How Trump’s “Big Beautiful Bill” Cuts Medicaid

Massive healthcare reductions are buried in a bill with a pretty name

We keep hearing that Congress will cut Medicaid by $880 billion, but it’s nearly impossible to find the evidence. There is no clear bill titled “Cut Medicaid.” There’s been no direct vote on the matter. So where, exactly, does it say Congress is going to cut Medicaid? All we have is a deep pool of vague news coverage and political chatter.

I’m not one to take people’s word for it on matters this important, and I have a dim view of mainstream media’s ability to explain it. Most outlets have political agendas, and even when they try to tell the truth, they distort it to fit their framing. So I decided to dive into the details and swim through the documents myself to find the facts.

What I found was a masterclass in political obfuscation. The process is complex, slow-moving, and buried in bureaucracy, but it’s also revealing. Medicaid is indeed on the chopping block. And unless we understand how this works, we’ll never be able to stop it or hold the right people accountable.

Below, I describe the process by which Medicaid can be cut. I’ll keep it simple and leave links where you can see the source material for yourself.

First of all, understand that by law, Medicaid must be funded. There’s no wiggle room; if someone meets the eligibility criteria set by law, the federal government is obligated to help pay for their care. This requirement is outlined in U.S. Code Title 42, Subchapter XIX. It’s a massive document, so good luck reading the whole thing. But here’s the short version: it establishes a baseline—or qualification floor—for who must be covered and how the funding works.

It also describes how the money flows. Federal dollars don’t go directly to individuals; they go to state governments, which administer Medicaid and determine eligibility based on federal rules, and, in some cases, expanded criteria each state chooses to adopt. While states technically can opt out of Medicaid, all 50 states have participated in basic Medicaid coverage since 1982.

States may also choose to expand eligibility beyond the federal minimum. Missouri, for example, did so in 2020, after voters forced the issue through an initiative petition. At the time, the federal government guaranteed it would cover 90% of the costs for newly eligible individuals. As a result, Missouri was able to cover roughly 300,000 additional people. This is what’s known as “expanded” Medicaid.

So, if Medicaid is mandatory and federally funded, how can Congress scale back that spending? The answer is simple: they change the law.

Every year, Congress passes something called a budget resolution. These resolutions don’t become law and don’t go to the president. Instead, they outline Congress’s priorities for the next ten years, including how much money should be spent. This year’s resolution is House Concurrent Resolution 14, or H.Con.Res.14. Tucked away in Title II (Reconciliation), Section 2001, subsection (b)(4), it instructs Congress to cut $880 billion from “mandatory spending” programs.

Medicaid falls into that category.

Specifically, the resolution states: “The Committee on Energy and Commerce shall submit changes in laws within its jurisdiction to reduce the deficit by not less than $880,000,000,000 for the period of fiscal years 2025 through 2034.”

Despite its name, the Energy and Commerce Committee oversees Medicaid. It doesn’t cut the Medicaid budget directly; instead, it proposes changes to U.S. Code Title 42 that reduce spending. In other words, if you don’t like what the law requires, you change the law. That’s the job they were given.

So, what changes did the committee recommend this year?

They proposed that some adults on Medicaid prove they work at least 80 hours per month. They recommended more frequent eligibility checks, creating more paperwork, and more people dropped from coverage. They introduced copays. They also recommended blocking states from using certain financing strategies that help keep their Medicaid programs solvent.

In short, they proposed changing the rules for who qualifies, how they qualify, how much people pay, and how much the federal government contributes. The result? Shrinking enrollment and reduced overall spending. The committee passed these recommendations along party lines. Since Republicans hold a majority, you can guess how the vote went.

After the work was done by all committees, including the Energy and Commerce Committee, all the recommendations were bundled into a single package. President Trump called it the “One Big Beautiful Bill.” Tucked inside that bill are the Medicaid cuts he once promised not to support. (Apparently, he changed his mind.)

As of now, the Big Beautiful Bill is stuck in the House Budget Committee. Several Republicans joined all Democrats in voting against it; Republicans wanted more cuts, Democrats wanted fewer. Because of this stalemate, the bill is temporarily on hold. If and when it passes the Budget Committee, it still has to go through the House Rules Committee, get a majority vote on the House floor, and survive potential pushback in the Senate. Surprisingly, Senator Josh Hawley of Missouri has said he won’t support the bill if it includes Medicaid cuts. We’ll see if he sticks to his guns on that matter.

Here’s where it gets crazy: because Republicans control both the House and Senate, they can pass the bill without any help from Democrats, and without the risk of a filibuster. That’s thanks to a rule called “Reconciliation.” It was created under the Congressional Budget Act of 1974 to streamline decisions on taxes and spending. Budget-related bills passed through reconciliation cannot be filibustered, meaning they only need a simple majority—51 votes in the Senate—to pass.

That’s why reconciliation has become one of the most powerful tools in Washington for passing controversial laws, like massive tax cuts or health care rollbacks, without needing bipartisan support.

And this is how Medicaid gets cut.

Politicians know that openly supporting Medicaid cuts is political suicide. That’s why they hide behind the complexity of committees, studies, amendments, and thousands of pages of U.S. Code. They’ll say they didn’t vote to cut Medicaid. But the truth is, they controlled the process all along.

The end result? Millions of Americans, including more than 300,000 Missourians, would lose health coverage. Despite its colorful name, the Big Beautiful Bill is a betrayal.

In an age when the government promises transparency but delivers smoke and mirrors, we need to understand not just what Congress is doing but how it’s doing it. If we don’t pay attention, they’ll dismantle more than just Medicaid and blame it on everyone but themselves.

Originally published in the Frontline Progressive, May 19, 2025