May 12, 2025
By Marc Stier
The Energy and Commerce Committee Medicaid Plan Release Last Night
Last night the House Energy and Commerce Committee released a chairman’s mark (or chairman’s draft) of its proposals for cutting Medicaid.
According to a Congressional Budget Office preliminary analysis, the proposal includes very deep cuts to Medicaid and the ACA, totaling $715 billion over ten years. This is worse than what we expected.
According to the CBO, the result is that between Medicaid and ACA cuts, 14.2 million people nationwide will lose health insurance. Other cuts not included in the CBO analysis might raise the total to 17 million people. Our rough estimate is that between 548,000 and 680,000 Pennsylvanians will lose health insurance. (We will have a firmer analysis in a few days.)
This translates roughly into between 57,000 and 70,000 people losing health insurance in the 8th Congressional District in Northeast Pennsylvania and roughly half that amount losing health insurance in the 1st Congressional District. Other Congressional districts will see results somewhere between these.
But we see some success from our work: the plan does not include major structural changes to how the Medicaid program is financed. It adopts neither a direct reduction in the federal share of Medicaid or per capita caps on federal spending. On the other hand, the plan includes many provisions discussed in our recent paper on Medicaid:
- work requirements for, we think, both traditional and expanded Medicaid.
- more frequent reapplication and review of Medicaid beneficiaries.
- no extension of expanded ACA tax credits.
- individual co-pays of, we understand, roughly $35 for a doctor’s visit.
- limitations on Medicare recipients using Medicaid to meet co-pays.
In addition, the plan freezes extra federal payments that are a result of the complicated process by which the state provides extra payments to health care providers while also taxing them and securing additional federal funding. (More on this process here.) It appears that the impact of this payment freeze is accounted for in the estimates of those who lose health insurance. (We are working on an estimate of the impact of the payment freeze on the state budget.)
As we point out below, none of these provisions are actually designed to reduce waste, fraud, and abuse in the Medicaid. There is little evidence of that. And work requirements don’t generate much work because the vast majority of Medicaid recipients are already working, taking care of children or elderly parents, or going to school.
The real point of these requirements is very simply to make access to health insurance more difficult and costly for people who are mostly poor, disabled, or elderly.
The Republican plan for Medicaid is, frankly, an ugly and direct attack on these people that makes them pay the cost for utterly unnecessary tax cuts that mostly go to the richest Americans.
Context
While there is now a House Committee plan, we are still not sure what the ultimate outcome of this process will be.
As we’ve explained in detail before, there are deep conflicts within the Republican Party in both the House and Senate over the extent of Medicaid and SNAP cuts and the nature and extent of the tax cuts. Some of those conflicts, such as over Medicaid cuts and what to do with state and local tax deduction, have deepened in the last week.
To help you understand what’s at stake this week—and in the following weeks, if and when a budget reconciliation bill moves to the floor of the House and then the Senate—we have updated a number of our policy briefs, including:
The Trump-Republican Threat to SNAP
The Trump-Republican Threat to Medicaid
Projecting the Costs to the Pennsylvania Budget of Federal Safety Net Cuts — a piece on the potential impact of federal policy changes on the state budget. We will be doing a revision of this piece given what the Energy and Commerce and Agriculture committees do this week. he
The Trump Republican Threat to Fair Taxes and Fiscal Integrity
The first three are available now on our website, and the last one on taxes will be available Tuesday morning.
We’ll be following the action in Washington closely this week and will update you as soon as we understand where things are heading. And should the Republicans reach some agreement on the reconciliation bill, we’ll do another round of updated policy briefs letting you know what they propose.
Feel free to reach out to me with any questions you have about our policy briefs or what is going on in Washington. stier@pennpolicy.org
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