The final version of President Donald Trump’s tax bill will likely come with significant changes to Medicaid, sparking concerns among the millions of Americans who rely on the government program.
Trump and the White House insist the changes aren’t about cutting Medicaid, but about “eliminating waste, fraud, and abuse” by adding work requirements and removing migrants in the country illegally from the program.
But the Congressional Budget Office predicts nearly 12 million Americans could lose access to Medicaid by 2034 under the Senate-passed version of the bill.
In a House Rules Committee meeting on Tuesday, ranking member Rep. Jim McGovern, D-Mass., expressed frustration over the cuts to Medicaid, calling them “cruel.” He said the bill will hurt the poor at the expense of wealthy Americans who will benefit from the tax cuts in the bill.
But other Republicans are supportive of the changes to the federal program.
Utah State Sen. Todd Weiler posted on X in support of the Medicaid work requirement.
“Republicans are adding a work requirement of 80 hours per month for able-bodied adults under the age of 65. There are exceptions for parents with children under the age of 14. How is that bad?” he wrote.
Meanwhile, Utah House Democrats were critical of the cuts, saying the bill would have “devastating consequences for Utah,” with the bill potentially cutting $1 billion from the state’s $5.5 billion Medicaid budget.
“The consequences are undeniable: sick, low-income, and at-risk Utahns will lose access to critical healthcare. Programs will be gutted. The quality and availability of services will decline. And rural hospitals, who cover more than just Medicaid patients, will close,” a statement from the caucus said.
According to the most recent data, about 71.3 million Americans are enrolled in Medicaid the federal government’s health insurance program for lower-income Americans, with another 7.3 million enrolled in Children’s Health Insurance Programs.
CBO: Senate version could affect coverage for almost 12 million Americans
After weeks of deliberation, the Senate passed its version of the Trump tax bill on Tuesday. In the approved package, there are several major changes to Medicaid, which would lead to deeper spending cuts than the version passed by the House.
The Congressional Budget Office (CBO) said the Senate bill would cut insurance for 11.8 million Americans, which is about 1 million more than the House’s version.
The Senate version of the bill includes an estimated $930 billion in cuts to federal health systems over the next decade, whereas the House version would have cut nearly $800 billion.
Here are some of the changes made in the bill and what is to come, should the bill land on Trump’s desk later this week.
Work requirements
Both the Senate and House versions include new work requirements for Medicaid. The bill would require adults to work, volunteer or study for 80 hours each month to be eligible to enroll in the government-sponsored program.
There are some exemptions for people who are caregivers for dependent children and pregnant women. The Senate version expanded on the work requirements by adding parents of children over the age of 14.
Reporting
Both versions of the bill require Medicaid recipients to prove that they are eligible for services twice a year instead of once a year.
Home equity
Medicaid applicants can’t qualify if their home equity is valued at more than $1 million, both the House and Senate said.
As it stands, states determine the maximum limits on home equity, which in some cases are more than $1 million and are pegged to inflation.
Transgender medical treatments
In the House’s version of the bill, federal Medicaid funding was prohibited from covering gender transition treatments, including hormone therapy, puberty blockers and surgery.
The Senate version originally included something similar, but the Senate parliamentarian said it needed to be removed or modified to comply with reconciliation rules. The Senate later removed the provision from its package to keep the bill moving forward in the chamber.
Planned Parenthood
Both versions of the bill looked to remove Planned Parenthood from receiving federal funding. The House’s version ended Planned Parenthood from receiving payments for 10 years, but the Senate-passed version stopped payments for one year.
State provider taxes
The bill rolls back state provider taxes, which are taxes placed by states on medical providers like hospitals and clinics that then boost Medicaid reimbursement from the federal government. The bill would incrementally reduce the provider tax limit from the current 6% down to 3.5% over seven years. Because of how that limit could affect states that rely on the tax, Senate Republicans added a $50 billion fund to be paid out over five years to rural hospitals.
Utah delegation weighs in on Medicaid changes
A spokesperson for Sen. John Curtis said he is “committed to honest, compassionate reform of entitlement programs.”
The spokesperson pointed out in Curtis’ first Senate floor speech he said lawmakers are “‘not being honest with the American people when we pretend that Social Security, Medicare, and Medicaid don’t need reform.’ The current system is unsustainable.”
“The Big Beautiful Bill puts Medicaid on a more responsible path—ensuring those who truly need help can still receive it, while safeguarding the program for future generations. Senator Curtis will continue working to deliver reforms that reflect Utah’s values: thrift, compassion, and long-term accountability," the spokesperson said.
Utah Rep. Burgess Owens said he is supportive of the reforms in the bill because he believes they will protect Medicaid for those who truly need it.
“From reining in over $700 billion in wasteful Medicaid spending, including benefits going to illegal immigrants, to enforcing work requirements and eliminating fraud, the One Big Beautiful Bill protects and strengthens Medicaid for those in Utah and across the nation who truly need it,” Owens said in a statement to the Deseret News.
Rep. Blake Moore said the bill “will have significant positive impacts on individuals, families, and small businesses.”
“I understand the angst about changes to the Medicaid process, but I believe these sound, structural changes will strengthen this program going forward for the people it’s intended to serve: low-income pregnant mothers, children, seniors, and those with disabilities,” he said in a statement provided to the Deseret News.
The Deseret News reached out to other members of the Utah delegation, but has yet to receive comment as bill deliberations in the House continue.
What experts are saying
Michael Cannon, the director of health policy at the Cato Institute, said the decrease in Medicaid spending could be likened to scrounging for “change in the couch cushions” when compared to the high cost of the bill.
“The weird political aspect of it is, when my party is doing it well it’s government efficiency ... but when your side is doing it, you’re throwing grandma off a cliff,” he said.
Cannon argued that the able-bodied work requirements will prove to be an interesting test for those who want to show they value the government-provided coverage.
“If someone doesn’t value Medicaid enough to work, then is it fair to require taxpayers to work in order to buy Medicaid for them?” he said, noting the exceptions built into the work requirement part of the bill.
“Medicaid is a government program ostensibly for low-income people, taxpayers fund it by paying the income tax and various other federal and state taxes, and the more people have sitting in the cart, the fewer people you’re going to have pulling it,” Cannon added.
Cannon said reducing the growth of Medicaid spending over the next several years would likely not lead to an increase in deaths in the way some have suggested. He pointed to the Oregon Health Insurance Experiment, which found Medicaid coverage played no significant role in physical health.
“It is completely irresponsible to say that people are going to be losing their lives as a result of this bill, but the best evidence says to us, ‘you don’t know that,’” Cannon said. “Notice that I’m not saying it’s not true. It could be true or could not be true, and that’s why it’s irresponsible to say, because they just don’t know.”
“If they are making that claim, they are ignoring the evidence,” he said.
But, in an op-ed in The New York Times, Matt Bruenig, founder of the People’s Policy Project called the changes “misguided” and said they would hurt those who lose their jobs unexpectedly, among others.
“Health care services have much in common with police and fire services. We turn to them when something has gone wrong, often unpredictably and catastrophically,” he wrote. “Our society could decide that police and fire departments will not respond to calls made by individuals who worked less than 80 hours in the prior month, but most would find this repugnant and contrary to the purpose of these services. Likewise, refusing medical care to people in their time of need based on how much they happened to work the month before is a cruel and pointless policy.”
Where the bill stands
The House will be working to quickly amend or vote through the bill ahead of Trump’s desired deadline on Friday.
On Wednesday, the House reconvened for procedural votes while Republican leaders work behind the scenes to secure support for the final vote, which could be Wednesday or Thursday.
Democrats and some Republicans have expressed frustration with the package sent to them by the Senate, but Speaker Mike Johnson, R-La., has projected confidence and said Wednesday that they are “almost there at that finish line.”
