'An Existential Fight Ahead': Why Trump's Medicaid Cuts Could Leave Millions Struggling With Healthcare Costs

Donald Trump is back in the White House and Medicaid is in the spotlight. With a nearly $900 billion price tag, the program that serves 79 million low-income or disabled Americans is now a major target for cuts. Republicans are pushing for big changes, which could mean fewer options and higher health care costs for many families.

Medicaid's expansion under the Affordable Care Act (ACA) added 20 million people to the program over the past 11 years. But the GOP wants to roll back that expansion and tighten funding. Trump has said he wants to drastically cut government spending and Medicaid seems to be in the crosshairs.

“Without them, we will watch this country sadly enter into fiscal collapse,” Rep. Jodey Arrington (R-Texas), chair of the House Budget Committee, told KFF.

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Work Requirements And Funding Cuts

Republicans are also considering bringing back work requirements, a policy Trump tried during his first term. Critics argue this will not reduce costs but add layers of bureaucracy. Rep. Chip Roy (R-Texas) told KFF that the goal is "wholesale reform" of health care spending, including scaling back ACA expansions.

"We should absolutely note that we are subsidizing the healthy, able-bodied Medicaid expansion population at a higher rate than we do the poorest and sickest among us," Arrington added.

Proposals include shifting Medicaid to block grants, cutting federal matching funds and requiring states to reapply for waivers that allow continuous eligibility. All these moves aim to save money – but at what cost?

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Who Loses Out?

For low-income families, these cuts could be devastating. Medicaid is often the last safety net for those without employer-sponsored insurance. Cutting eligibility or adding more hurdles could leave millions uninsured.

Joan Alker, executive director of Georgetown University's Center for Children and Families, called the situation dire. "Medicaid is an obvious target for huge cuts," she told KFF. "An existential fight about Medicaid's future likely lies ahead."

Already, Medicaid has faced major disruptions. After pandemic-era protections expired in 2023, more than 25 million people lost coverage. Experts say this could pale compared to the cuts Republicans are now proposing.

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The Bigger Picture

If Medicaid funding is slashed, taxpayers could still end up footing the bill in other ways. Without Medicaid, many low-income families would struggle to afford private insurance with high premiums and deductibles.

Matt Salo, former executive director of the National Association of Medicaid Directors, warns of a "seismic shift" in how Medicaid operates. "A lot of powerful entities … want to see Medicaid work efficiently and be adequately funded," he said to KFF. "And they will be highly motivated to push back on something they see as draconian cuts."

The fight over Medicaid's future is just beginning. And for millions of Americans, what happens next could determine whether they can afford the care they need.

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