The Honorable Brett Guthrie
Chairman
Committee on Energy and Commerce
U.S. House of Representatives
Washington, D.C. 20515
The Honorable Frank Pallone
Ranking Member
Committee on Energy and Commerce
U.S. House of Representatives
Washington, D.C. 20515
Dear Chairman Guthrie and Ranking Member Pallone:
The National Committee to Preserve Social Security and Medicare, representing millions of older adults, strongly opposes budget reconciliation legislation to be considered by the House Committee on Energy and Commerce that the Congressional Budget Office (CBO) has estimated would cut Medicaid funding by at least $717 billion dollars. This drastic proposal represents the largest cut to the Medicaid program in its history and is projected to cost at least 13.7 million Americans their health care coverage. This will irreparably harm millions of disabled people and older adults needing home care and maintenance medical care, equipment, medications and aide services.
Medicaid is fundamental to U.S. society. It is not only a health care program, but also a workforce economic engine and a long-term care program — accounting for 18 percent of National Health Expenditures. This robust investment in the health of our country cannot readily be replaced – and no program, or series of programs, has been proposed to provide comparable services to this population.
In addition, cash strapped states will be hard pressed to offset reductions made in federal Medicare payments to state programs, particularly if the Supplemental Nutrition Assistance Program (SNAP) is significantly reduced by your colleagues on the House Committee on Agriculture. According to the National Association of Business Economics Survey, about 40 percent of forecasters estimate there is a greater than 50 percent chance of a recession in the coming year. Hopefully, their estimates are wrong, but if a recession occurs, tax revenue to states will go down while the need for Medicaid will go up. Even without a recession, states would likely be forced to cut benefits and/or eligibility if Medicaid is slashed. In a preliminary estimate, the Congressional Budget Office estimates at least 13.7 million Americans would lose their health insurance coverage under this proposal.
Health care providers are very clear-eyed about the devastation that defunding Medicaid health care services would cause. For example, a February 2025 analysis by the Urban Institute and the Robert Wood Johnson Foundation found:
“If all states were to eliminate Medicaid expansion due to reduced federal funding, the U.S. would see an $80 billion decrease in overall health care spending in 2026. Hospitals would bear the brunt of this loss, experiencing a $31.9 billion reduction in revenue and a $6.3 billion spike in uncompensated care costs.”
Adding to the collapse in health care services delivery, the study projected the following reductions:
- Prescription drugs: -$20.9 billion
- Other healthcare services (dental care, home health care and services from non-hospital providers): -$20.7 billion and
- Office-based physician services: -$6.4 billion.
It is evident that this magnitude of Medicaid cut makes no economic sense for either providers who need to be paid for their services, or for constituents seeking those services.
According to the Kaiser Family Foundation, as of 2024, there were more than 700,000 individuals who were waiting to receive Medicaid home and community-based services (HCBS). Medicaid HCBS is designed to provide not only health care, but wraparound services (e.g., caregiver respite, behavioral supports and transportation), which allow patients to live with purpose and dignity in settings of their choosing. Given that Medicaid HCBS is an optional service, the proposed reduction in federal payments to state Medicaid programs would likely end coverage for the current 4.5 million Americans receiving HCBS.
For HCBS patients, their only choice would be to receive long term services and supports in a nursing home, which would also be subject to Medicaid reductions. Older Americans have made it clear they strongly prefer aging in their own homes to being forced into institutional nursing home settings. The Committee proposal may be penny-wise but it is pound-foolish. Nursing home care is by far more expensive than home and community based care, and would be especially problematic as the proposal also would allow nursing homes to continue limiting the availability of trained nurses and support staff.
As an organization that represents millions of seniors, we also would point out that raising the work requirements to qualify for Medicaid coverage to age 65 would also hurt countless numbers of older workers. Employers hesitate to hire older workers, and these employees are typically the first to go in times of economic stress. The Committee proposal would compound the loss of income that comes from losing one’s job by also costing these older workers their health care coverage if they receive Medicaid.
Hundreds of billions of dollars less spent on health care through Medicaid would fuel deep job losses in the health care sector, worsen disability and illness among millions of vulnerable Americans, and contribute to a surge in homelessness and a rise in preventable deaths. It is wrong to enact spending cuts that place the lives and well-being of so many of your constituents at risk.
For the sake of the country’s hundreds of millions of middle-class and working-class constituents, we urge you to vote NO on the Energy and Commerce Committee’s budget reconciliation bill slashing Medicaid.
Sincerely,
Max Richtman
President and CEO