Trump's Plan to Kick Millions of Americans Off Medicaid, Explained

Donald Trump and Republicans in Congress are imposing massive cuts to Medicaid in order to fund tax breaks for the richest Americans.

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The reconciliation bill President Donald Trump and Republicans are working to pass through Congress is chock-full of troubling provisions, but the tax plan ultimately boils down to a massive financial break for the wealthiest Americans at the expense of social programs that benefit the less fortunate — most notably Medicaid.

Trump implored Republicans to pass the “BIG, BEAUTIFUL BILL!” on Friday, writing about how it cuts taxes for “ALL Americans” (not true) and would “kick millions of Illegal Aliens off of Medicaid to PROTECT it for those who are the ones in real need” (also not true).

Republicans on the House Budget Committee failed to pass the bill hours after Trump’s message — not because of the Medicaid cuts, but because they wanted them to be more extreme. Americans do not want more extreme cuts. The public holds an overwhelmingly positive view of Medicaid, with a whopping 76 percent opposing significant cuts to the program.

The tax bill that Republicans ultimately pass — public opinion be damned — is going to make life more difficult for millions of low-income Americans. Here’s everything you need to know:

Medicaid is a government program that provides health insurance to low-income Americans, as well as those with certain disabilities and otherwise limited resources. Medicaid programs are funded by both state and federal money, with each state operating its own program in accordance with federal rules and regulations.

There are over 70 million Americans enrolled in Medicaid, over one fifth of the nation’s population.

Medicaid is not to be confused with Medicare, although Health and Human Services Secretary Robert F. Kennedy Jr. recently mixed up the programs when he said that Medicaid is “fully paid for by the federal government.” Medicare, not Medicaid, is fully funded by the federal government, and provides health insurance for Americans over 65. (Kennedy also claimed that Americans enrolled in Medicaid are upset about high premiums and deductibles, despite the fact that most Americans on Medicaid don’t have to make any such payments.)

RFK Jr.’s confusion doesn’t necessarily mean the program is inherently confusing — but it certainly can be given how much it can differ from state to state.

Republicans are planning to cut $880 billion from the budget of the Energy and Commerce Committee’s budget, which oversees Medicaid.

One way Republicans want to cut costs is by limiting “provider taxes,” which states use to help pay their share of Medicaid costs — with payments going to local health care providers like hospitals and doctors. Rolling Stone reported on the industry-wide concern that freezing these payments could force some rural hospitals to close. Republicans also want to cut  federal Medicaid funding to states that provide care for undocumented Americans, and require Americans at or above the federal poverty level to pay out-of-pocket costs for services they didn’t have to pay previously.

The primary way Republicans are going to cut funding for Medicaid, however, is by wrapping it in as much red tape as possible in order to reduce the number of Americans who are enrolled.

It’s already difficult enough to secure and maintain Medicaid coverage, especially for sick and disabled Americans. Trump and Republicans want to make it more difficult.

The crux of the cuts lies in what Republicans are calling “community engagement requirements,” which is a nice way of saying they want to put up a series of barriers to coverage that will inevitably result in Americans getting kicked off the program. The bill calls for Americans to prove they work at least 80 hours per week in order to qualify. It also requires them to verify they are qualified twice annually.

Medicaid is subject to strict income caps, which vary by state, but suffice to say recipients are not allowed to make enough money to live. By adding work requirements, Republicans are ordering Medicaid recipients to work — but not for too much money. States already check recipients’ income levels once annually, and this process frequently results in eligible beneficiaries losing their Medicaid coverage for administrative reasons — such as if they fail to respond to a phone call or piece of mail.  

Studies have shown that work requirements don’t actually result in more employment, anyway, in part because Americans on Medicaid are already working. Health policy group KFF published a study earlier this year finding that in 2023, 92 percent of adults under 65 on Medicaid were working or not working because of school attendance, caregiving, or a disability, while the other eight percent were retired, unable to find work, or not working for other reasons. Republicans are pushing the idea that millions of Americans are sitting on their couches, snacking on junk food and laughing as they collect free health care, but this is simply not the case.

The fallacy of the GOP’s rhetoric about work requirements is exemplified in Luke Seaborn, a 54-year-old Georgia man whose maddening journey with state health care was highlighted by ProPublica. Georgia currently has a work requirement for Medicaid coverage, and the state used Seaborn, a mechanic, as one of the faces of the program. Seaborn advocated for the program on camera when it was introduced, but he’s since been booted from it twice due to bureaucratic obstacles.

“My head exploded,” he told ProPublica after he lost his coverage for the second time after failing to make a deadline to file an income statement he didn’t know existed. “I didn’t get a text or an email. I did what I was supposed to, but that wasn’t good enough.”

(ProPublica reported earlier in the year on the general failure of Georgia’s Medicaid work-requirement program.)

The Congressional Budget Office projects that 10.3 million Americans will ultimately lose their health care as a result of the cuts.

The New York Times recently published an op-ed by Health and Human Services Secretary Robert F. Kennedy Jr., Centers for Medicare and Medicaid Services Administrator Mehmet Oz, Agriculture Secretary Brooke Rolliins, and Housing and Urban Development Secretary Scott Turner, in which the top Trump officials argued that the government is being too generous, and that too many Americans are mooching off welfare programs like Medicaid.

Republicans in Congress have been making similar arguments. 

“We’ve got some able bodies who really should not be on there or should be able to go to another insurance product that would help them to have health insurance,” Rep. Buddy Carter (R-Ga.) said this week. Carter did not explain where exactly these people should get health care otherwise, although he did say he wants to “make sure everybody has access” to it, which is a touching sentiment.

“The person we’re taking it away from is the able-bodied adult with no children who refuses to work,” Rep. Dan Crewnshaw (R-Texas) added in a gross misrepresentation of the effect of the cuts. “If they would just get a job, they would keep their Medicaid.”

Rep. Greg Murphy (R-N.C.) has argued that the government needs to raise the bar on what constitutes a disability. Murphy, a doctor, complained specifically about two of his own patients, including a 48-year-old woman he said is hard of hearing but could hear his questions thanks to her hearing aids. “These are difficult challenges to overcome, but they are no reason someone should be on Medicaid, disabled and not working,” he said, adding: “I don’t personally think they are disabled.”

There are some Republicans who seem to understand the reality of the Medicaid cuts, which is that millions of Americans, including working Americans, will lose their health insurance. Sen. Josh Hawley (R-Mo.) wrote an op-ed for the Times in which bashed the “corporatist Republicans” who prioritize “corporate giveaways” and “deep cuts to social insurance.”

“Republicans need to open their eyes,” Hawley wrote. “Our voters support social insurance programs. More than that, our voters depend on those programs. And there’s a reason for this that Republicans would do well to ponder. Our economy is increasingly unfriendly to working people and their families.”

Democrats, at least some of them, are livid over the cuts. Rep. Frank Pallone (D-N.J.), the top Democrat on the Energy and Commerce Committee, railed in a statement that “in no uncertain terms, millions of Americans will lose their health care coverage, hospitals will close, seniors will not be able to access the care they need, and premiums will rise for millions of people if this bill passes.”

“This is not trimming fat around the edges, it’s cutting to the bone,” he wrote. “The overwhelming majority of the savings in this bill will come from taking health care away from millions of Americans. Nowhere in this bill are they cutting ‘waste, fraud, and abuse’ — they’re cutting people’s health care and using that money to give tax breaks to billionaires.”

Sen. Bernie Sanders (I-Vt.) sparred with HHS Secretary Kennedy over the bill during a hearing earlier this week. “You cannot deny that the top two-tenths of one percent will get $235 billion in tax breaks while we cut Medicaid,” Sanders said in response to Kennedy trying to argue that the bill will benefit low-income Americans.

Pete Buttigieg hasn’t minced words, either. “Right now, front and center, we need to be talking about … Medicaid,” he said this week. “As we speak, congressional Republicans and Donald Trump are preparing to take Medicaid away from millions and millions of Americans. The impact on health, on poverty, on the economy, on their lives is enormous.”

There isn’t a ton Democrats in Congress or elsewhere can do to prevent the bill’s passage, though, which is why Republicans need to ram it through now, while they still have their majority.

Trump has insisted that his administration would not cut Medicaid. He told reporters in January that “we’re going to love and cherish” the program, that “people won’t be affected,” and that it will only be “better and more effective.” He insisted to Sean Hannity the following month that it wouldn’t be “touched” and that it will only be “strengthened,” and reiterated to reporters at a Cabinet meeting a few weeks later that “we aren’t going to touch it.”

In every instance, Trump added the caveat that the administration is looking to eliminate waste and fraud — which he is now irrationally using as a pretext for taking a hatchet to the program he claims to “cherish” so dearly. Yes, millions of less fortunate Americans will have their lives thrown into flux, but the wealthy ones who put Trump back into office need their tax cuts.

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