Projected Effects of Proposed Cuts in Federal Medicaid Expenditures on Medicaid Enrollment, Uninsurance, Health Care, and Health

Abstract

In January 2025, the Republican majority in the House of Representatives’ Budget Committee offered a list of possible spending reductions to offset revenue losses from proposed tax cuts. In May, the Committee advanced a bill incorporating several reductions on the list. The Committee estimated that the 6 largest potential Medicaid cuts (for example, work requirements for some Medicaid enrollees) would each reduce the federal government’s Medicaid outlays by at least $100 billion over 10 years. On the basis of the Committee’s estimates of savings; Congressional Budget Office analyses; and peer-reviewed studies of the coverage, financial, and health impacts of past Medicaid expansions and contractions, the authors project the likely effects of each option and of the House bill advanced by the Budget Committee in May.

Each option individually would reduce federal Medicaid outlays by between $100 billion and $900 billion over a decade, increase the ranks of the uninsured by between 600 000 and 3 900 000 and the annual number of persons forgoing needed medical care by 129 060 to 838 890, and result in 651 to 12 626 medically preventable deaths annually. Enactment of the House bill advanced in May would increase the number of uninsured persons by 7.6 million and the number of deaths by 16 642 annually, according to a mid-range estimate. These figures exclude harms from lowering provider payments and shrinking benefits, as well as possible repercussions from states increasing taxes or shifting expenditures from other needs to make up for shortfalls in federal Medicaid funding.

Policy makers should weigh the likely health and financial harms to patients and providers of reducing Medicaid expenditures against the desirability of tax reductions, which would accrue mostly to wealthy Americans.

Congressional Republicans and President Trump seek to extend and expand tax cuts implemented during Trump’s first term, which expire this year. In January 2025, the Republican majority in the House of Representatives’ Budget Committee circulated a menu of possible spending reductions (1) that could offset the estimated $5 trillion to $11 trillion in revenue losses over 10 years from such tax cuts (2, 3). Cuts to Medicaid (4–8)—which today covers 71 million Americans (9)—figured prominently in the Committee’s menu (1). In April 2025, the House passed a budget resolution calling for $2 trillion in funding cuts, $880 billion of which would come from Medicaid and a few other programs under the House Energy and Commerce Committee’s jurisdiction (10). On 18 May 2025, the Budget Committee advanced a reconciliation bill, which the House passed on 25 May 2025, that included several Medicaid cuts on the menu (11).

Using House Budget Committee figures (1), Congressional Budget Office (CBO) analyses (12–17), and studies of previous Medicaid expansions and contractions, we project the effects of the 6 largest proposed cuts—and of the bill advanced by the Budget Committee—on Medicaid enrollment and the number of persons likely to become uninsured, as well as the impacts of those coverage contractions on health care access, financial strain, and health outcomes (including mortality).

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