May 28, 2025
Academy Defends Access to Coverage During Reconciliation
House Minority Leader Hakeem Jeffries accused Republicans of bankrolling tax cuts for the rich while they added work requirements to the Medicaid program in what has become another clever attempt to undermine the Affordable Care Act (ACA). Early Thursday morning, House Republicans nevertheless voted to decimate the social safety of health care and food assistance that helps millions of families stay on their feet.
Although Trump vowed to protect Medicaid, House Republicans eyed the program to help pay for a sweeping piece of budget legislation created to extend his 2017 tax cuts. The amount of money GOP leaders have indicated they can squeeze from Medicaid, which now covers about 20 percent of Americans, is in the hundreds of billions of dollars.
Why It Matters: In 2024, the uninsured rate was 8.2 percent, near an all-time low, in large part because of the Medicaid expansion under the ACA. Health advocates know that work requirements are a backhanded way to slim down the Medicaid rolls, since the paperwork requirements of such programs have proved so burdensome that eligible people drop out, causing the uninsured rate to rise.
A Congressional Budget Office report estimates that the proposed change would reduce coverage by at least 7.7 million people in a decade. This leads to higher rates of uncompensated care, putting vulnerable health care facilities like rural hospitals at risk.
How It Affects Medicaid
Here are highlights to the bill’s impact on Medicaid:
- Revisions include moving up the start date of Medicaid work requirements from January 1, 2029, to December 31, 2026, and expanding the criteria for states that could lose a portion of their federal payments if they offer coverage to undocumented people.
- Work reporting would be required for most people to get Medicaid health insurance.
- Work reporting requirements could hit harder in rural areas.
- More people would be required to have jobs to receive food assistance.
- States that cover immigrants lacking legal status would lose federal funds.
- The bill could curtail abortion access by barring money for Planned Parenthood.
- Health services for transgender people would be cut.
How It Affects Medicare
This bill passed by the House also contains several provisions that would impact Medicare. The bill explicitly outlines which non-citizens would be eligible for Medicare, while the work and age requirements are unchanged. Here are highlights to the bill’s impact on Medicare:
- The Republican tax bill would directly cut Medicare eligibility.
- The bill would make Medicare unaffordable for people with low-incomes.
- Losing Medicaid increases risk of death for people with Medicare.
- The bill puts long-term care at risk for people with Medicare.
The cost of the pending legislation would trigger automatic cuts to Medicare. Without Congressional intervention, Medicare payments would be reduced by four percent, leading to a $500 billion cut over eight years beginning in 2026.
What’s Next
The bill now heads to the Senate, where Republicans are expected to tear up many of the policy provisions sought by House GOP hard-liners. The bill also includes a poison pill that eliminates the power of courts to hold officials in contempt for disregarding court orders.
House Republicans tried to hide their work in backroom deals and middle-of-the-night hearing markups, but it will be impossible to hide spiking premiums and increased out-of-pocket costs. It will also be impossible to hide the millions of people who will be forced off coverage as work reporting requirements take effect and states are forced to make up the difference.
Our resistance is more important than ever. For clinicians and advocates this fight is for the life of children, veterans, low-income working families and people who rely on rural hospitals across the country. Our fight is not over. We will keep fighting to defeat these proposals. Now we turn our attention to the Senate with the same message: No Cuts to Medicaid.
As advocates we feel an enormous sense of gratitude to the judges who are beginning to intervene to try to stop this. We are also grateful to the public servants still in their jobs standing up to this. And everyone else who is pushing back. Finally, we are grateful to the communities that are protecting their residents and neighbors.
Thank you to our members who continue to fight attacks on Medicare and Medicaid.
TAKE ACTION
Contact Senators – No to Medicaid Cuts
The reconciliation bill is now headed to the Senate, where it will face further deliberation and votes. Senators need to hear from the public now about the dangers of this bill. Contact your lawmakers today. Call Congress at 866-426-2631 and tell them Medicaid cuts should be off the table. Inboxes full? Can’t get through? Keep calling to get your voice heard! If you don’t have time, you can send a message to Congress today through a Families USA action alert.
Use hashtags #HandsOffMedicaid or #HandsOffOurMedicaid on social media.
Medicaid Action Alert Sponsored by Medicare Rights Center
Tell your lawmakers to protect Medicaid, Medicare, and everyone who relies on the programs. Join us. Raise your voice. Defend Medicaid. Send an Action Alert
Virtual Event: Medicaid Action on May 30 Sponsored by Positive Women’s Network
Take action through a virtual event on Friday, May 30, at 2:00 pm ET. Join Positive Women’s Network members, allies and community members for an hour-long event to build power together and defend Medicaid.
Comment Opportunity on Recent OPM Proposal
A recent Office of Personnel Management proposal would reclassify broad swaths of federal bureaucrats as political appointees — making their employment up to the whim of the administration in power. Notably, among those who would be reclassified are employees across the government involved in grant-making functions, which is seen by former National Institutes of Health officials as a route to making the directors of that agency’s institutes and centers political appointees without certain civil service protections.
We encourage Academy members to comment. The comment date has been extended to June 7, 2025. Please also disseminate this to your colleagues, especially those in red states.
ADVOCACY STATEMENTS, ACTIONS RESOURCES
Academy Alert for Energy and Commerce Committee to Protect Medicaid
On May 8, the Academy shared an alert focused on targeting Republicans to include the House Energy & Commerce Republicans in their reconciliation deliberation.
Academy Alert for Budget Committee to Protect Medicaid
On May 15, the Academy shared an alert as the Budget Committee prepared to fast-track the reconciliation bill to the House floor.
Academy Alert for Texas Members for ADAP
On May 15, the Academy urged its Texas members to support budget riders increasing the state’s investment in the Texas AIDS Drugs Assistant Program.
Academy Alert Urging Members to Comment on Proposed Schedule F Plan
On May 22, the Academy urged its members to comment on a proposed regulation to change National Institutes of Health independent grantmaking Institute Directors to political appointees.
Advocacy Resources to Save HIV Funding
- Resource from 5Calls to defend Medicare and Medicaid from cuts.
- For HIV specific Medicaid resources, The AIDS Institute has a one pager available.
- Resources from the American Hospital Association.
- Commonwealth Fund Analysis of Economic Impact of Medicaid Work Requirement.
- Also an article to use to talk against work requirements.
- Legal Action Report: Coalition for Whole Health Protect Medicaid Report.
Letter to the Editor Resources
- A template from the #SaveHIVFunding Campaign.
- AVAC tips on how to write a letter to the editor.
- Partners in Health Letters to the Editor Toolkit.
- Example of published letter to the editor in the Williamson Herald.
