This week, Republicans on the Energy and Commerce Committee shared plans to cut over $880 billion to partly fund President Trump’s domestic agenda.
Chair Brett Guthrie (R-KY) seems to have secured more savings than necessary, steering clear of the committee’s most contentious proposals.
While the Congressional Budget Office hasn’t issued any official score yet, a letter on Monday pointed out that the committee’s suggestions will surpass the savings targets outlined in Trump’s “big beautiful bill” and won’t increase the deficit beyond 2034.
However, as this measure progresses through the House and heads to the Senate, GOP leaders need to find a balance that keeps both moderates and conservatives satisfied. The panel will conduct a lengthy session on Tuesday afternoon to discuss and refine the package.
Here are the key points regarding the suggestions:
Structural changes to Medicaid are absent
The plan leans more towards the Republican moderate faction by leaving out two of the most controversial proposals being discussed.
Most savings come from adjustments where Medicaid beneficiaries would pay more for doctor visits and need to complete additional paperwork to demonstrate eligibility. Additionally, there are new requirements for poor, childless adults aged 19 to 64 to prove they work at least 80 hours a month.
The Medicaid and health section could save about $715 billion, according to the Congressional Budget Office, but it might also leave at least 8.6 million Americans without insurance.
Pant tight choices on the condition
One of the proposal’s significant savings stems from limiting states’ ability to impose taxes on healthcare providers, which includes hospitals and nursing homes.
These provider taxes have been beneficial for states looking to garner more federal Medicaid funds by taxing providers and returning a higher refund for treatment. The proposal will halt any new state taxes and maintain current tax rates.
While the plan doesn’t eliminate existing taxes, some conservatives argue it could have gone further.
However, as states lose this income, they may need to reconsider how they finance their Medicaid programs. States will ultimately decide between cutting benefits or raising taxes.
New work requirements will be federally mandated, but enforcement will fall on the states. Starting in 2029, states will need to introduce “community engagement” requirements for Medicaid enrollment.
Community engagement here refers to 80 hours of work, community service, or employment programs each month. Other options include at least part-time enrollment in an educational program or a mix of the available choices.
“This bill will refocus Medicaid on mothers, children, people with disabilities, and seniors—not on illegal immigrants or able-bodied adults who choose not to work. It’s irresponsible for my colleagues on the other side to claim such high numbers regarding coverage loss,” one member noted.
The proposal would also penalize some Democrat-led states that use their funds to offer Medicaid to undocumented immigrants. If these states continue to provide such coverage, the federal funding for that expanded population would drop from the current 90% to 80%.
New York, Washington, and California are among the hardest-hit states.
“Defunding” planned parent-child relationships
This proposal marks a win for anti-abortion lawmakers by removing Medicaid funds from Planned Parenthood and its affiliates.
While Planned Parenthood isn’t named in the proposal, Medicaid will restrict funding to any healthcare providers that also offer abortion services, with exceptions for cases of rape, incest, or when the mother’s life is at risk.
Medicaid already disallows coverage for abortions, but supporters argue that federal funding should not go to Planned Parenthood, as women often lack alternative options. While this might not result in significant savings, it sends a critical conservative message.
Moderate lawmakers have voiced concerns about the inclusion of such provisions, although anti-abortion groups are rallying support.
During a web event on Monday, Kristan Hawkins, president of Students, encouraged grassroots activists to contact specific House and Senate members to support the reimagined parent-child relationships.
Hawkins mentioned “pro-choice” Republicans like Sen. Lisa Murkowski (R-Alaska) and long-time anti-abortion advocates.
Conservatives seek deeper cuts
Guthrie is attempting to bridge the gap between moderates and conservatives, though it’s uncertain whether that strategy will be effective.
“Does the bill provide transformative changes to Medicaid and other programs? Currently—no,” one commentator noted. He voiced that the plan “ignores essential policy changes.”
“Even the adjustments it adopts are largely those made by Trump, leaving healthcare costs spiraling and allowing wealthy individuals to profit. It’ll take more extensive changes for me to lend my support.”
At the same time, Sen. Josh Hawley (R-Mo.) wrote on Monday, warning against efforts to cut Medicaid, stating it would be “morally wrong and politically suicidal” to finance “big, beautiful bills” by reducing health insurance for the working poor.
Hawley positions himself as a populist within the GOP, yet his continuing opposition to Medicaid cuts signals potential trouble as he approaches a Senate vote.
