by Jennifer Shutt, Georgia Recorder, [This article first appeared in the Georgia Recorder, republished with permission]

March 9, 2025

WASHINGTON — A majority of Americans don’t want to see Congress reduce spending on Medicaid and believe the health care program for lower income individuals and families is important to their community, according to polling released Friday.

The survey from KFF, a nonpartisan health research organization, broke down responses by political party as well as which presidential candidate voters supported during November’s election.

The results show there is a majority of support for the program among Republicans, including those who supported President Donald Trump. But it also showed that Americans might support changes to how Medicaid is run.

A total of 82% of those polled said that Congress should keep spending on Medicaid about the same or increase it. While the support was highest among Democrats and independents, 67% of Republicans polled said they believe government funding for the program should stay about the same or increase.

An overwhelming number of those polled, 96%, said Medicaid is important to their community. Ninety-five percent of Trump supporters responded that Medicaid is either very important or somewhat important.

Work requirement

KFF’s polling also looked at how Americans feel about the changes that Republicans in Congress might make to the program to offset the deficit increase that’s expected to come along with extending the 2017 tax cuts.

Work requirements for Medicaid appeared to be a popular policy choice among those polled, with 62% backing the requirement across political parties. Republicans held the highest share of respondents supporting work requirements at 82%, followed by independents at 60% and Democrats at 47%.

But KFF also asked three specific questions about work requirements, showing a fluctuation in support following each one.

A total of 32% of those polled supported work requirements after being asked: “What if you heard that most people on Medicaid are already working, or unable to work because they are either disabled or caring for a family member? Such a requirement would put many of them at risk of losing coverage due to the difficulty proving eligibility through required paperwork.”

When asked — “if you heard that imposing such a requirement would have no significant impact on the share of Medicaid enrollees who are working, but would increase state administrative costs to oversee program eligibility” — a total of 40% supported work requirements.

And 77% supported work requirements when asked: “What if you heard that imposing such a requirement could ensure that Medicaid is reserved for groups like the elderly, people with disabilities, and low-income children?”

Federal v. state funding

KFF asked those polled if they support reducing how much the federal government pays for the program compared to how much states are expected to pay themselves.

“As you may know, under the Affordable Care Act, most states have expanded Medicaid,” the question begins. “Currently, the federal government pays at least 90 percent of the costs of this expansion with states paying the rest. There is a proposal that would significantly reduce the share that the federal government pays for this coverage. Would you support or oppose this reduction in the federal government’s contribution?”

A total of 59% of respondents opposed the proposal, but there was a majority of support among Republicans, 64% of whom backed the idea.

KFF asked the question about the federal match rate in different ways, getting different results each time.

Support for changing the federal rate for states that expanded Medicaid under the ACA dropped to 24% when asked: “What if you heard that most states wouldn’t make up the rest of the funding and many of the 20 million people who are covered by Medicaid under the Affordable Care Act expansion would lose their Medicaid coverage and become uninsured?”

Support rose to 49% when those polled were asked: “What if you heard that this change would reduce federal spending by $600 billion over 10 years?”

Little consensus in Congress so far

Republicans in Congress are far from reaching agreement on what exactly they’re going to do with tax policy or how they’ll pay for some of the $4.5 trillion increase in the deficit that would cause.

House Republicans approved a budget resolution in late February that proposes the Energy and Commerce Committee, which oversees Medicare and Medicaid, find $880 billion in savings over the 10-year budget window to help pay for tax cuts.

GOP lawmakers and Trump have repeatedly said they won’t change Medicare, though they are looking at Medicaid as one place to find savings.

But Republicans still have several steps to go before any changes to Medicaid could become law.

Republicans want to use the complicated budget reconciliation process to move their core policy goals through Congress without having to garner Democratic support to get past the Senate’s 60-vote legislative filibuster.

In order to unlock the reconciliation process, the House and Senate must agree to adopt the same budget resolution with identical reconciliation instructions.

They have yet to do that.

The Senate is expected to take up the House’s budget resolution at some point, but it’s unclear how soon that might happen. When they do, several GOP senators plan on making changes to the reconciliation instructions in the House’s budget resolution and then sending it back to the other side of the Capitol for final approval.

What exactly Senate Republicans change will determine if Speaker Mike Johnson, R-La., will be able to rally enough support to adopt the amended budget resolution amid a razor-thin majority.

Final steps

After the House and Senate adopt a budget resolution, they can begin marking up the various sections of the bill in the numerous committees slated to get reconciliation instructions.

All of those bills will then be bundled together in one reconciliation package and sent to the floor for votes. While the House isn’t required to hold amendment votes on the floor, the Senate must under the reconciliation process.

That could lead to a ping-pong match of sorts between the two chambers as they try to figure out a compromise on their campaign promises.

The last time Republicans used the reconciliation process in 2017, they had much wider margins in the House, holding 241 seats at the time.

Getting the centrists and far-right members of the party to support one sweeping package that is expected to include tax cuts and hundreds of billions in spending cuts — potentially including Medicaid — will be more challenging this time around, with the GOP holding just 218 seats at the moment. 

Last updated 1:02 p.m., Mar. 7, 2025

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