WASHINGTON — As the U.S. House prepares to vote on a sweeping budget blueprint that was approved by the U.S. Senate last week, sizable cuts to Medicaid are one step closer — and just who would bear the brunt of those cuts is coming into better focus.
The budget reconciliation bill itself does not mandate any cuts to Medicaid, the government health program for low-income Americans that’s called Medical Assistance in Minnesota. But the budget resolution instructs the House Energy and Commerce Committee to cut the Department of Health and Human Services budget by $880 billion, a target experts say can’t be met without slashing Medicaid.
So, if the budget resolution is approved by the House, Congress would have to come up with a way to find $880 billion in savings when it drafts the spending bills that fund the federal government.
There are several ways to shrink federal spending on Medicaid, a joint federal-state program that requires Minnesota to pay about 43% of the cost to cover nearly 1.2 million state residents. One way to cut the cost of this program is to reduce the benefits to enrollees, something President Trump and GOP leaders in Congress have vowed not to do. Another is to reduce the number of people eligible for the program.
Medicaid has been a historical target for Republicans, who have long sought to impose national work requirements on Medicaid recipients. That means that able-bodied adults without children must work or be actively looking for work to qualify for the program.
The Center for Budget and Policy Priorities estimates that at least 33% percent of Minnesotans enrolled in Medicaid would lose coverage if work requirements were mandated — and challenged the idea that work requirements were needed.
“Work requirements are burdensome and unnecessary because 92% of people who receive Medicaid are already working full or part time, or they are not working because they are a caregiver, have an illness or disability, or are attending school,” the center said.
But work requirements may not be enough to reduce the Medicaid population, so the GOP-led House and Senate may seek to eliminate a key provision of the Affordable Care Act that expanded Medicaid coverage to people who earned a little more than those on traditional Medicaid.
Unlike traditional Medicaid, in which the cost of the program is more evenly shared, the federal government pays 90% of covering the expansion population and the state only 10%.
The Minnesota Department of Human Services said that in 2024, the average monthly enrollment in the Medicaid expansion group was 283,706.
Morrison ‘sounding the alarm’ on cuts
The budget reconciliation bill the House will consider this week calls for about $5 trillion in tax cuts, which would be partially offset by $2 trillion in spending cuts, including the projected cuts to Medicaid. The tax cuts would extend the ones implemented during Trump’s first term in office, which will expire at the end of the year.
The reconciliation bill would also lift the debt limit by $5 trillion.
It was approved by the U.S. Senate on a party-line vote and expected to pass the U.S. House on a partisan basis, too, although several ultraconservative Freedom Caucus GOP House members are balking because the legislation’s tax cuts are not fully funded.
For U.S. Rep. Kelly Morrison, D-3rd District, an OB-GYN and founding member of the Democratic Doctors Caucus, the looming cuts to Medicaid have provided the freshman lawmaker with a mission.
“The consequence of cutting Medicaid deeply is horrifying to me,” Morrison said.
She said 650,000 children and about one-third of the childbirths in Minnesota are covered through Medicaid. “I’ve been sounding the alarm in every way I can,” Morrison said.
She said she’s visited hospitals and health clinics in her suburban Twin Cities district and “they are all so afraid.”
“Many say they will have to shut their doors,” Morrison said.
She said she’s also trying to persuade GOP colleagues to keep their hands off Medicaid, but they appear hard to convince. Many Republicans insist Medicaid savings will be limited to the ferreting out of fraud, waste and abuse.
But experts say that would not be nearly enough to fulfill the savings mandated by the budget reconciliation bill. And it’s unlikely Minnesota, or any other state, will be able to pick up the additional cost of providing health care for low-income Americans who don’t have coverage on the job and can’t afford private health insurance.
State Rep. Aisha Gomez, DFL-Minnepolis, has introduced a bill that would establish a new individual income tax tier for Minnesotans who earn more than $1 million to offset any losses for Medicaid funding, which could be as much as $1 billion a year. But that legislation is likely to face high hurdles.
On Monday, Morrison read a letter sent to Trump and Minnesota’s Republican members of Congress from a group of GOP state lawmakers on the House floor.
“Just to emphasize what you already know, Medicaid includes services and care for the seniors and those with disabilities, not just health care for the poor,” said the letter, which was signed by six GOP state senators and eight GOP state House members. “Additionally, nearly 50% of all Medicaid enrollees are children.”
U.S. Rep. Betty McCollum, D-4th District, hopes to also take to the House floor to protest cuts to Medicaid. On Tuesday, she sent a letter to House Minority Leader Hakeem Jeffries asking for permission to hold a “one-on-one” debate, known as a colloquy, on the House floor.
“Republican members of Congress repeatedly denied that painful cuts will be made,” McCollum wrote Jeffries. “However, the nonpartisan Congressional Budget Office has confirmed that based on the text of the budget proposal there is nowhere else for cuts of that magnitude to come from other than the critical healthcare programs relied upon by everyday Americans to survive.”
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