The Pennsylvania delegation in the U.S. House voted along party lines this week to narrowly pass a GOP budget blueprint that calls for $2 trillion in spending cuts, including reductions at the federal agency that oversees Medicaid and Medicare.
While Republicans celebrated the resolution as a promise kept to voters calling for massive federal spending cuts, Democrats condemned it as a fatal blow to social services. And that concern is growing among health care advocates who worry cuts to Medicaid could be a matter of life and death for people who can’t afford private insurance.
“People are scared. They’re angry,” said Antoinette Kraus, executive director of the Pennsylvania Health Access Network. “People are [already] struggling to afford care. If you take the rug out from under them… they are going to face the tough choice of going uninsured or having to give up another necessity in their life.”
Medicaid, also known in Pennsylvania as Medical Assistance, provides free or low-cost health insurance to low-income adults, children, pregnant women, people with disabilities as well as some elderly adults who also qualify for Medicare. The program, which is jointly funded by states and the federal government, covers one in five Americans.
The budget resolution approved by the U.S. House on Tuesday does not name Medicaid or Medicare specifically, but it does call for $880 billion in spending cuts from the agency that oversees the insurance programs, the House Energy and Commerce Committee. And lawmakers would be hard pressed to cut enough elsewhere to meet that target without impacting Medicare or Medicaid.
An analysis by the New York Times found that if the committee cuts funding to everything other than health care programs, it would still be $600 billion short of the $880 billion target.
“The money is not there,” said Kati Brillhart, vice president of government and external affairs at Pennsylvania Partnerships for Children. “There are not enough programs that they could shave off a bit of funding from and then only impact Medicaid very slightly.”
Medicaid covers about 3 million people in Pennsylvania, and more than 246,000 in Allegheny County, according to state data.
That’s about 25% of the county, according to Allegheny County Department of Human Services Director Erin Dalton. She expressed concerns last week to County Council about potential cuts to the program.
“Any cut to Medicaid would be really devastating to our region,” Dalton said, noting her department receives $500 million annually in Medicaid funding. She said programs that provide mental health services and addiction treatment for those who cannot otherwise afford care could be on the chopping block.
The cuts could also impact children. About half of Pennsylvania kids under the age of 19 are insured through Medicaid or the Children’s Health Insurance Program, also known as CHIP. Nearly 100,000 kids in Allegheny County are covered under the programs.
And across Pennsylvania, Medicaid covers 1 in 3 births, which is higher than the national average. The state extended Medicaid and CHIP postpartum coverage from 60 days to a full year in 2022. That expanded access to postpartum care has been found to reduce maternal mortality rates, especially among racial and ethnic minorities.
“It's a really important coverage option for low-income, hard-working, pregnant individuals,” Kraus said.
Though many elderly are insured under Medicare, many qualify for additional coverage under Medicaid. The program is the primary payer for nursing homes nationwide, covering more than 60% of nursing home residents and about half the costs for all long term care services, according to the National Center for Assisted Living.
And others who require assisted living support rely on the program too, said Mary Hartley, president of the Arc of Greater Pittsburgh. Her organization, which is part of the Achieva Family of Organizations, supports more than 2,000 families with intellectual and developmental disabilities.
She said Medicaid could be the difference between a child with disabilities living in a medical facility or at home with their family “which is the best place for a child.”
“These are the services that allow people with disabilities to live in our communities and not in institutions or nursing homes,” she said.
Advocates said Wednesday that they are staying hopeful that the winding budgetary process will afford opportunities to convince lawmakers to keep Medicaid fully funded.
Brillhart said after conversations with lawmakers in D.C. Wednesday, she’s cautiously optimistic that Pennsylvania’s congressional delegation — including Republicans — would be willing to vote against any major “hasty” cuts to Medicaid.
“I am trying to be optimistic at this point,” she said. “I’m really hopeful that, especially some of our newer [Congress] members… will be hesitant,” to cut Medicaid.
But whether opposition from Pennsylvania’s delegation would be enough to block any larger-scale plan to cut spending has yet to be seen.
Pennsylvania could be forced to cut back its Medicaid program if federal funding is diminished. The state pays for less than half of the cost of traditional Medicaid and only 10% of the cost to cover those included under the Medicaid expansion over the last decade, according to KFF.
But Manuel Bonder, a spokesperson for Gov. Josh Shapiro, said Wednesday that Pennsylvania has no plans to take federal Medicaid cuts lying down.
“Governor Shapiro has fought to protect and expand health care for Pennsylvanians, and he will continue to do so in the face of these extreme, disastrous policies Republicans in Washington are pushing on our Commonwealth,” he said.
"Every member of Congress who voted for this budget resolution just voted to cut health care coverage for 800,000 Pennsylvanians,” Bonder said. “Make no mistake: if this were to become law, it would have devastating impacts on the health care folks all across our Commonwealth rely on.”
Pennsylvania’s state House democratic leaders sent a letter to Pennsylvania’s congressional delegation Tuesday urging them to vote against the budget resolution.
“Our constituents are struggling… the proposed cuts to critical healthcare programs like Medicaid and CHIP will only deepen the crisis,” the letter reads. “We implore you to put the needs of Pennsylvanians first. These cuts will devastate communities already on the brink.”
So far, state Republicans have not released a statement about the cuts.
In the nation’s capital, Pennsylvania’s congressional representatives voted 10 to 7 along party lines to pass the spending plan. Republicans characterized the budget outline as a promise kept to American voters who want to see lawmakers rein in government spending.
In a statement, Republican U.S. Rep. Guy Reschenthaler, whose 14th district encompasses more rural counties outside of Allegheny County, called the resolution passage a “strong signal that House Republicans are serious about delivering the America First results necessary to fully enact President Trump’s agenda of greatness and prosperity.”
“The American people made it clear at the ballot box — they want to live in a nation that secures its borders, unleashes its energy, protects its citizens, and is fiscally responsible with their hard-earned tax dollars,” Reschenthaler said.
Republican U.S. Rep Mike Kelly, whose 16th district stretches from Erie down through Butler County, similarly emphasized his party’s agenda of reducing spending, securing the border and expanding American energy production.
"2025 is the Super Bowl of Tax,” he said. “This 'one big, beautiful bill' seeks to deliver on the entirety of President Trump's agenda and fulfill our commitment to the American people."
House Democrats fiercely opposed the spending plan, alleging it would decimate public programs in service of a tax cut for the wealthiest Americans. The spending plan calls for $4.5 trillion in tax breaks to extend President Trump’s 2017 Tax Cuts and Jobs Act.
But according to the nonpartisan policy institute Center for American Progress, extending Trump’s 2017 tax cut bill would primarily benefit the top 10% of taxpayers, not the middle class.
“This budget is a betrayal. Plain and simple. It tells folks that their health, their futures, and their families’ well-being matter less than another tax break for the rich,” said U.S. Rep. Summer Lee whose 12th congressional district covers Pittsburgh and much of Allegheny County. “I made a promise to protect people’s hard-earned benefits, and that’s exactly why I voted against this shameful Republican budget resolution.”
U.S. Rep. Chris Deluzio, whose 17th district includes Allegheny County suburbs and Beaver County, said in a statement opposing the budget resolution that it would “plunder health care all to enrich huge corporations and the ultra-rich.”
“My hard-working constituents need a tax cut, not more debt to pay for giveaways to billionaires and massive corporations,” Deluzio added. “I’m a ‘no’ on this fiscally dangerous Republican plan to cut healthcare for more than 117,000 of my constituents in Western Pennsylvania, all to funnel money to the richest and most powerful while ballooning the deficit.”
After Tuesday’s vote, the resolution now heads to the Senate for consideration.
WESA’s Kate Giammarise contributed to this report.
