February 26, 2025: House Republicans Take the Second First Step for Trump’s Agenda

House Republicans passed their budget proposal last night, overcoming what at points seemed like insurmountable intraparty opposition and marking another step towards advancing President Trump’s legislative agenda. Sort of.  

Below I’ll explain how GOP leaders encouraged their members to vote yes, where those encouragements fall short, and what to watch next. 

How House Republicans assuaged their members’ concerns about Medicaid…

Last week, “at least double digits” of House Republicans were wary of supporting their leaders’ Trump-endorsed budget proposal given massive cuts on the table for programs their constituents depend on—namely, Medicaid, the health insurer for more than 72 million people. 

House GOP leaders spent the past week working to convince hesitant Republicans that their votes for the GOP budget resolution would not clear the path for kicking Americans off their health care coverage. Rather, they argued, they’d hit their savings targets by rooting out Medicaid waste, fraud, and abuse. 

As evidenced by last night’s vote, that argument seems to have worked: ultimately, just one House Republican joined Democrats to oppose the budget blueprint. One previous holdout Republican said, “there’s a lot of space to address the issue without hurting beneficiaries.” 

…while continuing to threaten Medicaid.

The idea that House Republicans can cut anywhere close to the amount of money their budget proposes without taking health care away from families is simply not credible. Here’s why. 

First: the House GOP budget tasks the committee in charge of Medicaid with making the deepest cuts.

Republican leaders have tried assuaging holdouts’ concerns by claiming the budget doesn’t mention Medicaid. Technically, that’s true. However, the budget directs the House Energy and Commerce Committee, which oversees Medicaid, to make at least $880 billion in cuts. 

To argue that Medicaid won’t be on the chopping block here is kind of like saying we’re going to an ice rink to play a sport, but we didn’t say we were going to play hockey—we could go there to swim or play soccer. All signs point to: we’re going to play hockey defund Medicaid.

Second: House Republicans’ own documents propose Medicaid policies to kick people off the program—not improve program integrity.

Our January 21 update discussed a leaked document listing measures Republicans might attempt to pass via reconciliation (the fast-track process they’re using to enact the president’s agenda without Democratic votes). The 50-page list describes dozens of provisions and their estimated budgetary impacts. 

Despite GOP claims that they’ll save money by targeting Medicaid “waste, fraud, and abuse,” this list doesn’t echo recommendations from the Government Accountability Office or Medicaid and CHIP Payment and Access Commission to do just that. It does, however, propose several options that would force Americans off of Medicaid, including through “work requirements” and “per capita caps.” We’ve covered these policies’ expected impacts in previous updates, but I’ll briefly dig into one example below.

Data shows that Medicaid work requirements reduce participation in the program considerably—including among people who meet the requirements but are confused by mandated reporting. Reports also indicate that people who lose coverage due to work requirements suffer long-term consequences: data from Arkansas shows that half struggle to pay off medical debt and nearly two-thirds delay taking medications due to their high cost. 

On top of that, there’s ample data showing that “work requirements” do little to actually promote employment. Most Medicaid enrollees already work, and most people within the minority who do not are caring for family members, have a disability, or attend school.  

Third: even if Republicans were serious about improving Medicaid program integrity, there’s no evidence that there is anything close to the level of waste, fraud, and abuse that would facilitate these kinds of cuts.

Republicans have pointed to one statistic to argue that they could save Medicaid $50 billion annually by targeting wasteful spending. However, as multiple health care experts note, this metric does not measure fraud. And even if it did, $50 billion a year over the life of this 10-year budget proposal is $500 billion—well short of that $880 billion target for cuts from the Energy and Commerce Committee.

On a personal note: I worked for a member of the Energy and Commerce Committee years ago and recall hearing after hearing after hearing about eliminating Medicaid waste. I have no doubt there have been more since. I mention this because I know from experience that there’s been no shortage of congressional efforts to identify wasted Medicaid dollars. If there were hundreds of billions of dollars worth of savings to be found here, we’d be talking about those findings. 

Lastly: there’s already a watchdog for Medicaid fraud. President Trump fired her. 

The Department of Health and Human Services’ (HHS) inspector general tracks waste, fraud, and abuse within programs like Medicaid and reports annually on efforts to improve program integrity. The most recent report came out just two months ago.  

Despite the GOP’s purported interest in rooting out waste, the President fired HHS’ inspector general Christi Grimm within days of his inauguration. Grimm warned, “if you're reducing without regard and you get rid of these watchdogs and the people that work for them, I fear for some of these programs, including oversight for Medicare and Medicaid.”

What happens now?

As a reminder, the Senate passed its own budget proposal last week, and it’s quite different from the House’s version (see our Friday update for details). Agreeing to the same budget blueprint in both chambers is step one for advancing the President’s agenda via the fast-track reconciliation process—and we’re not even there yet. 

If anything, last night’s House vote was the second step one. If Republicans are actually going to advance a bill that can become law, they’ll need to take a third step one in which both chambers agree to the same budget proposal. 

Bottom line: there’s a long way to go before this agenda is even close to becoming law. For a deeper dive into the next steps, check out The Basics of Budget Reconciliation. And on that note…

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