House passes reconciliation bill with sweeping Medicaid changes
House Speaker Mike Johnson returns to the Capitol after meeting with President Trump at the White House Wednesday. Photo: Anna Moneymaker/Getty Images
The House passed the reconciliation bill in a 215-214 vote early Thursday morning that includes the first set of federal work requirements.
Why it matters: The reconciliation bill includes the biggest Medicaid rewrite in the history of the safety-net program, which will likely result in millions of Americans losing their health insurance coverage.
The big picture: The package represents an uneasy compromise between conservative Republicans' demands and the concerns of GOP moderates.
- Moderates had pushed back against more sweeping Medicaid policy changes, like altering the federal share of costs for states (FMAP) or implementing per capita caps, though they were on board for work requirements.
- Hardline conservatives then staged their own rebellion this week, demanding deeper cuts to Medicaid to help pay for state and local tax deductions — but then caved after GOP leadership and the White House agreed to some limited changes.
- House Freedom Caucus members had continued up unto Wednesday to try to push for deeper cuts for FMAP, but were unsuccessful.
What's inside: The manager's amendment filed on Wednesday had a few updates to the health provisions — most notably by moving up the start of work requirements to the end of 2026, from 2029, which was a Freedom Caucus demand.
- It also would fund cost-sharing reduction payment to insurers and allow state-directed payments to be higher in states that have not expanded Medicaid than in expansion states.
- The original bill also would cut the FMAP for states that cover undocumented immigrants with state funds, impose cost-sharing on enrollees for medical services and increase Medicaid eligibility checks to every six months.
- And it includes several other GOP health care priorities on PBMs, the Medicare physician payment cut and delaying the nursing home staffing measure.
- In one more last-minute change, the amended bill would now ban Medicaid funding for gender-affirming care for all individuals, not just minors as the original bill would have done.
By the numbers: The Congressional Budget Office estimated that around 10 million individuals will lose health insurance coverage due to the policy changes.
The bottom line: The bill is likely to face changes in the Senate, where senators may be wary of some of the Medicaid cuts.
