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What are the proposed Medicaid cuts in the current Continuing Resolution?
Executive Summary
The current Continuing Resolution (framed in reporting as the “One Big Beautiful Bill Act” or H.R.1) would enact large, multi‑year reductions and new restrictions on Medicaid, with estimates ranging from roughly $840 billion to $1 trillion in federal Medicaid cuts over ten years; key mechanisms include accelerated work requirements, eligibility redeterminations, and changes to federal‑state funding rules [1] [2] [3]. The precise headline number varies across analyses, but all sources agree the package would substantially shrink federal Medicaid support and add administrative barriers that experts project will cause millions to lose coverage and increase state budget pressure [4] [5] [6].
1. Why the dollar estimates diverge — big cuts, many accountants fighting over the total
Analysts provide differing ten‑year price tags for the proposed Medicaid changes because they count different provisions and baselines; some track an $880 billion reduction that appears in budget‑resolution language [5], others calculate roughly $840 billion over ten years [1], while some advocacy and legislative summaries describe reversing or restoring about $930 billion or about $1 trillion depending on whether they compare to prior law or include related financing changes and tax offsets [3] [2]. The variance also stems from whether estimates incorporate cascading effects on marketplace coverage or state behavior, and whether they treat the end of temporary pandemic FMAP enhancements and limits on provider taxes as part of the Medicaid cut total; analysts reference the same core changes but produce different totals based on methodology [2] [4]. All sources consistently indicate the package is large enough to reshape Medicaid enrollment and state dynamics.
2. The policy levers that drive most of the savings — work rules, FMAP sunsets, and redeterminations
Multiple sources identify a short list of policy changes that together account for the bulk of projected savings: a federally imposed work requirement (commonly framed as 80 hours per month) that is modeled to produce the single largest reduction, an early sunset or rollback of enhanced FMAP for Medicaid expansion states, and frequent eligibility redeterminations that increase disenrollment [2] [6] [4]. The work rule is explicitly estimated in some analyses to account for hundreds of billions in reductions (for example, about $325.8 billion in one attribution) and is projected to strip coverage from millions who fail to meet documentation or reporting rules even when exempted [2] [1]. These administrative and eligibility changes, more than a simple across‑the‑board cut percentage, are what analysts say will drive enrollment losses.
3. Human and state budget impact — millions uninsured, states squeezed
Economic and health‑policy briefs tied to the CR assert that the package will increase the uninsured population by several million and raise state fiscal pressure. Estimates across sources cite losses of roughly 7.8 million to 11.8 million people losing Medicaid coverage directly, with additional marketplace spillover losses in some models [1] [2]. State budgets would face reduced federal support while still carrying baseline program costs and potential new administrative burdens, particularly where provider‑tax restrictions and changes in the federal‑state cost‑share are enacted; experts warn this combination could prompt state program contractions or higher eligibility hurdles [4] [6]. Analyses agree the human impact is substantial and concentrated among low‑income adults, children, people with disabilities, and behavioral‑health patients.
4. Political framing and which actors emphasize what
Different organizations emphasize different metrics to advance distinct narratives: legislative proponents and some budget committees frame the changes as necessary savings or reforms embedded in H.R.1 and the CR, while medical societies and advocacy groups emphasize coverage losses, health harms, and strained provider networks [6] [7] [3]. The AMA and health‑care advocates highlight administrative burdens, access reductions, and population counts affected [6], whereas budget statements focus on aggregate dollar savings and fiscal targets assigned to committees [4]. Both frames rely on the same provisions; they diverge in which consequences—fiscal balance versus coverage outcomes—they foreground.
5. What remains unresolved and where analysts disagree most
Key unresolved issues are the final legislative text, start dates for provisions, and behavioral responses by states that could mitigate or magnify projected effects; these variables explain much of the numerical spread in estimates [5] [8]. Analysts disagree on how many people will be permanently uninsured versus temporarily disenrolled, and on the extent to which states will offset federal reductions through eligibility changes, provider payment shifts, or other state revenue choices [2] [4]. The common ground is that the CR advances substantial policy changes that, if enacted as analyzed, would significantly shrink federal Medicaid outlays and increase administrative hurdles for beneficiaries.