Key components of the bill to fund President Donald Trump’s agenda looks to provide major tax breaks by cutting spending elsewhere, including massive cuts to Medicaid.
Medicaid is a joint federal and state health insurance program for disabled and low-income Americans. The Centers for Medicare & Medicaid Services (CMS) works with state programs to administer Medicaid, under which more than 71.2 million people are enrolled.
Medicaid offers benefits including nursing home care, personal care services and assistance paying for premiums and other costs, according to CMS.
An analysis from the Congressional Budget Office estimates cuts to Medicaid could increase the number of people without health insurance by at least 8.6 million by 2034.
“Medicaid is an important safety net for so many Americans,” Jennifer Mensik Kennedy, president of the American Nurse Association, told ABC News. “When we look at the most vulnerable and most underserved, it’s going to impact these groups disproportionately.”
Many Republicans have insisted that cuts to Medicaid are only to eliminate fraud, waste and abuse and will not result in lost coverage for those who need it, which was repeated during testimony this week by Health and Human Services Secretary Robert F. Kennedy Jr.
But some Americans who rely on Medicaid for their own coverage, or coverage for their families, told ABC News they’re worried that cuts could reduce their ability to receive health care, or force them to choose between paying for coverage or paying for necessities.
Speaker Mike Johnson speaks to reporters as he leaves the House Chamber at the U.S. Capitol, May 15, 2025 in Washington.
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‘I feel very scared’
Rosa Andresen, from Southgate, California, has been her 27-year-old daughter’s caregiver for the past 13 years.
Her daughter, Amanda, is disabled and has conditions including cerebral palsy and a seizure disorder. Over a decade ago, Andresen left her job at a data entry retrieval company to care for her daughter full time.
Andresen, 54, said Amanda is covered by Medicare and Medicaid, which has helped pay for diapers, seizure medication and mobility tools such as a shower chair and a ramp to help her go up and down stairs.
It’s unclear if Amanda would lose Medicaid coverage under the new proposal but, if she did, it would be a massive blow to her care, Andresen said.
“It’s very devastating,” Andresen told ABC News. “I’m very, very sad, and I feel very scared for my daughter’s well-being. It could drastically affect her health and her life, the quality of life that she has.”
Andresen said she is scared that she will receive a letter in the mail telling her that her daughter is no longer eligible for Medicaid or she’ll take Amanda to a doctor’s appointment and find out that her daughter cannot receive care there or can no longer be prescribed a certain medication.
She said she has tried to see if she could get private insurance for her daughter, such as through her husband’s job, but insurance companies allegedly told her they don’t cover people with chronic illnesses.
According to the HHS, “health insurers can no longer charge more or deny coverage to you or your child because of a pre-existing health condition like asthma, diabetes, or cancer, as well as pregnancy”.
While California does have Medi-Cal, which is the state’s implementation of the federal Medicaid program, Andresen said she doesn’t know what the program would cover and what she would have to pay out of pocket.
“I use government assistance to buy food, like the [electronic benefit transfer], to put food at my table and if I have to also use money out of my pocket, I don’t know if I’m going to be able to make it if I [have to] decide to buy my daughter’s medication or put food on the table,” Andresen said.
Work requirements could jeopardize care
Four years ago, Jodie Montplaisir, a mother-of-five from North Hampton, Massachusetts, was struggling with opioid use disorder. She was unhoused, unemployed and separated from her children.
Montplaisir said she realized she had hit a low point and needed help. She entered an opioid treatment program (OTP), paid for by Medicaid.
“I really just was like, ‘I need to fix my life,’ and I did,” Montplaisir, 38, told ABC News. “I really stuck in with the clinic and doing all of the meetings, all the groups, all my therapy, just really utilizing the clinic … and they really helped me.”
Montplaisir is now three years into her recovery, currently living in an apartment, reunited with her children and has a job working with unhoused people.
Medicaid currently covers her medication-assisted treatment, and she attends clinic weekly to stay accountable. However, she fears any interruption, such as red tape or new requirements, could jeopardize her progress.
“If I didn’t have Medicaid, I wouldn’t have been able to do the clinic,” she said. “There’s absolutely no way possible. If I didn’t have Medicaid and the help of the system, I wouldn’t have been able to do it alone.”
The Republicans’ proposed bill would impose work requirements on able-bodied Medicaid recipients — at least 80 hours per month — or require enrolling in an educational program for at least 80 hours or some combination per month.
Mary Beth Cochran, an activist, speaks out against House Republican’s Budget Resolution in front of the U.S. Capitol in Washington, Feb. 25, 2025.
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Not all Republicans are in favor the bill in its current form. A growing number of House GOP members are expressing grievances, some because they don’t believe the bill does enough to protect vulnerable Americans and others because it does not include some of the most drastic cuts that Republican hardliners were pushing for.
Montplaisir said if work requirements were in place when she was in OTP, it would have made it impossible for her to focus on her recovery, and it will make it difficult for the unhoused people she now works with.
While the draft language has exemptions for certain adults, including those who have substance use disorder, Montplaisir worries proving an exemption could be complex and may result in lost coverage anyway.
Additionally, trying to prove work requirements as opposed to focusing on recovery could derail people’s progress, she said.
“Medicaid is there to help us … how we supposed to work if we’re trying to get sober?” Montplaisir said. “If I had to have paid money while I’m trying to get sober or having to work while I’m trying to get sober, it wouldn’t work.”
ABC News’ John Parkinson and Lauren Peller contributed to this report.
