GOP Medicaid Cuts Could Leave Millions Uninsured

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Millions of Americans could lose their health insurance under Republican proposals to reduce Medicaid spending in order to help fund President Trump’s domestic agenda, according to a new report released Wednesday by the Congressional Budget Office (CBO).

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The analysis estimates that imposing a cap on Medicaid funding for individuals in the expansion group would save $225 billion but leave 1.5 million more people without coverage by 2034. Another option—restricting states’ ability to tax healthcare providers—could cut federal spending by $668 billion but would result in an additional 3.9 million uninsured.

The CBO report was prepared at the request of Rep. Frank Pallone Jr. (D-N.J.) and Sen. Ron Wyden (D-Ore.), and it highlights the difficult trade-offs Republicans face as they seek to offset the cost of their proposed legislation, which includes extending parts of the 2017 Trump-era tax cuts.

“This nonpartisan CBO analysis makes the consequences clear: the GOP’s health care proposals mean deep cuts and loss of coverage for millions relying on Medicaid,” said Wyden.

Republicans have directed the House Energy and Commerce Committee—responsible for Medicaid oversight—to find $880 billion in savings as part of a broader effort to trim at least $1.5 trillion from federal spending. A prior CBO review suggested that achieving this level of savings within a decade would be nearly impossible without making substantial cuts to Medicaid.

The latest report examines five Medicaid-related policy options floated by Republicans, including ending enhanced federal funding for Medicaid expansion states, placing limits on provider taxes, instituting per-person spending caps across the full Medicaid population or just the expansion group, and reversing a Biden administration rule expanding eligibility.

While GOP leadership has not finalized a plan, House Speaker Mike Johnson (R-La.) said Tuesday that eliminating the enhanced federal match is no longer under consideration, and that per capita caps on the expansion group may also be dropped.

The report did not include analysis of Medicaid work requirements. However, a 2023 CBO study found that implementing such requirements for adults aged 19 to 55 could save $109 billion over 10 years but would result in 600,000 losing coverage. It would also shift roughly $65 billion in costs to the states.

Importantly, the CBO’s estimates assume that states would absorb about half of the lost federal funding—a level of support many analysts say is unrealistic. Without state intervention, the number of uninsured could be even higher. States facing these shortfalls would likely respond with cuts to provider payments, benefits, or enrollment, or by raising taxes and reducing funding for other services like education and public safety.

“Despite President Trump’s repeated claims that Republicans aren’t cutting health care, the CBO makes it clear: these proposals would lead to devastating coverage losses,” Pallone said.