⚡️ NIMITZ HEALTH NEWS FLASH ⚡️ 

Full Committee Markup of Budget Reconciliation

House Energy and Commerce Committee

May 13-14th, 2025 (recordings linked here)

LEGISLATION COVERED

• Subtitle A - Energy, providing for reconciliation pursuant to H. Con. Res. 14.

• Subtitle B - Environment, providing for reconciliation pursuant to H. Con. Res. 14.

• Subtitle C - Communications, providing for reconciliation pursuant to H. Con. Res. 14.

• Subtitle D - Health, providing for reconciliation pursuant to H. Con. Res. 14. 

EXECUTIVE SUMMARY OF THE HEALTH SUBTITLE

After a grueling 26.5-hour markup concluding Wednesday afternoon, the House Energy & Commerce Committee advanced the health care portion of Republicans’ sweeping reconciliation bill. The vote was 30–24, strictly along party lines. Read Chair Guthrie’s statement here and Ranking Member Pallone’s response here.

The markup centered on massive structural changes to Medicaid, with Republicans claiming fiscal responsibility, and Democrats accusing them of gutting health care to fund tax cuts for the wealthy. Partisan politics were evident as Democrats repeatedly introduced amendments to soften or eliminate the most controversial provisions. Yet, all Democrats’ amendments were voted down. Heated exchanges also occurred over whether lawmakers could name each other in debate. A poster criticizing GOP Medicaid cuts in GOP districts was partially censored under new rules.

This health care package is the cornerstone of the GOP’s “Big Beautiful Bill,” a $3.8 trillion tax cut and spending overhaul designed to fulfill core promises of Donald Trump’s 2024 campaign. With most House committees having approved their portions of the reconciliation legislation, the House Budget Committee announced that it will hold a markup to combine these pieces into a single package on May 16th.

MAJOR MEDICAID OVERHAULS

• Work Requirements: Adults aged 19–64 without dependents would be required to verify 80 hours/month of work, education, or community service. Exemptions apply for people who are pregnant, medically frail, caregivers, or in hardship areas. Democrats warned of high disenrollment rates seen in Arkansas and Georgia pilot programs. Read more here.

• Copays for Expansion Adults: For Medicaid recipients over 100% of the federal poverty level, copays of up to $35 per service would be permitted. Primary care, prenatal, pediatric, and emergency care remain exempt. Opponents dubbed this provision a “sick tax” on the working poor.

• Eligibility Checks Every Six Months: Expansion group adults would face biannual income redeterminations—a significant tightening from the current annual standard. Critics argue this could lead to inadvertent coverage loss for eligible enrollees.

• Freeze on State Provider Taxes: States would be barred from raising or adding new provider taxes used to draw federal Medicaid funds. CBO projected this would save $87 billion over a decade.

• Defunding Planned Parenthood: Medicaid payments would be blocked to certain reproductive health providers, notably those performing abortions (outside Hyde exceptions). The provision is controversial among centrist Republicans, signaling a potential fight ahead.

• By The Numbers: Per GOP-released CBO data, 10.3 million people would lose Medicaid and 7.6 million would become uninsured. Total estimated Medicaid cuts exceed $880 billion.

WHAT WAS NOT INCLUDED

While the committee considered dozens of potential changes in earlier drafts, some rumored or proposed items did not survive the final markup:

• No Medicaid block grants or per-capita caps.

• No ACA repeal language—though restrictions on ACA eligibility verification were debated in other committees.

• No immediate changes to disability eligibility, though Democrats questioned vagueness in definitions tied to exemptions.

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