGill Johnson described the provision as a “fight for survival” for the organization and access to non-judgmental healthcare. Susan B. Anthony Pro-Life America praised the provision as a step towards ending taxpayer funding of the “Big Abortion industry.”
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Cuts to Transgender Healthcare: Starting in 2027, Medicaid would cease covering gender-affirming care for individuals of all ages under a last-minute provision added to the bill. Furthermore, coverage of these treatments could not be mandated on insurance plans sold through Affordable Care Act exchanges. This expands on previous Trump administration efforts targeting transgender individuals. Advocates for Trans Equality director Olivia Hunt described gender-affirming care as a cost-effective public health strategy.
The bill now moves to the Senate, where its future and potential revisions remain uncertain.
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