Republican lawmakers are ending President Donald Trump’s “big and beautiful bill” to reduce the wealthy and gut safety net that the rich and gut already provide for the poor, and they are working to ensure that cuts to cut health care are enough to be destructive and potentially politically harmful.
Trump's tax laws will begin kicking out Medicaids, faster than previous versions of the bill, according to a deal that House Speaker Mike Johnson (R-la.) and Republican leaders appease Conservative law on Sunday night. This is thanks to a faster requirement for Medicaid work or volunteers for at least 80 hours a month.
"It's obvious that the goal here is to create an ugly bill - a 'big and beautiful' bill, with lots of ugly details - even uglier, and speed up that ugly speed," said Rep. Lloyd Doggett, who said the goal of the job requirement is to "create more bureaucracy, more traditional tape festivals, more excuses to reject people's coverage."
The legislation is expected to force more than 10 million people to leave Medicaid before the new changes are made. Now, Medicaid job requirements may come into effect in late 2026 or early 2027, rather than 2029. This means people will start losing their health insurance plans faster – and more people will eventually lose coverage over the next decade. Rolling stones. These people are also not allowed to register alternative coverage in the state market.
"The fraud in pursuing Medicaid is politically welcome, but paying benefits is an attack on our own constituents," said a longtime Trump World adviser.
The White House publicly supports the idea of adding work requirements to Medicaid, but Republicans around the Trump administration and the rest of the country are concerned about the consequences of the changes proposed by the House Republicans. According to multiple sources of work within and close to the government, internal anxiety about the potential for a political rebound, including from certain bases of Trump, is growing, if the ultimate “big and beautiful” bill includes cutting too steep Medicaid benefits and services cuts.
While some of Trump’s senior administration officials have long dreamed of cutting programs like Medicaid, others in the Marg Elite believe that Republicans on Capitol Hill are interested in leading the party in a politically “suicide” direction to quote terms often used by professional Trumpists, including Senator Josh Hawley (R-Mo-Mo). These people don't know if Trump likes to say he will protect Medicaid and he will step in trying to limit cuts.
The exact details of the changes in the conservative negotiations have not been released, so it is unclear whether Conservative MPs want to cut federal funding for states’ Medicaid expansion.
However, the increased work requirements will now take effect earlier, possibly just weeks or months after the midterm elections. Experts say the purpose of these job requirements is not to get people into the job market - most Medicaids are already in effect - but to force loss of coverage.
"It's a job requirement, but it's really about the coverage of health insurance through complexity," said Larry Levitt, executive vice president of KFF, a health policy research organization. "This creates an administrative barrier that makes it difficult for people to get health coverage."
Anthony Wright, executive director of American Family, told Rolling stones“The purpose of the bill is to let Americans drown from paperwork to make it harder to continue and continue to report.” He added: “Saves were gained from those who fell from the coverage.”
Levitt noted that the majority of Medicaid’s robust adults are already working, so the bill is “a search for solutions to problems.”
Medicaid eligibility is subject to strict income caps that vary by state and usually require recipients to earn very little money. States must check the recipient’s income annually, and the consistent result is that many beneficiaries technically qualify for the program, losing coverage for administrative reasons, for example, their failure to respond to phone calls or emails.
Under the bill, these income eligibility checks will be conducted at least twice a year, as well as efforts to verify compliance with job requirements. These increased administrative burdens will certainly lead to more Americans losing Medicaid coverage, although both poor and working, and therefore qualify.
"This is the focus of bureaucratic obstacles," Wright said.
Another complication is that many Medicaid workers are unable to work properly but have not been approved for disability, which is a tedious process. The result will lose coverage.
The additional Medicaid in the bill would cut supplementary funds for hospitals and rural health care providers and force Medicaid recipients to pay out of their own expenses.
Americans who lose Medicaid benefits due to job requirements will not qualify for a market health insurance plan, Levitt and Levitt said.
In addition to the Medicaid change, Republicans plan to allow people with personal health insurance plans to expand subsidies due - a change expected to cause another four million Americans to lose insurance.
Democrats estimate that Trump and Republicans' health care policies will reach health insurance for nearly 14 million Americans. This will generate a high rate of about 50%, and more Americans will have no insurance at any time since the Democratic Party’s signature health care law (the Affordable Care Act).
Levitt said Republicans are pushing for a range of policies that “will be the largest rollback of federal support for health care ever, meaning that the largest number of people far away is not insured.”