House Budget Reconciliation Bill Proposes History's Largest Cuts to Health Care Programs and SNAP
New CBO numbers show an enormous gulf between current proposal and the largest past cuts ever signed into law
Earlier this week, the Congressional Budget Office (CBO) published its final estimates of the fiscal effects of the House Budget Reconciliation bill. We now know that the bill would cut health care programs by almost $1.2 trillion dollars and eliminate nearly 30% of all federal spending on the Supplemental Nutrition Assistance Program (SNAP) over the next ten years. Our country has never experienced cuts to these basic need programs on anything like this scale.
An unprecedented defunding of American health coverage
CBO projects that the bill would cut health programs by nearly $1.2 trillion over the next 10 years. That includes an $864 billion cut to Medicaid and a $320 billion cut to Marketplace coverage under the Affordable Care Act (ACA). Each of these cuts far exceeds any previously enacted.1
Medicaid
Calculated in fixed dollar terms, the House’s proposed Medicaid cuts are 15 times the size of the largest previous Medicaid cut ever enacted—namely, the cuts made by the Deficit Reduction Act of 2005, which, in 2025 dollars, cut an average of $5.8 billion per year within the applicable CBO scoring window. The current cut averages $86.4 billion per year.
Another way to compare current to past cuts involves the percentage reduction in projected spending. The Omnibus Budget Reconciliation Acts of 1981 and 1982 cut projected spending by 5.0%, history’s largest prior cut, in percentage terms. By contrast, the House bill’s $864 billion cut would eliminate 11.6% of projected spending—more than twice the depth of the 1981-1982 cuts. The latter cuts reduced Medicaid enrollment by 13%, according to the Reagan administration’s official evaluation. The current proposal, more than twice the size of those earlier cuts, would surely do even more damage to Americans’ health coverage.
ACA coverage
The proposed cuts to the ACA’s system of Marketplace coverage represent an even more dramatic departure from recent history. Past legislation changing the ACA has addressed such things as penalties paid by individuals for going without health insurance, taxes on employers for offering generous health benefits, the ACA’s allotments for public health investments, and the legislation’s new system of long-term care insurance. Premium tax credits and related ACA investments that make Marketplace coverage more affordable to families have been strengthened over time, not cut, mainly through an increase in premium tax credits that is scheduled to expire after this year.2 Against this backdrop, the proposed $320 billion cut to ACA Marketplace coverage stands out as unique. To place that cut in perspective, it would eliminate almost one in four dollars CBO currently expects the federal government to spend helping families buy their own ACA health insurance over the next 10 years.
Eliminating nearly 30% of all SNAP dollars, making history’s largest cut to America’s most important food program
CBO projects that the House bill would cut SNAP spending by $319 billion dollars, amounting to 29% of all projected SNAP spending from 2025-2034. In percentage terms, that is approximately twice the size of the largest previous cuts to SNAP ever enacted, which were made by the Personal Responsibility and Work Opportunity Budget Reconciliation Act of 1996 (PRWORA). That bill eliminated roughly 15% of all projected program spending.
In real dollar terms, the gulf between history’s largest past SNAP cut and the current proposal is even wider. In 2025 dollars, PRWORA reduced SNAP spending by $6.67 billion during the average year within CBO’s scoring window. The current cut averages $31.9 billion per year — more than four times the prior amount.
Federal researchers found that PRWORA was a major factor behind 10 million people losing SNAP after the legislation’s enactment. Far more damage would be done to Americans’ ability to feed their families if the Senate goes along with the House bill’s attack on SNAP.
Conclusion
The cuts proposed by the House Reconciliation bill would be far and away the largest ever made to programs on which tens of millions of low-income Americans rely for food and medical care. It is not plausible to suggest that Congress can cut federal health care programs by almost $1.2 trillion and eliminate roughly 30% of all SNAP spending without hurting vulnerable people. Children, older adults, people with disabilities, and low-income working families will all suffer serious harm if anything like the House bill is signed into law.
These cuts would be offset by a $43 billion increase in spending and a $5 billion drop in revenue, as a result of interactive effects between the health-related provisions of the House Energy and Commerce Committee’s provisions and the House Ways and Means Committee’s provisions.
One exception involves increases to “safe-harbor” limits on low-income taxpayers’ obligation to repay excess advance premium tax credits. Even in terms of such limits, the House bill goes far beyond previous legislation by completely eliminating, rather than raising, those limits.