WASHINGTON—House Republicans passed the “One Big Beautiful Bill” on Thursday morning after an overnight session with a vote of 215 votes to 214. The sweeping bill is being criticized by homecare industry organizations, with some saying it could harm millions of older adults who rely on at-home care.
The bill proposes cutting $800 billion in federal Medicaid funding to states and $500 billion from Medicare. Medicaid's website says it provides health coverage to 7.2 million low-income seniors. Additionally, it provides coverage to 4.8 million people with disabilities who are enrolled in Medicare. Twelve million people are dually eligible, meaning they are enrolled in both Medicaid and Medicare.
"If enacted, the policies in the House-passed bill will have a devastating impact on millions of older adults and their families who rely on Medicaid and Medicare for health care and long-term care and services, and on our nonprofit provider members who serve them," said Katie Smith Sloan, president and CEO of LeadingAge. "Recognize this for what it is: cold-hearted legislation that will have ugly consequences, essentially eliminating for vulnerable people the support they rely on, leaving them with few options."
House representatives have spoken out against the bill as well, with Rep. Judy Chu saying it "is a shameful and cruel bill." According to The Hill, Chu said the cuts will be "really tough" for seniors impacted by them.
The National Health Law Program (NHeLP) condemned the legislation, saying it "prioritizes tax breaks for billionaires and the largest corporations over the health and dignity of low-income communities."
“There is nothing beautiful about this bill. It is a direct attack on low-income people, on people with disabilities, on immigrants and on families doing their best to survive in an economy stacked against them,” said Elizabeth G. Taylor, executive director of NHeLP. “Lawmakers know exactly what this bill will do. It will kick people off Medicaid and make it harder to get and keep coverage. That is not fiscal responsibility. It is cruelty and indifference by design.”
Cutting funding to Medicaid will also impact people with disabilities. According to KFF, Medicaid provides comprehensive health and long-term care coverage to one in three people with disabilities—this includes 2.3 million children, 8.8 million working-age adults and 4.4 million adults ages 65 and older.
"Protecting Medicaid is necessary to protect people with disabilities," said Barbara Merrill, chief executive officer at ANCOR. "The U.S. House voted today to approve a total of at least $715 billion in cuts to federal health programs, with Medicaid bearing the brunt of those reductions, thereby putting people with disabilities in jeopardy of losing access to crucial supports and services. Even though the approved cuts are not directly aimed at community-based services, the non-mandatory nature of these supports means people with disabilities will be harmed as a result. The health, safety and quality of life of people with disabilities hinges on a robust and adequately resourced Medicaid program. Their right to live full and independent lives in their communities—rights we should all be able to enjoy—hangs in the balance."
The “One Big Beautiful Bill” also includes a national mandate for Medicaid work requirements. The bill would require Medicaid recipients to provide proof of employment in order to receive health insurance.
"This is an attack on working-class people,” said Mara Youdelman, managing director of federal advocacy at NHeLP. “People need Medicaid in order to work. It is not the other way around. Imposing work requirements will disproportionately harm people with disabilities, caregivers, people with chronic conditions and older adults. It will push more families deeper into poverty. We have seen the data. We know this does not work.”
The NHeLP spearheaded a legal challenge that overturned a Medicaid work requirement program in Arkansas during President Donald Trump's first term. It has also blocked similar efforts in other states, saying courts "agreed that imposing work requirements is arbitrary and ... counter to the purpose of the Medicaid program."
Many are calling on the Senate to not pass the bill as it is currently written.
"The Medicaid and Medicare programs, and the aging services infrastructure they support, help older Americans age with dignity, not desperation," Sloan said "They must be protected. We urge the Senate: do not follow in the House’s footsteps."
The National Alliance for Care at Home (the Alliance), urged the Senate to amend the bill and reconsider the spending cuts to Medicaid and Medicare, saying the Senate should work with health care providers to create legislation that protects patients' access to care while also safeguarding taxpayers money.
"The Alliance continues to believe there are opportunities for common ground and agreement on reasonable program integrity provisions to the Medicaid program, as well as opportunities to shift care into more person-centered and less costly services," the Alliance said in a released statement. "Unfortunately, the reductions approved by the House tonight do not address care improvements and instead will reduce access to care for millions of needy and deserving Americans."
ANCOR called on the Senate to protect people with disabilities by rejecting the proposed cuts.
"We urge all Senators to reject Medicaid cuts and to consider the impact of reducing the supports many of us take for granted that enable us to live, work and thrive in our communities," Merrill said. "All lawmakers should remember that real lives of real people, and the very prosperity and well-being of people with disabilities, are at stake when you take up this budget legislation."