Community Health Centers rely heavily on Medicaid funding to serve millions of patients. As Congress moves forward with the budget reconciliation process, cuts to Medicaid funding could impact their patients’ access to primary care.
Budget reconciliation provides a fast track for certain legislation
The budget reconciliation process allows for expedited consideration of certain tax, spending, and debt limit legislation. Reconciliation allows bills to pass the Senate with a simple majority, bypassing the filibuster. To proceed, the House and the Senate must adopt the same budget resolution that sets spending goals and directs committees to produce spending or savings.
Congressional Republicans aim to use reconciliation to pass President Trump’s priorities, including extending the 2017 tax cuts, increasing border and defense funding, and reducing federal spending. However, the chambers are currently divided on the strategy to pass the budget: House leaders and President Trump prefer bundling everything into one large bill, while Senate leaders favor splitting them into two smaller bills.
Senate advances its two-bill strategy
On February 21, the Senate moved forward with its preferred two-bill strategy, passing the first budget resolution mostly along party lines 52-48, except for Sen. Rand Paul (R-KY), who voted no. The resolution, championed by Senate Budget Committee Chairman Sen. Lindsay Graham (R-SC), focuses on national security and immigration. Senate Republicans have said their resolution would have minimal impact on Medicare, Medicaid, and the Community Health Center Fund.
House advances one-bill strategy
Separately, the House began moving forward with its one-bill strategy. The resolution, championed by Budget Committee chairman Rep. Jodey Arrington (R-TX), includes tax cuts and instructs the House Committee on Energy and Commerce to produce at least $880 billion in savings over 10 years. Reaching such a large amount would almost certainly require cuts to Medicaid, which is in the committee’s jurisdiction.
The House floor vote on February 25 was a nail-biter. Speaker Mike Johnson (R-LA) could only afford to lose a handful of votes while balancing concerns from moderate Republicans about possible cuts to Medicaid and opposition from conservative Republicans that the proposed cuts did not go far enough. After an intense whipping operation, the House adopted the resolution narrowly along party lines, 217-215, with only conservative Thomas Massie (R-KY) opposing.
House and Senate must agree on one budget resolution
While both chambers have adopted resolutions, they still must agree on an identical resolution before they can begin to consider an actual bill. Senate Majority Leader John Thune (R-SD) said that Senate Republicans “will want to do some things” with the House’s resolution, which did not provide any instructions to Senate Committees. This means each Chamber will have to vote again on whatever compromise their leadership agrees to.
Growing resistance to Medicaid cuts
Concerns about changes to Medicaid through reconciliation are real for all Community Health Centers because Medicaid is such an important payor for our patients. In 2023, Medicaid accounted for 43% of health center revenue and covered 50% of health center patients, compared to 19% of the overall U.S. population. Cuts to Medicaid could result in health center patients losing access to cost-effective primary care.
There is clear political reluctance within the Republican party to make significant Medicaid cuts through the reconciliation process. President Trump has repeatedly said there will be no cuts to Medicaid. Speaker Mike Johnson and Energy and Commerce Chairman Brett Guthrie (R-KY) downplayed the extent of cuts his Committee would allow in the eventual reconciliation legislation. Instead, they said Congress would focus on eliminating waste, fraud, and abuse in the program.
NACHC and health centers mobilizing to protect Medicaid
Health centers are working hard to protect Medicaid. Earlier this week, NACHC posted a statement urging lawmakers to oppose any cuts to Medicaid that would impact access to essential health services for millions of Americans. NACHC is also hosting a fly-in on March 11 to continue educating lawmakers about Medicaid’s importance to health centers and their patients. More details on the fly-in and policy papers focusing on Medicaid can be found on NACHC’s fly-in page.
Legislators return to their districts the week of March 17, which presents another opportunity for advocacy on health center priorities. NACHC has developed a toolkit to support these efforts, which is available on the Health Center Advocacy Network website.