Last week, Congress moved one step forward toward enacting a bill that could lead to steep Medicaid cuts. On Thursday, April 10, the U.S. House of Representatives passed a budget framework for fiscal year 2026, following Senate passage earlier in the week. Now that the House and Senate Republicans have agreed on an identical framework, they must work together through a partisan process known as “budget reconciliation” to advance a final bill, which could take anywhere from one to several months.
What this means for Community Health Center patients, board members, staff, and supporters
While lawmakers in the House and Senate hammer out details on policies to include in the final bill, they need to hear from Community Health Center (CHC) supporters about the importance of protecting access to health care through Medicaid. Make plans to contact your elected officials while they are home for the in-district work period, April 14 to 27 and May 24 to June 1. View NACHC’s toolkit, with updated Medicaid messaging.
Why is Medicaid under threat in the budget?
Republican members of Congress plan to use the budget reconciliation process to enact President Trump’s legislative agenda, which is focused on extending expiring tax cuts and decreasing federal spending on non-defense programs. The reconciliation process allows a bill to advance through the Senate with only Republican votes, thus removing the chance of Democratic opposition through the filibuster.
Medicaid coverage is potentially on the chopping block. The House Energy and Commerce Committee, which oversees Medicaid, has been directed to reduce spending by $880 billion over 10 years. We anticipate extensive debate among Energy and Commerce Committee members on how to accomplish that goal. If that Committee settles on which spending cuts to recommend, there will likely be further deliberation with the Senate before any policy or spending changes can be finalized and voted upon by the whole Congress.
House and Senate now must agree on final budget bill
Republicans in Congress face the challenging task of crafting a final bill that can pass the narrow margins in both the House and Senate. As PBS explained:
“The resolution adopted this week was only a first step that allows Republicans to draft legislation that they can push through Congress without Democratic support. Next, they begin crafting a final bill with enough spending cuts to satisfy those on the right while not jeopardizing the reelection prospects of more vulnerable lawmakers whose constituents rely on key safety net programs.”
Growing resistance among Republicans against Medicaid cuts
Concerns about changes to Medicaid through reconciliation are real for all Community Health Centers because Medicaid is such an important means of affordable health care access for our patients. In 2023, Medicaid 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.
Additionally, major changes to Medicaid coverage could also destabilize CHC operations, as Medicaid accounted for 43% of health center revenue last year. If health centers are forced to make difficult financial choices due to Medicaid cuts, there may be unintended negative economic consequences due to workforce reductions and site closures.
Many Republican Members of Congress have also recognized the possibility of these adverse consequences and spoken out against making changes to Medicaid that would hurt the Americans they represent. Speaker Mike Johnson (R-LA) and Energy and Commerce Committee Chairman Brett Guthrie (R-KY) have suggested they would limit the extent of cuts to Medicaid this Committee would allow in the eventual reconciliation legislation.
Instead, they have said Congress would focus on eliminating waste, fraud, and abuse in the program. Furthermore, President Trump has repeatedly said there will be no cuts to Medicaid, which may be a position that many elected officials in his party may be persuaded to support.
NACHC, our partners, and health centers are mobilizing to protect patients
NACHC is working with other national organizations and our state PCA and HCCN partners through coalitions to convey the great harm to patients and health center operations that could be caused by large cuts to the Medicaid program. NACHC recently joined 90 other organizations in sending a letter asking Congress to protect Medicaid. See letter.
Take Advantage of In-District Work Periods: Now’s the time to take advantage of the two upcoming in-district work periods on April 14-25 and May 26-30 when health centers can host their elected officials. Download NACHC’s Toolkit for Hosting In-District Visits and Meetings to assist your planning and outreach to host members of Congress. This step-by-step guide has templates and resources you and your health center team can use to plan and prepare for an impactful visit with your members of Congress.
Notify NACHC if you are hosting a member of Congress: Please use this form to inform NACHC of upcoming meetings with members of Congress. This will allow NACHC to provide support to you and your health center.