Updated May 2, 2025 at 12:16 PM CDT
As Speaker Mike Johnson and his slim GOP House majority work to pass President Trump's budget, they'll have to work around the fact that cuts to Medicaid are unpopular with the public and enough members of their own party to upend the process.
An April poll from KFF found that both Republicans and Democrats say they broadly oppose funding cuts to Social Security, Medicare and Medicaid. About 76% of the public overall opposes major cuts to Medicaid.
But an analysis from the nonpartisan Congressional Budget Office found that if Republicans want to meet their desired savings, they will likely have to make cuts to the social safety net program that provides health insurance to low-income adults and people with disabilities.
The prospect of deep cuts to Medicaid benefits led to 12 House Republicans sending a letter last month telling House Speaker Johnson they would not support a final reconciliation budget bill if it reduces Medicaid coverage for vulnerable populations.
Rep. Jeff Hurd, R-Colo., one of the 12 lawmakers to sign the letter, told Morning Edition that the focus should be on "preserving the original purpose of Medicaid." He added that the attention should be on children, pregnant women, low-income individuals and seniors.
Colorado Public Radio reports that about a fifth of Colorado's population relies on Medicaid — with about a third of the population in Hurd's congressional district being dependent on Medicaid coverage.
Hurd told NPR's Michel Martin that work requirements and stopping "improper" Medicaid payments are areas where savings could come from.
This interview has been edited for length and clarity.
Interview highlights
Michel Martin: So tell me about your district in Colorado. When you said vulnerable populations, who do you have in mind? Who are you picturing?
Rep. Jeff Hurd: So my district is Colorado's third congressional district and nearly one-in-three people in that district rely on Medicaid. When I talk about vulnerable populations from my perspective, I'm talking on preserving the original purpose of Medicaid, providing health care for low-income groups, people like children, seniors who are dual enrolled in Medicare, pregnant women, individuals with disabilities, and families who can't afford private insurance.
Martin: So the letter you co-signed said you would support what you called "targeted reforms." Can you just give me, like, one example of something you think makes sense?
Hurd: One example would be re-evaluating the continued federal subsidization of able-bodied working age adults under the Affordable Care Act expansion.
Martin: Would you say more about that? Are you talking about work requirements? That's something that Walker Johnson supports.
Hurd: Certainly that would be something that I think we should be looking at. We need to protect those. Medicaid was created to serve, but we shouldn't allow the expansion to crowd out the traditional priorities.
Martin: You know, some people say work requirements are a backdoor way to force people out of the program. You don't think that's true?
Hurd: No, I think we should incentivize people who are able to work, to work and to have jobs that allow them to support themselves and not need to rely on assistance from taxpayers. One of the things that I think we might want to look at as well, maybe this is going down the road, but things that would reduce the or eliminate the so-called benefits cliff, where an individual gets a job and starts working and then all of a sudden they lose their Medicaid benefits. It creates sometimes perverse incentives. That's one of the structural reforms that I think maybe down the road we need to be looking at as well to make sure that we're incentivizing people who are able to work and not need to rely on Medicaid.
Martin: Isn't that the issue, though, that some people who earn so little and they work in jobs where they don't have access to health care? I mean, think about somebody who might work at a gas station, for example, and yet if they get sick, then they become reliant on public funds like. So what's the answer to that?
Hurd: Well, I think we can account for that. We can account for the people that are having extenuating circumstances and who are trying to work, who have been working. We can distinguish between those individuals and those individuals who aren't doing that and who are taking away the funds and resources from people that need it the most. Those vulnerable populations that I mentioned before, I think there's a way that we can find the right balance.
Martin: So the same letter says you support cutting administrative red tape. This is something that's confusing to me, right? Every few years you hear about these overbilling scandals or somebody's getting paid for care that doesn't exist. Right? Like every few years, there's some scandal like this, for example, some you know, some agency that is supplying, say, home care workers. And it turns out that these people don't exist. So to try to forestall that, they lay on more paperwork. And then everybody who deals with health insurance has this maddening experience of dealing with more and more paperwork. And then we complain about red tape. Why can't we get that balance right?
Hurd: I saw the Medicaid application packet when I was visiting my district last week and it is frustrating. It can be difficult to navigate. That said, the Government Accounting Office suspects that they're about $50 billion each year in improper Medicaid payments. There has to be a better way to look at this. We need to find the right reforms in the right ways to make sure that we're spending these dollars correctly and to incentivize individuals that are trying to get through this process – who are doing so in good faith and they're the core populations that we're trying to support the most – that they have the ability to do so. There's a way to do it. We can do it better, and that's one of the things we should be working on.
Martin: So Medicaid accounts for about 10% of the federal budget. It's a big number. If it's important to you, as it is important to others to preserve access to this program, where do the savings come from?
Hurd: Well, I think it's from the one of the things that we talked about just now, possibly work requirements, eliminating improper payments. I think there's also some possible reforms that we can make to things like the so-called Section 1115 waivers that fund non-health care services like housing stipends or nutrition benefits or transportation costs. Housing and food are important, but we already have programs for that. I think Medicaid should be focused on health care. So that's another example of ways that I think we can realize more effective spending within the system that we have. If you talk to folks in rural Colorado, they will tell you that Medicaid is already under a significant amount of stress. I think that we can deliver these dollars in a more effective way. The answer isn't always just spending more money, it's spending it more effectively. And I think that's what we as Republicans need to be doing, and that's what I'm focused on from my perspective.
Martin: It is unusual sort of in the current environment for Republicans to organize and make sort of a public statement about a specific policy issue. Can you just tell me a little bit about why you and the others, lawmakers who signed this letter felt it was important to make a public statement like this?
Hurd: Well, I think it's important to let the folks back home that I represent know that this is an issue that's important to me and that we are part of the Republican coalition that is working together to advance the president's priorities, the priorities we ran on as Republicans, but make sure that we do so responsibly in a way that protects the most vulnerable in our districts. And so that was the animating spirit behind my writing that letter. I'm also not on the committee that's writing the actual legislation with respect to Medicaid. And so it was important for me and some of the others on that letter to make sure that the folks writing the legislation know what our priorities are as part of that Republican coalition.
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