10.22.2026 / Press Release
New Analyses Offer Comprehensive Guide to the Real Consequences of Republican Health Care Cuts
Dissecting the Deepest Cuts series tracks the choices states are making now as H.R. 1 and CMS implementation rules take root, and how those decisions will determine who keeps coverage and care.
WASHINGTON, D.C. – As many of the Medicaid cuts enacted by President Trump and the Republican-led Congress in 2025 are set to take effect January 1, Families USA’s new six-part series show the damage is greater than the sum of its parts. The analyses highlight the biggest hurdles that would bar eligible individuals from getting Medicaid coverage and care, and the constraints states face as the Republican budget law begins to go into effect. The series lays out the most stringent parts of the law and regulations, the choices states have made so far, and the administration’s rulemaking that piles on paperwork for enrollees and expenses for states, providers, and patients. Of note, the briefs also detail what states and advocates are doing and additional recommendations for reducing the harm to health care.
While the Republican budget bill cut more than $900 billion in funding to Medicaid and other health care programs, the briefs also detail how the Centers for Medicare & Medicaid Services (CMS) furthered the harm in its initial implementation, writing rules that go beyond what the law requires.
The full Families USA series of briefs takes a magnifying glass to the harms of key provisions of the budget, including eligibility and coverage (work reporting requirements and six-month redeterminations, retroactive coverage), health care costs for consumers (cost sharing) and state financing (state directed payments, and provider taxes). Much of the coverage of H.R. 1 has looked at each provision on its own. This series puts the law and CMS’s rules side by side, showing how they compound one another. Even within the narrow limits set by H.R. 1 and CMS, states still have choices — from how they verify work requirements to how much retroactive coverage and cost sharing they allow — and those choices will help decide how many people keep their coverage. The briefs provide details on the decisions states have made so far to limit the damage, and what else advocates can do.
“Last year congressional Republicans passed the most massive cuts to Medicaid in its more than 60-year history, which will push millions of Americans off coverage directly and indirectly, and otherwise cut care and services throughout the health care system,” said Anthony Wright, executive director of Families USA. “The cuts enacted by the current Congress are devastating enough, but the Trump administration doubled down on that damage in its regulations, going well beyond the law to hamstring state budgets, and force additional cuts and bureaucratic burdens that will result in further reductions to benefits and coverage. Last year’s congressional votes are about to become next year’s headlines as the devastating cuts take their toll, with Americans seeing higher costs and more paperwork, less coverage and fewer services, and a real blow to the health system and safety net we all rely on.”
The latest fact sheets in the series examine new major burdens for eligible low-income adults: six-month renewals and mandatory work reporting as a condition of eligibility (beginning January 1, 2027), and mandatory cost sharing once enrolled (beginning October 1, 2028). States have some latitude in how they implement these policies, and their choices will determine whether millions of adults can get the care they need to stay healthy, as well as how burdensome and costly these policies are for states to implement. These changes are already estimated to cause 4.9 million to 10.1 million people to lose health coverage by 2028. CMS’s decision to further restrict medical frailty exemptions and self-attestation could cause an additional 1.8 million people to lose coverage each year.
“Imagine being too sick to work, dealing with a cancer diagnosis, and also having to fight to prove you qualify for the coverage that is your literal lifeline,” said Mary-Beth Malcarney, senior advisor on Medicaid policy at Families USA and lead author of the series. “States are forced into bad and very bad options in how they integrate these restrictions into their Medicaid programs. Some pragmatic states are seeking to mitigate the harm and ease the burden on their most underserved communities; others have taken even harsher approaches — implementing the most restrictive guidelines that will inevitably lead to more Americans losing coverage,” Malcarney added.
With implementation deadlines fast approaching, Families USA will continue documenting how H.R. 1 and CMS’s rules play out in states and communities and will hold lawmakers accountable for these impacts on the health and financial security of millions of individuals and families.