As Republicans push to pass President Donald Trump’s massive reconciliation bill by July 4, growing concern surrounds its proposed overhaul of Medicaid — the federal-state insurance program that covers over 71 million low-income and disabled Americans.
The bill, which passed the House with approximately $600 billion in Medicaid cuts, now faces even deeper reductions in the Senate version. According to the Congressional Budget Office, the legislation could slash federal Medicaid spending by $1 trillion and leave nearly 12 million more Americans uninsured by 2034.
This move contradicts Trump’s past promises to protect Medicaid, critics say.
Health Workers, Experts Warn of Harm to Vulnerable Americans
Health policy experts warn that the proposed cuts could devastate vulnerable populations — not only by stripping individuals of coverage, but also by forcing clinics and hospitals to shut down due to lost funding.
“These changes could mean that some Americans simply won’t be able to get care,” said Jennifer Mensik Kennedy, president of the American Nurse Association. “The people most at risk are those who already live on the margins.”
Work Requirements Could Disqualify Millions
One of the bill’s most controversial provisions is the introduction of work requirements: beginning in 2026, adults aged 19 to 64 without dependents would need to work or participate in approved activities — like job training or volunteering — for at least 80 hours a month to retain Medicaid coverage. While exemptions exist for parents of young children and individuals with disabilities, experts say many people could fall through the cracks.
A recent analysis from the UC Berkeley Labor Center found that older Americans — especially those between 50 and 64 — could be hit hardest.
“By their 50s, many people who’ve done physical labor for decades are worn down and can’t keep working,” said Nari Rhee, director of the center’s Retirement Security Program. “Even if they want to work, age discrimination, caregiving duties, and declining health make it difficult — and that’s before dealing with red tape just to prove eligibility.”
AARP Pushes Back Against Coverage Cliff
Over the weekend, AARP sent a letter to Senate leaders opposing a provision that would strip ACA premium tax credits from people who fail to meet Medicaid work requirements. They warned this would create a “steep coverage cliff” for older adults working part-time or preparing for retirement — effectively leaving them with no affordable health options.
Rural Hospitals in the Crosshairs
Cuts to Medicaid could also threaten rural health systems. Many small hospitals and clinics rely heavily on Medicaid payments. Senate Republicans have proposed a $25 billion rural health fund to help offset losses, but critics question whether it will be enough.
“Rural hospitals are already struggling to stay open,” said Mensik Kennedy. “With these cuts, we could see hospitals shutting down completely — forcing people to drive hours for emergency care or even childbirth. That’s unacceptable.”
Arnulfo De La Cruz, president of SEIU 2015 — the largest long-term care union in the U.S. — echoed the warning, emphasizing how vital Medicaid is to California’s health infrastructure.
“In California, Medicaid underpins everything from nursing homes to home care,” he said. “If you dismantle it, you’re not just cutting numbers on paper — you’re closing hospitals, nursing homes, and community clinics.”
He added, “That means sicker people, delayed treatment, and higher costs down the line.”
What Comes Next?
Despite the outcry, Republicans remain focused on passing the reconciliation bill by Trump’s self-imposed July 4 deadline. Whether the proposed Medicaid provisions survive in the final version remains to be seen, but health workers, advocacy groups, and millions of Americans are bracing for the fallout.
