Senate Republicans Consider Changes to Medicare to Pay for Tax Cuts in Reconciliation Bill

By Kim Johnson, Senior Director of Policy

Senate Republicans are considering changes to the House-passed reconciliation bill that would cut funding for Medicare to pay for the increasing price tag of the bill’s proposed tax breaks. According to the Congressional Budget Office (CBO), the reconciliation package would add an estimated $3 trillion to the federal deficit over the next decade.   

Medicare is a federal health insurance program serving over 68 million adults over the age of 65 and people with low incomes under 65 with qualifying disabilities or medical conditions. Senate Majority Leader John Thune (R-SD) noted his colleagues may look at changes to the program as a potential cost-saving measure after some Senate Republicans expressed concern over cuts to Medicaid and the Supplemental Nutrition Assistance Program (SNAP) included in the House-passed bill.  

Senators Josh Hawley (R-MO), Lisa Murkowski (R-AK), Tommy Tuberville (R-AL), and John Boozman (R-AR) have voiced concerns about the steep cuts to Medicaid and SNAP included in the House bill, in particular a provision that would shift the costs of these programs on to state and local governments. The CBO estimates that, under the House bill, an estimated four million people could lose their Medicaid coverage and millions—including more than two million children—would lose some or all of their SNAP assistance. However, cuts to Medicare would also face significant pushback from Republicans in the Senate, with Senator Hawley noting he would vote “no” on any cuts to the program.  

The reconciliation bill would also make changes to the Medicaid program that would make it more difficult for people experiencing homelessness to find and maintain healthcare coverage. As the National Health Care for the Homeless Council (NHCHC) explains, address verification requirements for Medicaid that would be imposed by the reconciliation bill would pose a significant barrier for people living on the street or in cars, shelters, or other temporary spaces. Citizenship verification requirements would also be difficult to navigate, as homelessness makes it extremely difficult for people to store or obtain important documents like birth certificates, Social Security cards, or IDs, which can be stolen or lost in an encampment sweep and difficult to replace. The bill would also require eligibility redetermination for Medicaid recipients every six months, which is not only inefficient, but exceedingly difficult for people experiencing homelessness who likely do not have consistent or reliable access to mail, phone, or internet. Likewise, the bill would put in place burdensome monthly work reporting requirements, which are difficult to comply with for people who may not have reliable access to a phone or the internet.  

While housing assistance is not a target for cuts, the anti-poverty programs being considered for cuts play a crucial role in economic stability for people and families with low incomes, helping them put food on the table and receive needed medical care. The financial assistance these programs provide also promotes housing stability: by helping families afford the cost of food and other necessities, more money is left over at the end of the month to ensure rent is paid. States can also use Medicaid to cover health-related social needs, including housing.