Republicans pass Trump-backed tax plan that could drastically cut Medicaid

• House Republicans moved forward on President Donald Trump's sweeping immigration, energy, and tax cut plan.
• Their plan could lead to significant cuts to Medicaid.
• GOP lawmakers will now have to flesh out their proposal, including potential cuts to programs.

House Republicans on Thursday voted to pass a GOP-budget plan that could lead to massive cuts to Medicaid after President Donald Trump leaned on a handful of conservative holdouts.

The final vote was 216 to 214. The budget resolution, which requires Senate committees to identify spending cuts totaling a low floor of $4 billion, includes controversial language that calls for the House Energy and Commerce Committee to cut $880 billion in programs it oversees over the next decade. Speaking alongside Senate Majority Leader John Thune, Speaker Mike Johnson said Republicans want to find at least $1.5 trillion in cuts. Johnson pulled a vote on the legislation Wednesday evening amid uncertainty that it would pass.

Before Thursday's vote, Johnson held a joint news conference with Thune. The pair sought to reassure House conservatives that the GOP will cut significant spending in addition to tax cuts.

The budget plan is the next step in unlocking the special fast-track power, known as reconciliation, that Republicans are using to ram Trump's "big, beautiful bill" through Congress. GOP lawmakers will now have to fill in the details of their sweeping proposal, including whether they will cut Medicaid and if so by how much.

Johnson and GOP leaders have repeatedly stressed that their bill does not explicitly cut Medicaid, a healthcare program for millions of disabled and low-income Americans. However, Medicaid will likely get cut by or near $880 billion over a decade, as Medicaid and Medicare, which Trump has pledged not to cut, comprise most of the committee's budget. The federal government picks up the bulk of the tab for Medicaid spending. As of 2023, the federal share was about 72%.

Three Senate Republicans, Sens. Josh Hawley, Lisa Murkowski, and Susan Collins, joined Democrats in an unsuccessful effort to strip that language out of the plan before it passed their chamber.

Republicans will likely have no choice but to slash the program to reach the $880 billion in required cuts, much of which could hit Medicaid expansion. Failing to meet the spending target would risk the sweeping policy bill losing its special procedure power. If that were to happen, Republicans wouldn't be able to ram their bill through the narrowly controlled Senate where Democrats can use the filibuster to stop most other legislation.

Some Republicans have expressed uneasiness about potential Medicaid cuts. Hawley, a Trump ally, represents Missouri, where 20.3% of residents are Medicaid recipients. He previously told reporters that it was "a big concern" if the legislation would slash the healthcare program. Hawley said Trump shared his views. The president previously said he would "love and cherish" Medicaid.

About 23.3% of all Americans, or over 79 million, receive either Medicaid or the related Children's Health Insurance Program, a Business Insider analysis showed using July 2024 population estimates and October 2024 Medicaid enrollment data. States including New Mexico, California, and New York have over a third of residents on Medicaid, the analysis found. Nearly all states have at least 10% of residents on Medicaid or CHIP.

Missouri, Oklahoma, and South Dakota all mandate in their state constitutions that they participate in Medicaid expansion.

If Medicaid does get cut, some Republican leaders have suggested adopting per-capita Medicaid caps to limit how much federal funding an enrollee could receive, which could save as much as $900 billion.

Some have mulled adding Medicaid work requirements, while others have proposed cutting Federal Medical Assistance Percentages, the federal government's Medicaid spending share per state. Some critics have further argued that recipients can secure insurance from elsewhere, including from work.