The Big Story 

The House passed legislation early Thursday morning to fund President Trump’s domestic agenda, which includes steep cuts to Medicaid and the Affordable Care Act, totaling nearly $800 billion. 

© PAP

It does this through a combination of provisions including work requirements on “able-bodied adults” through age 64 without dependents, a freeze on provider taxes, more frequent checks of eligibility and reducing federal Medicaid payments to states that provide health care coverage for undocumented immigrants. 

The effort united the feuding factions of the House GOP behind a massive bill, but it faces headwinds in the Senate. Some senators are pushing for steeper cuts, while others want to protect Medicaid. 

But even among members who say they oppose Medicaid cuts, work requirements get no objection.  

A last-minute change made to appease House conservatives would accelerate the start of the work requirements and prohibit future administrations from widening exemptions for certain populations. Instead of Jan 1, 2029, the bill requires states to start imposing work requirements Dec. 31, 2026.  

States could lose Medicaid funding if they don’t comply and continue to cover people who don’t prove their eligibility. 

Lawmakers rushed the amended bill through the chamber before the Congressional Budget Office (CBO) could update its analysis.

Under the original version, work requirements would save the federal government $280 billion over six years, about triple what the CBO had estimated an earlier Republican plan would cut. But all those savings come from millions of people losing their Medicaid coverage. 

In the two states that have tried work requirements previously, red tape due to data and paperwork errors was common.  

Experts predict giving states less than two years to set up complicated verification systems is inviting disaster and will result in many people getting wrongly kicked off Medicaid.  

Welcome to The Hill’s Health Care newsletter, we’re Nathaniel Weixel, Joseph Choi and Alejandra O’Connell-Domenech — every week we follow the latest moves on how Washington impacts your health.

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