In recent congressional appearances, Health Secretary Robert F. Kennedy Jr. pushed back as lawmakers raised concerns about how changes tied to President Donald Trump’s 2025 tax and spending law could affect Medicaid, rural hospitals, and people who rely on the program. The dispute centered on whether the law amounted to “cuts” to Medicaid spending, despite projections that Medicaid spending would increase over time.
Kennedy told lawmakers, “There are no cuts to Medicaid,” and argued that the federal government was instead increasing Medicaid spending. In his remarks, he said, “We are increasing Medicaid spending by 47% over the next 10 years,” framing the growth as incompatible with the idea of a cut.
Kennedy’s staff supported that position by citing a February Congressional Budget Office report that, in the staff’s characterization, showed Medicaid spending growing 47% over a 10-year period. The argument, as presented in those congressional hearings, was that if Medicaid spending is projected to rise year after year, “there can’t be a cut.”
Medicaid analysts and researchers challenged that framing as inaccurate political spin, arguing that growth under the enacted law does not negate a reduction in federal funding compared with what would have happened absent the legislation. They pointed to reforms in the law, including new work requirements and eligibility changes, which they said were designed to reduce Medicaid spending over the decade.
The dispute also reflected differing descriptions of what constitutes a “cut.” Georgetown’s Edwin Park said Kennedy’s logic echoed a conservative argument that if spending still grows in nominal terms, then policymakers have not cut it. Park said, “This is an old, sort of tired argument that’s been used by conservatives to justify spending cuts by saying, well, if spending is still growing in nominal terms, somehow there wasn’t a cut,” and he added that “The federal government is spending nearly a trillion dollars less than it otherwise would have in the absence of the legislation.”
Sara Rosenbaum, a professor emerita at George Washington University’s school of public health, said Kennedy’s claims followed a long-running pattern in disputes over Medicaid. She called the argument “absurd,” saying, “They cut a trillion dollars.” Rosenbaum’s remarks echoed the view that the relevant comparison is the funding level implied by the enacted policy changes rather than whether spending continues to rise in dollar terms.
The Trump administration and congressional Republicans said the Medicaid reforms were aimed at addressing misuse rather than reducing support for intended beneficiaries. Department of Health and Human Services spokesman Andrew Nixon said, “To be clear, HHS is taking steps to ensure Medicaid serves those it is intended to support,” adding that “These actions are not cuts — they are focused on addressing waste, fraud, and abuse to better position the program for those who rely on it.”
Park said the law’s more burdensome enrollment requirements would likely affect eligible Americans as well. He said the result would be “many more uninsured people, and people going without needed care,” arguing that the enrollment changes would reduce access even for people who qualify.