As Republicans work to pass President Donald Trump’s reconciliation bill by his July 4 deadline, many are worried about the changes that could be coming to Medicaid.
Medicaid is a joint federal and state health insurance program for disabled and low-income Americans. The Centers for Medicare & Medicaid Services works with state programs to administer Medicaid, which enrolls more than 71.2 million people.
The original measure passed by the House made around $600 billion in cuts to Medicaid, which then faced deeper cuts in the Senate.
New estimates from the Congressional Budget Office project federal spending on Medicaid will be reduced by $1 trillion and that the current version of the bill in the Senate would increase the number of uninsured by 11.8 million by 2034.
The passage of the bill would go against Trump’s repeated promises to keep Medicaid intact.
Health policy experts and health care workers say sharp Medicaid cuts could result in vulnerable Americans no longer being able to receive care, either by losing coverage or by closing the centers that provide such care.
Work requirements could result in lost coverage
The bill imposes new 80-hour per month work requirements on able-bodied Medicaid recipients aged 19 to 64 who don’t have dependents. These requirements include working or other approved activities, such as volunteering.
There are exemptions for parents or guardians of children under age 14 and those with disabilities. Under the bill’s current text, these work requirements won’t kick in until 2026.
President Donald Trump speaks during a meeting with Democratic Republic of the Congo’s Foreign Minister Therese Kayikwamba Wagner and Rwanda’s Foreign Minister Olivier Nduhungirehe in the Oval Office at the White House in Washington, June 27, 2025.
Manuel Balce Ceneta/AP
An analysis published last week from the UC Berkley Labor Center found that work requirements could have a devastating impact on older Americans, between ages 50 and 64.
Nari Rhee, director of the Retirement Security Program at the UC Berkeley Labor Center and author of the analysis, told ABC News that after age 50, employment becomes increasingly difficult.
For instance, many older workers become physically unable to continue employment until they reach retirement age.
“Most people hope and plan to retire at something like age 65, but life happens and quite often what happens is people start having health issues,” Rhee said. “If you’ve had blue collar work or manual work, often you started working probably in your late teens. And so, by the time you get into your 50s, your late 50s, your body is just really worn out, and you’re not no longer able to work the kinds of jobs that you used to do.”
She added that some older workers who are physically unable to do the jobs they used to do or who were laid off have a hard time finding employment again due to age discrimination.
Additionally, many older adults are responsible for caring for family members including spouses and parents, which may mean leaving the workplace entirely.
“In practical terms, there are all kinds of legitimate reasons why, especially older adults, might not be able to meet the work requirements in terms of actually putting in the number of hours, and that’s before we even get to all the administrative issues,” Rhee said. “Even if you do work, you might not be able to navigate the red tape.”
AARP, an interest group that focusing on issues affecting those 50 and older in the U.S., sent a letter over the weekend to Sen. Majority Leader John Thune and Sen. Minority Leader Chuck Schumer expressing opposition to a provision that would disqualify people who fail to meet Medicaid work requirements from receiving Affordable Care Act premium tax credits.
“This creates a steep coverage cliff for those in their 50s and early 60s — particularly for those nearing retirement or working part-time — who may be left with no affordable coverage option at all.”
Risk of rural hospitals, health centers closing
Jennifer Mensik Kennedy, president of the American Nurse Association, said cuts to Medicaid could force rural hospitals and community health centers to close.
Although Senate Republicans have proposed a $25 billion rural health stabilization fund due to cuts to the Medicaid provider tax, it is unclear if that will be enough to prevent hospitals from closing.
Many rural health care centers receive revenue from patients covered by Medicaid and losing that revenue could be costly.
Sen. Ed Markey speaks on the floor of the Senate, June 30, 2025, in Washington.
Senate TV
“These hospitals have been on the verge of tight finances for years, and this could be enough to shut them down,” Mensik Kennedy told ABC News. “If we have cuts to Medicaid, we’re going to see these hospitals start to shutter their doors, and people are going to have to drive three, four, hours to deliver a baby, to go have emergency care to get seen, and that’s got to be unacceptable to everyone.”
Arnulfo De La Cruz, president of SEIU 2015, the nation’s largest long-term care union and California’s largest labor union, concurred, saying cuts to Medicaid would impact states’ ability to provide health coverage and long-term care, particularly for rural and low-income Americans.
“Any cuts to Medicaid, the impact in California would be devastating … Medicaid is really the core of how the long-term care system is structured and funded,” he told ABC News. “Medicaid helps to fund clinics, hospitals, nursing homes, home care — it’s all connected as part of our health delivery system. If you were to dismantle or cut to the extent that they’re talking about, I think you see clinics close, you see hospitals close, you see nursing homes close.”
He went on, “I think it would have a devastating impact on the ability for rural Californians and low-income Californians to be able to access their health care, thereby becoming sicker and having to look to much more high-cost alternatives.”
