More Than $1 Trillion on the Chopping Block
Congressional Republicans have put forward budget proposals that would cut more than $1 trillion from Medicaid over the next decade. These are not modest adjustments — they represent the largest proposed reduction to a public health program in American history. At that scale, there is no way to achieve the savings without fundamentally dismantling the program that nearly 70 million Americans rely on for their health care.
The cuts would be achieved through a combination of mechanisms designed to shrink enrollment and shift costs. Per-capita caps would limit federal funding regardless of actual need, forcing states to absorb shortfalls or cut people from the program. Work requirements would create new bureaucratic hurdles that have been shown to reduce coverage without meaningfully increasing employment. And block grants would convert Medicaid from an entitlement that responds to demand into a fixed pot of money that cannot keep pace with costs.
Independent analyses from the Congressional Budget Office and health policy researchers consistently find that cuts of this magnitude would result in 7.5 million people losing their Medicaid coverage. The human toll — measured in missed diagnoses, untreated chronic conditions, and preventable deaths — would be staggering.
Who Gets Hurt
Medicaid is not a program for a narrow slice of America. It covers one in five Americans, including more than 40 million children, 8 million people with disabilities, and millions of seniors who depend on it for nursing home care and home-based services that Medicare does not cover. It pays for nearly half of all births in the United States and is the single largest source of funding for mental health and substance use disorder treatment in the country.
The people who would lose coverage under these proposals are overwhelmingly working families. More than 60 percent of non-disabled adult Medicaid enrollees are employed, and most of the rest are caregivers, students, or people with health conditions that prevent them from working. The myth that Medicaid serves people who are not contributing to their communities has been debunked repeatedly, yet it continues to drive policy proposals that would punish the most vulnerable.
Rural communities would be hit especially hard. In many rural areas, Medicaid is the financial backbone of the local hospital, and cuts would accelerate the wave of rural hospital closures that has already devastated communities across the country. More than 370 hospitals and 570 nursing homes nationwide are at risk if these cuts move forward.
The 'Sick Tax' on Working Families
One of the most dangerous proposals being considered is the imposition of premiums and cost-sharing requirements on Medicaid enrollees — effectively a sick tax on people who are already struggling to make ends meet. Research from states that have tried similar approaches shows that even modest premiums cause significant drops in enrollment, not because people no longer need coverage, but because they cannot afford to pay.
When people lose Medicaid due to premiums they cannot pay, they do not simply switch to private insurance. They become uninsured. They delay care until conditions worsen. They show up in emergency rooms with problems that could have been prevented with a routine office visit. And the costs of that uncompensated care get passed on to everyone else through higher premiums and hospital charges.
Work requirements function as another form of this sick tax. States that have implemented Medicaid work requirements have seen dramatic coverage losses with no measurable increase in employment. The administrative burden of documenting work hours every month falls hardest on people with irregular schedules, limited internet access, and language barriers — exactly the populations Medicaid is designed to serve.
What Is at Stake in 2026
The current moment represents the most serious threat to Medicaid since the program was created in 1965. Congressional leadership has made clear that Medicaid cuts are a top priority, and the budget reconciliation process could allow these changes to pass with a simple majority vote, bypassing the normal legislative safeguards that have protected the program in the past.
The stakes could not be higher. If these cuts become law, millions of Americans will lose access to the doctors, medications, and treatments they depend on. Hospitals and health centers will close. States will be forced to make impossible choices between cutting other essential services and watching their Medicaid programs collapse. The damage would take decades to undo.
This is a fight that affects every community in America. Whether you receive Medicaid yourself or not, you benefit from a health care system that keeps your neighbors healthy, your hospitals open, and your economy functioning. The time to make your voice heard is now — before these cuts become a reality that cannot be reversed.