The Scale of Medicaid and CHIP
Medicaid and the Children's Health Insurance Program (CHIP) together cover more than 85 million Americans — roughly one in every four people in the United States. This makes the combined programs the single largest source of health insurance coverage in the country, surpassing employer-sponsored insurance and Medicare. The scale of these programs reflects a simple reality: tens of millions of Americans cannot afford private health coverage and depend on public programs to see a doctor.
CHIP alone covers approximately 7 million children in families that earn too much to qualify for Medicaid but too little to afford private insurance. The program has been one of the most successful bipartisan health policy achievements of the past three decades, dramatically reducing the rate of uninsured children and improving pediatric health outcomes across the country.
Together, Medicaid and CHIP serve an extraordinarily diverse population: newborns and pregnant women, working adults, children and teenagers, people with disabilities, veterans, seniors in nursing homes, and individuals battling mental health conditions and substance use disorders. These are not abstract statistics — they are your neighbors, coworkers, family members, and friends.
Who Depends on These Programs
The typical Medicaid enrollee defies the stereotypes that have been used to justify cutting the program. The majority of non-disabled adult enrollees work, and most of the rest are caregivers, students, or individuals with health conditions that limit their ability to hold a job. Medicaid families pay taxes, contribute to their communities, and rely on the program to bridge the gap between what they earn and what health care costs.
Children are the largest group of Medicaid and CHIP enrollees, accounting for more than 40 million beneficiaries. For these kids, the programs provide well-child visits, vaccinations, dental care, vision screenings, and treatment for the full range of childhood illnesses and injuries. Losing this coverage does not just affect individual children — it affects classrooms, schools, and entire communities.
Medicaid is also the backbone of the behavioral health system in America. It is the single largest payer for mental health services and the primary funder of treatment for opioid and other substance use disorders. At a time when the country is grappling with overlapping mental health and addiction crises, cutting the program that funds the majority of treatment would be reckless.
The Republican Plan to Cut $1 Trillion
Despite the overwhelming evidence of Medicaid's effectiveness and the breadth of the population it serves, Congressional Republicans have made cutting the program a centerpiece of their budget agenda. The proposed cuts — exceeding $1 trillion over the next decade — would be achieved through structural changes designed to permanently shrink the program's reach and reduce federal responsibility for health coverage.
Per-capita caps would limit federal spending per enrollee regardless of actual health care costs, leaving states to cover any shortfall. Block grants would convert Medicaid from an entitlement that automatically expands during economic downturns into a fixed allocation that cannot respond to rising need. Work requirements would impose documentation burdens that have been proven to reduce coverage without increasing employment. Each of these mechanisms is designed to cut spending by cutting people.
The Congressional Budget Office and independent health policy analysts have consistently found that cuts of this magnitude would result in 7.5 million Americans losing Medicaid coverage. For CHIP specifically, proposed changes to federal matching rates could make it unaffordable for states to maintain the program at current levels, threatening coverage for millions of children who are currently insured.
The Fight Ahead
The push to cut Medicaid and CHIP is not hypothetical — it is happening now, through the budget reconciliation process that allows major spending changes to pass with a simple majority in the Senate. This means that the usual bipartisan negotiations that have historically protected these programs may be bypassed entirely.
Public opinion is firmly on the side of protecting Medicaid. Polls consistently show that large majorities of Americans — including majorities of Republican voters — oppose cutting the program. But public support alone is not enough. Elected officials need to hear directly from their constituents that cutting health coverage for 85 million Americans is unacceptable.
Every person who benefits from Medicaid or CHIP, every family member who has seen these programs work, and every community that depends on the health care infrastructure they support has a stake in this fight. The moment to act is now. Contact your representatives, share your story, and make clear that health care is not a budget line to be slashed — it is a lifeline that millions of families cannot afford to lose.