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Republicans Say Medicaid ‘Work Requirements’ Don’t Count As Cuts

WASHINGTON — Republicans have a strategy for moving Medicaid cuts through Congress when many of their own members say they can’t support cuts: Don’t call them cuts.

House Speaker Mike Johnson (R-La.) said Tuesday that nobody will miss the hundreds of billions of dollars Republicans want to chop from the program, which covers health care costs for more than 70 million Americans.

“We’re not gutting Medicaid. We’re going to reduce fraud, waste and abuse, which every single American should be applauding,” Johnson said.

The meaning of “fraud, waste and abuse” in this context includes regular Medicaid benefits for unemployed adults without children or disabilities, who have received coverage in most states thanks to the health care reform signed into law by President Barack Obama in 2010. The money spent covering their health costs, in Republicans’ view, is a waste.

Even among the Republicans who’ve said they won’t vote for Medicaid cuts, a “work requirement” policy banning certain unemployed adults does not count as a cut.

“They should be seeking the skill sets for better jobs,” Rep. Don Bacon (R-Neb.) told HuffPost on Tuesday. “I think most Americans support this. If you’re an able-bodied adult with no children, you should be seeking the skills or seeking a better job.”

Bacon was one of a dozen moderate House Republicans who said in a letter to party leaders this month they wouldn’t support legislation with “any reduction in Medicaid coverage for vulnerable populations.”

Medicaid cuts are a crucial part of the “big beautiful bill” Republicans hope to send to President Donald Trump’s desk this year, with the savings intended to offset part of the cost of $5 trillion or more in tax cuts. Spending reductions in Medicaid and the Supplemental Nutrition Assistance Program could reduce the cost of the bill by more than $1 trillion.

Among experts with a conventional understanding of Medicaid, tightening program eligibility, and thereby reducing federal expenditures, is the same as cutting the program.

“It’s definitely a cut, and I think that’s just framing in terms of talking about it as not a cut – all evidence points to it being a big cut,” Gideon Lukens, a senior fellow at the liberal Center on Budget and Policy Priorities, said in an interview. “You’re definitely going to get savings when you’re cutting people off of coverage.”

When the first Trump administration granted Arkansas a waiver to deny Medicaid benefits to able-bodied adults in 2018, more than 18,000 people lost coverage — about 25% of the population subject to the requirement, thanks in part to the difficulties people had in fulfilling the state’s paperwork requirements. Federal survey data show that, in general, most non-elderly adults on Medicaid already work full or part time, with a significant number of those not working engaged in caregiving or attending school.

Republicans included a work requirement for childless Medicaid recipients aged 19 to 55 in a piece of legislation that failed to pass in 2023. The Congressional Budget Office estimated the policy would save $109 billion over 10 years by canceling federal funding for Medicaid benefits for 1.5 million people, with states using their own funds to cover 60% of those affected while another 600,000 people were expected to wind up uninsured. Another estimate, by the Urban Institute, said around 5 million would lose coverage under the policy.

Rep. Brett Guthrie (R-Ky.), chair of the House committee overseeing Medicaid, said he believed work requirements had widespread support among Republicans. He said program spending will go up over the next 10 years even if Republicans make cuts, meaning their cuts don’t count as cuts in absolute terms.

“The question is, how much is it going to go up? And that’s what we’re working on,” Guthrie told HuffPost.

House Republicans set a target of $880 billion in savings from programs under Guthrie’s committee’s jurisdiction, with Medicaid the largest target. The target sum amounts to about 11% of projected program spending over the next decade.

Republicans are also looking to require more frequent eligibility checks for Medicaid recipients, and they’re considering reducing the percentage of Medicaid spending covered by the federal government. The latter policy, which would likely lead states to drop their own Medicaid spending, could result in as many as 20 million people losing coverage if Republicans pursue it in an aggressive form and states don’t increase spending to fill the void.

Many moderate lawmakers who are happy with a work requirement don’t like the idea of an across-the-board reduction in the federal government’s cost-sharing arrangements with states.

Rep. Mike Lawler (R-N.Y.), for instance, described a work requirement as “something that Bill Clinton and the Democrats previously championed” in reference to the infamous 1996 welfare reform law. But he hates the idea of cutting the federal match rate or instituting a “per capita cap” to hold down future growth in costs per enrollee.

Sen. Josh Hawley (R-Mo.) noted that Missouri’s constitution requires the state to provide Medicaid benefits to low-income adults, meaning the state would be in a jam if Congress cut the federal government’s cost-sharing rate.

“That would create huge problems for us,” Hawley told HuffPost. “I mean, 21% of Missourians get either Medicaid or CHIP, so all that [is] to say, I’m pretty skeptical of any serious fiddling, but I will entertain their proposals, but not if they result in benefit cuts.”

Sen. Bernie Moreno (R-Pa.) was even more skeptical.

“We don’t have to take away benefits from American citizens,” Moreno told HuffPost. “We’re going to take benefits away from non-American citizens. So that’s what we’re going to do. So we don’t need to do draconian cuts. Quite the opposite, and it won’t pass. By the way, you need 50 Republicans, right? Those kinds of things won’t pass.”