House GOP eyes new Medicaid reforms in ‘one big, beautiful bill’ to stave off conservative revolt

House Majority Leader Steve Scalise said Thursday that House Republicans would accelerate the timeline for Medicaid work requirements in President Donald Trump’s “one big, beautiful bill” as House GOP leadership looks to stave off defections from conservative lawmakers who are threatening to block the bill from moving forward.

Conservative GOP lawmakers who sit on the House Budget Committee, including Republican Rep. Chip Roy of Texas, suggested they would oppose advancing the president’s vast tax and spending package Thursday, citing in part the bill’s failure to implement Medicaid work requirements for childless, able-bodied adults until 2029. House conservatives want to move that timeline up significantly, which would allow the bill to achieve additional savings, potentially as much as several hundred billion dollars over a decade, according to Roy.

The House Budget Committee is expected to vote Friday to advance the president’s budget reconciliation package. House Speaker Mike Johnson has stated he wants House Republicans to pass the bill by the end of next week before lawmakers leave Washington for the Memorial Day recess.

Lawmakers’ fight over reforms to Medicaid is just one issue area that threatens to delay passage of the vast tax and spending package containing much of the president’s legislative agenda.

House Republicans are proposing to tighten eligibility requirements for the popular entitlement program by requiring able-bodied, childless adults up to 64 years old prove they are working, seeking employment, volunteering or in school for at least 20 hours a week.

The work requirement proposal would save roughly $300 billion over seven years, according to a partial estimate from the nonpartisan Congressional Budget Office (CBO). House conservatives want those requirements to come into effect much sooner.

“The Medicaid work requirements starting in 2029 is absurd,” Roy told reporters Thursday.

“I don’t think anybody feels good about it,” House Budget Committee chairman Jodey Arrington told reporters leaving the Capitol Thursday evening. “[It’s] probably the most commonsense and most broadly supported reform of able-bodied people working and closing loopholes so that we can be assured that it’s enforced.”

Scalise told reporters the Medicaid work requirements will come into effect sooner than the floated 2029 deadline following discussions with conservative GOP lawmakers about making additional reforms to Medicaid.

“There have already been some agreements to go further,” Scalise said.

Conservative lawmakers have also voiced concerns about the overall fiscal impact of the budget reconciliation package under consideration by the House Budget Committee.

“We’ve got a lot of work to do,” Roy said Thursday. “There’s too much backload in the savings, too much front-load in the tax policy.”

Arrington said Thursday more changes could be made to the spending package to earn the support of conservative GOP lawmakers. Several members of the House Freedom Caucus are pushing for a full repeal of former President Joe Biden’s Inflation Reduction Act, something the package had failed to incorporate.

“I think people are already looking at making those changes,” Arrington said, referring to an expedited timeline for Medicaid work requirements. “They’re will be plenty of other examples of things [in the bill] which will generate more savings.”

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