Medicaid, the insurance program for low-income and disabled Americans, is proving to be a sticking point in getting President Donald Trump‘s colossal spending bill over the finish line.
Republican lawmakers, who are facing a self-imposed July 4 deadline, proposed restructuring the program that provides coverage for more than 70 million people.
A new work requirement, which appears in both House and Senate proposals, may prompt millions of Americans to lose Medicaid coverage. The requirement calls for people to participate in qualifying activities for 80 hours each month.
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“It is perfectly reasonable for taxpayers who are paying into the Medicaid program to insist that everyone in the program who can contribute do so, by working,” Michael Cannon, Director of Health Policy Studies at the Cato Institute, told FOX Business.
“Will the work requirements as the House and Senate have drafted them result in some people not enrolling in Medicaid? Yeah, probably,” he added. “There is no obvious way to strike a balance between helping too much and helping too little, but a work requirement is a perfectly reasonable one.”
The bill asks Medicaid members who are able-bodied, prime-age adults without children to work or volunteer roughly 20 hours a week.
Nina Schaefer, the director of the Center for Health and Welfare Policy at the Heritage Foundation, described the Medicaid provisions as “common sense administrative changes.”
“The Medicaid program is over 60 years old and has been running on autopilot for far too long. These changes begin to bring much needed oversight, transparency, and accountability to the program,” she said.
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Schaefer said the bill works to ensure “that only those who are eligible for the program are on it, weeding out budget gimmicks used by the states to shift more costs to federal taxpayers, and bringing a work requirement for able-bodied enrollees into Medicaid, as is required in other welfare programs.”
The Congressional Budget Office projects that Medicaid spending will total $8.2 trillion over the 2025–2034 period. For this year alone, spending is expected to hit $656 billion, rising to an estimated $986 billion by 2034.
Matthew Dickerson, the director of Budget Policy at the Economic Policy Innovation Center, writes that the $8.2 trillion figure is more than 20 times the projected spending for U.S. Customs and Border Protection and U.S. Immigration and Customs Enforcement.
“The worst thing about Medicaid is that it delivers poor outcomes for the most vulnerable in our society while hundreds of billions of dollars per year flow to hospitals, insurance companies, and state bureaucracies,” Dickerson writes in a February report.
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Sen. Thom Tillis, R-N.C., broke with the GOP on Saturday, saying he could not vote for the “big, beautiful bill” because it would kick approximately 663,000 people in North Carolina off their healthcare plans.
Tillis, in a floor speech, warned Senate Republicans “are about to make a mistake on healthcare and betraying a promise” on Medicaid.
“I’m telling the president that you have been misinformed. You supporting the Senate mark will hurt people who are eligible and qualified for Medicaid,” he said.
The two-term senator, who announced over the weekend that he would not seek re-election, said that while he agreed with the work requirement, the July 4 deadline was “artificial” and lawmakers should “take the time to get this right.”
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When asked about Tillis’ position, White House press secretary Karoline Leavitt said “he is just wrong” and said Trump spoke to lawmakers over the weekend about the legislation.
“This bill protects Medicaid… for those who truly deserve this program, the needy, pregnant women, children and sick Americans who physically cannot work. It ensures that able-bodied Americans who can work 20 hours a week are actually doing so, and that will therefore strengthen and protect those benefits for Americans who need it,” Leavitt told reporters during a White House briefing.
Leavitt added that the measure will address “waste, fraud and abuse” and remove approximately 1.4 million illegal immigrants from the program.
“Of course, more could be done, but this lays the groundwork for a more comprehensive review of the Medicaid program in the future and reforms that will ensure America’s most vulnerable have access to the care they need,” Schaefer told FOX Business.
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Trump met with House Speaker Mike Johnson, R–La., and Senate Majority Leader John Thune, R–S.D., at the White House on Monday as senators offered amendments to the bill in a process called a “vote-a-rama.” Leavitt said that the White House was confident the bill would cross Trump’s desk by the Fourth of July.
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