US advocacy groups are waging an intensive campaign to protect Medicaid and Obamacare from Donald Trump’s “big, beautiful bill”, after House Republicans proposed an $880bn cut that could leave an estimated 13 million Americans without health insurance.
The House bill left Republicans’ most controversial proposals on the table, but has divided Senate Republicans: one called the effort to yank away healthcare “morally wrong and politically suicidal”. Others have described the cuts as insufficient and “anemic”.
“One of our patients just shared with us that when she had stage 4 lung cancer, she was not officially disabled but she could not work. It was a rare day she could even get off the couch,” said Erika Sward, assistant vice-president of National Advocacy for the American Lung Association.
“The idea you then have to justify your sickness while you’re fighting for your life is incomprehensible.”
Sward joined colleagues from other disease-specific health advocacy groups in a press call earlier this month, a sign of the gathering opposition to a Republican bill that proposes cuts to everything from healthcare to family and food support. Republicans have floated proposals to cut Medicaid for months, but their ideas were only put to text last week.
“This Medicaid fight is the fight we are all in – and have been in for a long time,” said Julie Nickson, director of federal relations at the American Cancer Society Cancer Action Network, in a press call.
The bill is one of two Republican proposals; the second is a White House budget proposal for the health department that could significantly reshape healthcare and scientific research in the United States.
The House bill would primarily extract savings from Medicaid by adding work requirements, a change expected to save $715bn, according to early estimates from the congressional budget office. Medicaid is a public health insurance program that covers about 71 million low-income, disabled and elderly Americans.
Work requirements add a significant administrative burden for beneficiaries while failing to push people into the workforce, the requirement’s stated goal, according to multiple studies. Republicans’ bill would require people to have work before applying to Medicaid, according to the left-leaning Center for Budget and Policy Priorities, a proposal that would be especially difficult for sick Americans to meet.
Even some on the right question the strategy: the conservative Missouri senator Josh Hawley derided the idea in a New York Times opinion article.
Trump has sent mixed messages about his support for Medicaid, notably leaving it out of programs he promised to protect during the campaign, but promising to protect it as recently as April. Republicans attempted to repeal Obamacare in 2017, an effort that dramatically failed and Trump later called “mean”.
Health secretary Robert F Kennedy Jr defended the proposal vociferously at a hearing on Capitol Hill, telling lawmakers that “able-bodied [adults] who refuse to look for a job, to volunteer” pose a threat to the health system.
He later said that “Medicaid is for poor children, for mothers, and it’s for the disabled” – a population significantly smaller than the millions of low-wage workers and elderly who rely on the program.
Most people who receive Medicaid and are able to work do so, according to the healthcare research group Kaiser Family Foundation. States have already experimented with work requirements, such as in Arkansas, where work requirements led to 18,000 people losing coverage. The Biden administration revoked most states’ permission to add work requirements to Medicaid.
The House proposal to cut Medicaid is paired with Republicans’ desire to allow premium tax credits available through the Affordable Care Act (ACA) to expire. ACA, or Obamacare, tax credits lower the cost of health insurance individuals can purchase on regulated, state-based health insurance exchanges.
Prior to the ACA, it was difficult for individuals to buy health insurance, because the majority of the US health system is based around employer-based insurance. Together, the congressional budget office estimates that these proposals could cause more than 13 million people to lose insurance by 2034.
“We know an overwhelming – almost nine in 10 individuals – who are enrolled in Medicaid who can work are working,” said Sward, adding that work requirements “don’t address the bigger question in our county of people needing to be healthy to be able to work”.
Republicans advanced the bill out of committee last week. Speaker Mike Johnson has set a Memorial Day deadline to pass it out of the chamber.
