Republicans are eyeing cuts to Medicaid that could kick young Americans off of the program — though many still insist the program won’t be touched.
Despite assurances from a wide range of party figures, including President Donald Trump, it appears as if the upcoming GOP budget proposal will take one big swing at the expansion of Medicaid to cover lower-income Americans.
Speaker Mike Johnson on Sunday, when he spoke to Sunday Morning Futures host Maria Bartiromo.
“We have to root out fraud, waste and abuse, we have to eliminate on, for example, on Medicaid who are not actually eligible to be there. Able-bodied workers, for example, young men, who are– who should never be on the program at all,” the House speaker told Fox.
With his comments, Johnson referred back to a repeated assertion of his — that young, “able-bodied” adults are leeching off of the Medicaid system while not holding employment. In a CNN interview in February, he claimed that ”29-year-old males sitting on their couches playing video games” were taking Medicaid benefits, adding: “We’re going to find those guys. We’re going to send them back to work.”
“The president has made absolutely clear many times, as we have as well, that we’re going to protect Medicare, Social Security, Medicaid, for people who are legally beneficiaries of those programs,” Johnson said in that same interview.
The intent seems clear: the Republican House caucus remains open to cutting Medicaid benefits in states that expanded the program under the Affordable Care Act, better known as Obamacare. In 2014, the federal government began assisting states with coverage for low-income individuals of all age groups — including “able-bodied workers” and “young men”, whom Johnson said should not have coverage.
Republicans have long opposed benefits to younger, low-income adults and families, arguing that Medicaid and other programs incentivize individuals to avoid work.
Activists and experts who supported the Medicaid expansion under the Obama administration now warn that the program is both extremely popular and part of a key revenue stream for hospitals in lower-income and rural areas.
“Rural hospitals are going to close,” said Dr Rob Davidson, executive director of the Committee to Protect Health Care. He warned that facilities such as nursing homes would also lose key funding and be threatened.
“Our hospital is so dependent on folks’ ability to have access to insurance, and Medicaid is a huge payer, you know– about a third or more overall,” added Davidson, an emergency room doctor based in Michigan.
Access to hospitals and health services remains a major hurdle for rural residents of all income groups — not just Medicaid recipients. A 2024 report from CNN found that in Pennsylvania’s more remote counties, the average travel time to reach a hospital with a maternity ward for imminently expecting mothers was nearly an hour.
Dozens of rural hospitals have closed or shuttered some services across the country in the past two decades, and hundreds more are said to be at risk. A February report from the National Rural Health Association stated that “nearly 50% of rural hospitals operate with negative margins” and stated that kicking low-income “able-bodied” Americans off the program with work requirements (and the associated red tape) would be a major burden on rural hospitals.
Progressives say that employment reporting requirements would force many off of the program entirely, through a combination of burdensome red tape, clerical errors and the often unstable nature of employment itself for low-income Americans and those in rural communities.
Kelly Hall, whose group has supported and won seven Medicaid expansion ballot measure campaigns, told The Independent: “We know that states that have expanded Medicaid have been more successful in keeping their rural hospital infrastructure open and functioning. States that have not expanded Medicaid have seen more hospital closures.”
“The places that have expanded Medicaid are at real risk of losing their rural hospital infrastructure if the program is rolled back, and that is not just devastating to people who are beneficiaries of the Medicaid program, but anyone who lives in those communities, regardless of their type of insurance,” said Hall, executive director of the Fairness Project.
So far, few Republicans beyond Johnson and hardcore conservatives in his caucus have come out in explicit favor of implementing Medicaid work requirements — or simply kicking low-income young adults off the program altogether.
Part of that comes from reflex. Donald Trump’s first term, like Joe Biden’s after him, was marred by a major legislative defeat on a signature policy issue during his initial year. A massive blow to any president enjoying twin majorities in the House and Senate, the defeat of the Trump-supported GOP effort to repeal the Affordable Care Act altogether sapped the president’s political capital and led to the Republican Congress passing just one major plank of Trump’s campaign platform, tax cuts, before the midterms began.
Republicans could be well on their way to a self-imposed state of deja vu. A battle over one of the ACA’s most popular provisions, Medicaid expansion, could divide the House and Senate GOP caucuses and tank a bill that only passed its latest hurdle last Thursday by the thinnest of margins.
Further defections within the GOP caucus could very well occur if Republicans broach the topic of work requirements any further. At least two House members, Nicole Malliotakis and Jeff Van Drew, have threatened to switch their votes to oppose the bill’s final passage over the issue already.
“Working class people receive Medicaid as they are working. This is not just lazy people who are sitting around not doing their job,” said Rep Jeff Van Drew of New Jersey, who added to TIME that he had phoned the president to warn him: “I very well may not vote for this, and I’m certainly waiting until the last minute to see if some changes can be made, because I’m very unhappy.”
Malliotakis was even more explicit on her position: “We will not vote for something that takes away eligibility from our constituents, period.”
They are far from the only ones. Progressives believe that more holdouts will emerge as the reality of cutting potentially billions of dollars, which would have otherwise ended up making their way to hospitals and health centers already threatened by closure or service reductions, is made clear.
Fair Share US, one of the progressive groups opposed to the GOP budget plan, held a rally outside the Capitol aimed at driving up popular opposition to the bill last week, which was attended by Democratic lawmakers. The DC rally was also attended by union leaders and others who warned that Trump was threatening to betray working-class voters whom he pledged to champion if he signed Medicaid cuts into law.
“Two-thirds of adults on Medicaid are already working. […] They don’t need any incentives to get a job. They need steady hours and a real pay raise – not cuts to the services that help them stay afloat while they do their essential jobs,” said one attendee, Charlotte Neal of AFSCME local 3930.
Activists like Kelly Hall hope to spur further Republican resistance by making as much noise as possible, especially in red and purple districts where Democrats have held “empty chair” town hall-style events to draw scrutiny on GOP lawmakers over the past few months.
She predicted: “I think we’ll see an evolving landscape on people’s concern and outrage about potential Medicaid cuts, the more real they become.”
