The U.S. Senate Must Protect Medicaid, SNAP, and Our Nation’s Healthcare System

Today’s passage of the budget reconciliation bill by the U.S. House—by a narrow party-line vote of 215 to 214—poses severe threats to programs critical to the health, well-being, and livelihoods of millions of Americans. PHI strongly opposes these developments, and we urge the U.S. Senate to take action to protect Medicaid, SNAP, and other vital programs.

The legislation would impose $716 billion in cuts to Medicaid, the largest cut in the program’s 59-year history. Short-sighted and dangerous components of this bill include, but are not limited to, the following:

• Implementation of community engagement (work) requirements—which will require many Medicaid recipients to prove that they work, volunteer, or are enrolled in an educational program for at least 80 hours per month—has been accelerated. It will be required by the end of 2026, presenting an untenable administrative burden for states and likely resulting in significant additional lost Medicaid coverage. Disrupting health coverage for Medicaid-eligible people will impact vital caregiving connections between direct care workers, older adults, and people with disabilities.
• For Medicaid beneficiaries living just above 100 percent of the poverty line ($16,000 per year for individuals), the bill will require cost-sharing. These changes will further undermine access to health coverage and economic security for direct care workers.
• Or More than 30 states will see large federal funding cuts for Medicaid expansion if they continue to use state resources to provide health coverage to immigrants who do not meet specific eligibility requirements. These sweeping cuts will impact coverage for countless immigrants while affecting overall availability of coverage in targeted states. These states will face an untenable choice between ending health coverage for a vital segment of their workforces (including direct care workers) or cutting their Medicaid programs due to reduced federal funding.

The bill will also result in nearly $270 million in cuts to SNAP and shift costs to individual states for the first time. These changes will seriously undermine access to this essential benefit for direct care workers and many across the country.

It is not too late for these provisions to be stopped. The United States Senate has an urgent responsibility to ensure that  benefits for direct care workers, older adults, people with disabilities, and family caregivers are protected. Our health systems—and the U.S. economy—depend on it.