Cuts, Changes To Medicaid Proposed In New Bill: What To Know In NH

NEW HAMPSHIRE — House Republicans have unveiled the cost-saving centerpiece of President Donald Trump’s “big, beautiful bill” that could have a big effect on New Hampshire’s 186,000 Medicaid enrollees.

The legislation unveiled Sunday calls for at least $880 billion in cuts across a decade, mainly to Medicaid, to help cover the cost of sustaining the 2017 Jobs and Tax Cuts Act, about $4.5 trillion, into the future.

The proposal highlights the biggest political fight about health care since Republicans tried but failed to repeal and replace the Affordable Care Act during Trump's first term in 2017. Central to the savings are changes to Medicaid, which provides almost free health care to more than 70 million Americans, and the Affordable Care Act, which has expanded in the 15 years since it was first approved.

Republicans insist new work and eligibility requirements are needed to root out “waste, fraud, and abuse.” “60 Minutes” reporter Cecilia Vega revealed on Sunday during interviews with the FBI and the General Accounting Office that there is at least $550 billion to $750 billion annually stolen from the federal government, mostly by scammers, hackers, and transnational criminal organizations.

Democrats warn millions of Americans will lose their health care coverage. The nonpartisan Congressional Budget Office said in a preliminary estimate that 8.6 million people would lose their health care coverage over a decade.

About half of New Hampshire Medicaid financing comes from the federal government. The state received around $1.4 billion in fiscal year 2024, according to data reports online. About 186,000 people were enrolled in the program, or about 13 percent of the population.

Republicans are planning around-the-clock hearings this week on various sections to meet House Speaker Mike Johnson’s Memorial Day deadline to pass the bill.

“Savings like these allow us to use this bill to renew the Trump tax cuts and keep Republicans’ promise to hardworking middle-class families,” said Rep. Brett Guthrie of Kentucky, the GOP chairman of the Energy and Commerce Committee, which handles health care spending.

The 2017 Jobs and Tax Cuts Act doubled the child tax credit to $2,000 per child yearly. Every income tax rate sector, except the upper middle class, also received a rate cut. Individual earners between $9,525 and $93,700 and couples filing jointly earning between $19,050 and $156,150 received a 3 percent tax rate cut, while individual earners between $93,700 and $195,450 and couples between $156,150 and $237,950 received a 4 percent tax cut. Earners and couples between $195,450 and $424,950 received a 1 percent tax cut, while earners between $424,950 and $480,050 received no tax cut. Individuals earning more than $426,700 and couples earning more than $480,050 — citizens and workers who pay the bulk of the income taxes in the United States, received a 2.6 percent tax cut under the plan.

Democrats said the cuts were “shameful” and essentially amount to another attempt to repeal Obamacare.

“In no uncertain terms, millions of Americans will lose their health care coverage,” said Rep. Frank Pallone of New Jersey, the top Democrat on the panel. “Hospitals will close, seniors will not be able to access the care they need, and premiums will rise for millions of people if this bill passes.”

Earlier this month, U.S. Rep. Maggie Goodlander, D-NH, cosponsored the Hands Off Medicaid and SNAP Act, legislation to block Republican budget proposals.

“Protecting Medicaid is a matter of life or death for tens of thousands of people across New Hampshire,” she said. “The same is true for SNAP. That’s why I’m proud to help lead this legislation and why I am working to expedite a vote on it in the House as soon as possible. This cannot wait.”

U.S. Sen. Maggie Hassan, D-NH, last month, believed proposed cuts to Medicaid could severely undermine ongoing efforts to combat the fentanyl crisis. The reductions also run counter to the Trump Administration’s newly released drug policy priority of increasing access to addiction treatment, she said.

According to data from KFF, Medicaid and CHIP (Children’s Health Insurance Program), of Medicaid recipients nationwide:

• 82 percent are children living below the poverty level;
• 62 percent are people living in nursing homes;
• 41 percent are pregnant women giving birth;
• 39 percent are children;
• 31 percent are non-elderly adults with disabilities;
• 19 percent are Medicare recipients.

The politics ahead are uncertain. More than a dozen House Republicans have told Johnson and GOP leaders they will not support cuts to the health care safety net programs that residents back home depend on. Trump himself has shied away from a repeat of his first term, vowing there will be no cuts to Medicaid.

Medicaid is a valued safety net program, according to a recent KFF poll that showed 77 percent of Americans and 84 percent of Medicaid recipients view it favorably. Nearly half (46 percent) and two-thirds of Medicaid enrollees believe the federal government isn’t spending enough on the program, according to the poll.

To be eligible for Medicaid, there would be new "community engagement requirements" of at least 80 hours per month of work, education or service for able-bodied adults without dependents. People would also have to verify their eligibility to be in the program twice a year, rather than just once.

This is likely to lead to more churn in the program and present hurdles for people to stay covered, especially if they have to drive far to a local benefits office to verify their income in person. But Republicans say it'll ensure that the program is administered to those who qualify for it.

Many states have expanded their Medicaid rosters thanks to federal incentives, but the legislation would cut a 5 percent boost that was put in place during the COVID-19 pandemic. Federal funding to the states for immigrants who have not shown proof of citizenship would be prohibited.

There would be a freeze on the so-called provider tax that some states use to help pay for large portions of their Medicaid programs. The extra tax often leads to higher payments from the federal government, which critics say is a loophole that creates abuse in the system.

The Associated Press contributed reporting.

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