The House Just Passed The Biggest Medicaid Cut in U.S. History, Twice the Size of Reagan's Cuts

So much for realignment. New analysis from UnidosUS shows the House’s cuts to Medicaid and SNAP are unprecedented, twice as large as anything under President Reagan,

Even though I had braced for bad numbers, the sheer scale of the Medicaid cuts in the House-passed Big Beautiful Budget (BBB) bill still stunned me. Cuts this vicious, even as the wealthy and well-off get big tax cuts and the deficit explodes further, appear historically unprecedented.

Are they? There’s excellent work being done on how this budget will impact everyday people, whether it is Groundwork Collaborative explaining how the bill will raise the cost of living or the Hamilton Project showing how Medicaid will get cut for workers with unstable hours. But I was curious about whether these cuts stand out historically.

Fortunately, Stan Dorn, Director of the Health Policy Project of UnidosUS, and someone who has been working on health care policy for decades, has done the work. He put together old CBO analyses, historical knowledge, and data analysis to be able to compare those cuts to now, both in terms of 2025 dollars per year and as a percentage of total spending.¹ Here is his chart for Medicaid:

Let’s put the percentage of total Medicaid spending cuts into its own charts:

As Dorn summarizes (my bold):

The $70 billion average annual Medicaid cut under the current legislation would be more than 10 times the size of the largest previous cut, the Deficit Reduction Act of 2005’s average annual reduction of $5.8 billion in March 2025 dollars.

The current bill’s 9.6% drop in projected Medicaid spending would be roughly twice the size of the largest previous percentage drop that resulted from two sequential budget reconciliation bills added together—namely, the 5.0% Medicaid spending reduction that resulted from the Omnibus Budget Reconciliation Acts (OBRA) of 1981 and 1982. According to the Reagan Administration’s official evaluation, the latter legislation caused a 13% drop in total Medicaid coverage. 

And it’s not just Medicaid that stands out historically. Dorn and Hannah Garelick find similar extremes for SNAP:

In dollar amounts, it’s more than three times the size of any prior cut. Ronald Reagan cut food stamps by 12.6 percent and Bill Clinton, ending welfare as we knew it, cut it by 18.6 percent. This budget would cut it by 26 percent.

The idea that the largest Medicaid cut in U.S. history is being used to fund tax breaks for pass-through entities and high earners doesn’t square with Trump’s plan to realign the electorate. And it can’t. Medicaid expansion supports the working-class families conservatives want to realign into the GOP. And as Senator Hawley and others have noted, the ability of conservatives to secure this realignment depends on making peace with social insurance, and especially Medicaid. Medicaid also backstops rural hospitals, and provides care to roughly half of new births.

But when push comes to shove, Trump and conservatives are going to cut Medicaid by twice as much as President Reagan did when he formally brought libertarianism into the political mainstream and the federal budget.

1. The analysis uses the CPI to adjust for inflation to current dollars. This makes past cuts even larger than if he had used a slower-growing PCE deflator. Yet even with these higher past numbers the 2025 bill stands out as the largest.

There are complicated choices into how to standardized these laws to compare them, how to group them and scale the years. But from discussions and my own diving into the topic, no set of choices is going to change that the current bill moving through Congress is an outlier in how big the cuts are, on the order of twice the size of the next largest one.