Senate GOP Eyes Medicare Changes to Advance Bill

Highlights

• Senate Republicans are considering Medicare cuts focused on “fraud, waste, and abuse” to gain support for a major budget bill.
• The House narrowly passed the bill 215–214, with no Democratic support.
• Medicaid work requirements will now begin December 31, 2026, and six-month eligibility checks will start at the same time.
• Coverage for gender-affirming care under Medicaid has been banned for all individuals in the House version of the bill.
• Healthcare advocacy groups and professional organizations warn the bill will lead to mass insurance loss and strain on hospitals and emergency departments.
• The ORPHAN Cures Act provision allows more drugs to bypass price negotiation under the Inflation Reduction Act.
• The bill faces uphill challenges in the Senate, despite pressure from former President Trump.

Medicare in the Crosshairs Amid Budget Push

As Senate Republicans seek a pathway to secure passage of President Donald Trump’s sweeping reconciliation legislation, changes to Medicare are under serious consideration. According to Politico, GOP lawmakers are evaluating potential cuts to Medicare, specifically targeting areas perceived as “fraud, waste, and abuse,” to satisfy fiscal conservatives in the party. These proposals are viewed as a potential strategy to balance the budgetary implications of the bill and move it forward in the Senate.

The discussions reportedly include possible policy revisions to Medicare Advantage (MA), a program that has faced scrutiny over alleged overbilling practices. "These changes could come in the form of policy updates in Medicare Advantage," Politico reported. However, any such moves are expected to face substantial resistance from the powerful insurance industry, which benefits significantly from the MA program.

House Passes Sweeping Budget Bill

On May 22, the House of Representatives narrowly passed what Speaker Mike Johnson (R-La.) described as “generational, nation-shaping legislation” by a vote of 215–214. The vote took place after an all-night session and saw no Democratic support. One Republican voted present and two voted against the package. The bill includes an extension of Trump-era tax cuts and a $4 trillion increase to the national debt ceiling. It also enacts significant healthcare reforms and tax policy changes, such as banning taxes on tips and overtime.

Medicaid Overhaul: Earlier Work Mandates, Coverage Reductions

The most contentious aspects of the legislation involve healthcare provisions, particularly those concerning Medicaid. Despite internal disagreement among Republicans, the final version of the bill accelerates work requirements for Medicaid recipients, pushing the start date up from January 2029 to December 31, 2026. Under the new rule, able-bodied adults must work at least 80 hours per month to maintain Medicaid eligibility. The bill also authorizes states to begin eligibility checks every six months starting at the end of 2026.

Notably, the legislation expands a controversial ban on Medicaid-funded gender-affirming care. "The original bill banned Medicaid from covering gender-affirming care for minors. But, now, the proposal passed by the House prohibits coverage for all individuals."

Projected Loss of Coverage Draws Outcry

The Congressional Budget Office projects that millions of Americans will lose their health insurance as a result of the legislation. Healthcare advocacy organizations swiftly condemned the bill, warning of widespread disenrollment and negative repercussions throughout the healthcare system.

Anthony Wright, Executive Director of Families USA, criticized the passage of the bill without full analysis or hearings, stating, “Even without a full accounting yet, we know enough to know that the consequences will be devastating.” He pointed to anticipated increases in premiums, co-pays, and administrative barriers, as well as reduced benefits.

Drug Pricing Loopholes Spark Concern

The bill also includes the ORPHAN Cures Act, which expands exemptions for certain high-cost drugs from negotiation under the Inflation Reduction Act of 2022. Merith Basey, Executive Director of Patients For Affordable Drugs Now, warned that the change "handed pharmaceutical corporations a new and unnecessary way to protect monopoly pricing."

Healthcare System Faces Strain

Susan Dentzer, CEO of America’s Physician Groups, condemned the bill’s Medicaid cuts, stating they would lead to mass disenrollment and loss of access. She also noted the omission of enhanced ACA premium tax credits as a further blow to health coverage.

“The SNAP cuts and loss of food assistance will imperil the ability of millions to obtain healthful food and lead to adverse health effects down the road,” Dentzer added. She argued that the benefits of the bill are disproportionately skewed toward high-income earners.

Emergency Departments at Risk

The American College of Emergency Physicians (ACEP) expressed alarm over the bill’s potential impact on already strained emergency departments. Dr. Alison Haddock, ACEP President, stated, “Patients with unmet health care needs will delay treatment and their conditions will worsen, leaving them with no other option than the emergency department.” She warned that reduced health coverage would overload emergency systems and endanger patient care.

Widespread Opposition from Healthcare Stakeholders

Leading healthcare organizations, including the Federation of American Hospitals, the Catholic Health Association, and America’s Essential Hospitals, voiced opposition to the bill’s current form. Concerns center on the broad reductions to Medicaid and changes to coverage requirements, which critics argue would exacerbate existing pressures on the healthcare system.

Senate Awaits Contentious Debate

Attention now turns to the Senate, where internal GOP divisions remain a hurdle. Though President Trump has increased his involvement to encourage passage, several Republican Senators remain skeptical. While the House cleared the bill despite resistance, it remains to be seen whether similar unity can be achieved in the Senate chamber.