The U.S. House of Representatives narrowly passed a budget resolution (H Con Res 14, 119th Congress) on Tuesday evening, voting 217-215 to advance an agenda that could cut $880 billion from Medicaid over the next decade. The resolution, which is part of a broader Republican effort to enact $4.5 trillion in tax cuts, would affect nearly 80 million Americans who rely on Medicaid and CHIP, disproportionately impacting low-income families, seniors, and people with disabilities.
The vote came after direct intervention from Donald Trump, who pressured wavering House Republicans to support the resolution. Despite initial GOP resistance, House leadership secured just enough votes after a dramatic 90-minute delay in proceedings.
Under the new budget resolution, the House Energy and Commerce Committee, which oversees Medicaid and other healthcare programs, has been tasked with cutting at least $880 billion over the next decade. This move would allow states to impose work requirements on Medicaid beneficiaries, a controversial provision that could result in millions of people losing coverage. States may also be forced to make up for the funding shortfall, likely leading to stricter eligibility rules, benefit reductions, or higher out-of-pocket costs for enrollees.
The resolution also mandates $230 billion in cuts to the Supplemental Nutrition Assistance Program (SNAP), potentially removing millions of low-income Americans from food assistance programs. Critics argue these cuts disproportionately harm the most vulnerable, including children, seniors, and people with disabilities.
The resolution’s passage did not come easily. The House leadership paused the vote for 90 minutes as they scrambled to secure the last necessary votes. With fewer than 20 votes left to cast, one Republican lawmaker switched from a “no” to a “yes” vote at the last moment, ensuring its passage.
Even within the Republican Party, the proposal caused friction. Some GOP members opposed the resolution, arguing that the cuts were too extreme, while others pushed for even deeper Medicaid reductions. Lawmakers from swing districts—where millions rely on Medicaid—faced intense pressure from constituents and advocacy groups.
Meanwhile, Trump personally lobbied House Republicans, contradicting previous White House assurances that Medicaid would not be impacted. His involvement proved decisive in securing the necessary votes.
If this budget resolution is enacted, it could have devastating consequences for Medicaid recipients. Work requirements alone could result in millions of people losing access to healthcare, even among those who are employed but struggle to meet rigid documentation requirements. Additionally, the reduction in federal funding could force hospitals, nursing homes, and community health centers—many of which rely heavily on Medicaid reimbursements—to cut services or shut down entirely.
The consequences could be particularly severe in rural areas, where hospitals are already struggling to remain open. Medicaid cuts would accelerate hospital closures, leaving many Americans with few or no local healthcare options.
A Politico review found that 11 Republican lawmakers in swing districts collectively represent 2.7 million Medicaid recipients. Some of these lawmakers—including Reps. David Valadao (R-CA), Mike Lawler (R-NY), and Robert Bresnahan (R-PA)—have voiced concerns about the bill’s impact on their constituents.
In the Senate, Republican opposition is also growing. Sen. Josh Hawley (R-MO), representing a state where 21 percent of residents rely on Medicaid, said he did not support massive cuts to the program. Alongside Sen. Susan Collins (R-ME), Hawley backed a Democratic amendment that would have blocked tax cuts for the wealthy if Medicaid funding was cut. The amendment was ultimately rejected by the rest of the GOP.
House Speaker Mike Johnson (R-LA) defended the resolution, claiming it does not “cut Medicaid directly” but rather instructs committees to “find savings”. However, the House Energy and Commerce Committee, which oversees Medicaid spending, has been explicitly tasked with cutting $880 billion, making it clear that Medicaid is a target.
Republicans also rejected numerous Democratic amendments aimed at preventing Medicaid and SNAP cuts during the budget reconciliation process. Rep. Pramila Jayapal (D-WA) condemned the move, stating:
“99 percent of House Republicans just voted to gut Medicaid so they can lower taxes for the richest 1 percent.”
Democrats and policy experts have widely condemned the budget resolution. Rep. Brendan Boyle (D-PA), ranking Democrat on the House Budget Committee, said:
“Republicans are cheering the passage of their extreme budget resolution that betrays the middle class.”
Sharon Parrott, president of the Center on Budget and Policy Priorities, stated:
“The enormity of program cuts called for by the House budget stands as a singular threat to the well-being of people in every state, city, and rural community.”
David Kass, executive director of Americans for Tax Fairness, accused House Republicans of prioritizing tax cuts for billionaires over healthcare for working families:
“House Republicans have ignored the demands of their constituents and instead chosen to side with their billionaire donors.”
The resolution’s future remains uncertain as it moves to the Senate, where Republicans are pursuing a smaller budget plan that prioritizes border security and defense spending over Medicaid cuts. If the House and Senate cannot reconcile their differences, the proposal may stall.
Meanwhile, legal experts argue that Medicaid is a federal entitlement, and drastic cuts could face legal challenges under provisions of the Affordable Care Act.
The House GOP’s budget resolution makes drastic cuts to Medicaid and food assistance to fund trillions in tax cuts for the wealthiest Americans. If enacted, it would lead to millions losing healthcare, higher costs for working families, and worsening health outcomes nationwide.
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