The Senior Citizens League (TSCL) Monthly Washington Update for the end of May 2025
News out of Washington, D.C., has changed so frequently during the last several months that it’s hard to keep current on the happenings on Capitol Hill. This information is as up-to-date as possible, as of the time it was written.
Most of the news below covers the major changes that may be made to Medicaid and how they could affect millions of seniors. But we also cover President Trump’s new order to try to lower prescription drug prices, and the administration’s proposal to slash funding at the National Institute on Aging.
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Medicaid – Is it being cut?
The big news in Washington has been the Republican rush to pass President Trump’s “One big, beautiful bill” so he can sign it by July 4. A key component of that bill is cutting the amount of money the government spends on Medicaid. The money from those cuts is then intended to help offset the cost of the tax cuts that President Trump wants.
However, the cuts to Medicaid will not pay for the entire cost of the tax cuts, and the Congressional Budget Office says President Trump’s bill will increase the national debt by $2.4 trillion.
Since Republicans control both the Presidency and Congress, it has to be understood that the bill is a Republican bill. The Democrats cannot stop it or change it on their own.
The Republicans say that they are only cutting waste, fraud, and abuse, while Democrats, and some important Republicans, say the cuts will cause millions of people to lose health care.
Explaining these changes can take some time, but TSCL is committed to helping you stay informed about these developments, as they represent significant shifts in U.S. healthcare policy.
Why Medicaid?
As a reminder, Medicaid is a joint federal and state program that provides health coverage to over 72 million Americans, including millions of seniors and older Americans who rely on Medicaid coverage. Approximately 7.2 million Americans over 65 are enrolled in Medicaid, and more than 11 million Americans ages 50 to 64 have health coverage through Medicaid. Nearly 6 million older adults live below the federal poverty level. For millions of seniors and older Americans on fixed incomes, Medicaid is a literal lifeline.
Medicaid funds nearly half of long-term care nationwide. As seniors age, long-term care services become increasingly essential, serving approximately 70 percent of seniors who will require some form of long-term care during their lifetime.
Medicaid pays for about 62 percent of long-term care residents in nursing homes. In 2019, this totaled over $50 billion. The median annual private nursing home room cost exceeded $100,000 in 2024.
Approximately 12 million seniors who are covered by Medicare also have Medicaid coverage. Nearly 8 million of the dual eligible Medicare-Medicaid beneficiaries are “full benefit” Medicaid enrollees who have access to a range of Medicaid benefits, not otherwise covered by Medicare, such as transportation to medical appointments and medical equipment.
Seniors and older adults depend on Medicaid for affordable, comprehensive care. Older Americans often have more complex health issues, requiring additional medical attention that is costly, and would be out of reach if not for Medicaid. Nearly half of dual enrollees are seniors of color, and over half of dual enrollees suffer from long-term disabilities.
The bill passed by the Republicans in the House of Representatives would reshape the country's healthcare system in several key ways. First, it would force states to make decisions about their Medicaid program and what parts of it they would fund because of reduced federal funding. In the past, what has usually been first on the chopping block are the home and community-based services. The cuts would make it harder to access those services.
The second is work requirements. Strict work requirements would add a significant administrative burden to the shoulders of family caregivers, who are already navigating a complex bureaucracy. And then, thirdly, there will be a loss of healthcare coverage.
What effect will the cuts have?
The Congressional Budget Office estimates that 11 million people will lose health care coverage. Among those could be over 4 million Americans who are family caregivers and rely on Medicaid for their own healthcare coverage.
One of the key provisions the Republicans have inserted into the bill is a work requirement for those on Medicaid who are deemed capable of working. It would establish nationwide work requirements for the first time. Seniors, people with disabilities, caregivers for dependent individuals, and pregnant women are supposed to be exempt from the work requirements. However, while this may seem like a reasonable requirement at first glance, there is some gray area regarding these exemptions.
Some decisions regarding how to implement the requirements will be left to the states. They could, for instance, require Medicaid enrollees to report their activities on a monthly or semiannual basis. However, past research has shown that additional reporting requirements tend to result in more otherwise-eligible individuals losing benefits.
One of the key provisions introduced in the bill is a work requirement for those on Medicaid who are deemed capable of working. This proposal would establish nationwide work requirements for the first time. Seniors, people with disabilities, caregivers for dependent individuals, and pregnant women are intended to be exempt from these requirements. However, questions remain about how these exemptions will be defined and implemented.
Some decisions on the specifics of the requirements, such as how individuals report their activities, would be left to the states. Reporting could involve submitting information monthly or semiannually. Past experiences with similar policies suggest that additional reporting requirements can sometimes result in eligible individuals losing benefits due to administrative challenges.
For example, during a previous trial of work requirements in Arkansas, thousands of individuals lost their health insurance within months. In many cases, this was due to difficulties in navigating the reporting process, rather than failure to meet the requirements. Participants were required to report their work activities via paper forms, phone calls, or an online portal, but challenges with communication and clarity in the process led to unintended consequences.
What happens next?
The bill passed by the House of Representatives is now in the Senate, where Republicans hold the majority. The Senate must pass its version of the bill and then send it to a conference committee, where members of both chambers will attempt to resolve the differences and draft a single bill that will then be returned to each chamber for final passage.
Since Republicans are in the majority, this would seem to be a simple task. However, several Senate Republicans have been critical of the bill.
Senator Josh Hawley of Missouri wrote an opinion article in the New York Times where he said: “Mr. Trump has promised working-class tax cuts and protection for working-class social insurance, such as Medicaid. But now a noisy contingent of corporatist Republicans — call it the party’s Wall Street wing — is urging Congress to ignore all that and get back to the old-time religion: corporate giveaways, preferences for capital, and deep cuts to social insurance.
“This wing of the party wants Republicans to build our big, beautiful bill around slashing health insurance for the working poor. But that argument is both morally wrong and politically suicidal.”
Likewise, Senators Susan Collins, Lisa Murkowski, Rand Paul, and Ron Johnson, all Republicans, have been very critical of the bill, albeit for varied reasons.
TSCL opposes these massive cuts to Medicaid due to their impact on millions of seniors. We will be closely monitoring the Senate's actions over the next few weeks to see how they proceed with the bill. In the meantime, we urge you to call your Senators and tell them not to cut Medicaid.
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President Signs New Executive Order on Prescription Drugs
President Trump has signed an executive order aimed at lowering prescription drug prices by tying U.S. costs to the lowest prices paid in other developed nations.
While the policy promises long-term relief on medication costs, its short-term effects are uncertain and depend on responses from legal, legislative, and industry stakeholders.
According to some sources, his order could affect drug prices in 5 ways.
Centered on the “Most Favored Nation” pricing model, the executive order expands Medicare’s ability to negotiate costs and pushes for more domestic drug manufacturing.
The order gives a 30-day window for pharma companies to lower prices voluntarily and outlines potential follow-up actions, like regulatory rulemaking and antitrust enforcement, if those targets aren’t met. However, while the intent of the order is clear, its practical impact will depend on the industry's response and the feasibility of implementation.
The executive order could provide much-needed relief to middle-class families by addressing the high cost of prescription drugs.
If widely adopted, this pricing model could ripple beyond Medicare, potentially lowering premiums and out-of-pocket costs for middle-class families with private insurance.
However, rather than accept lower prices, drugmakers could disrupt access for patients, especially those with chronic conditions.
Drug companies might start playing games: raising prices overseas, holding back drugs in lower-cost countries, or cutting access in rural hospitals where margins are already tight.
Unfortunately, because Trump’s order lacked strong implementation rules, the benefits may never actually reach patients.
Additionally, legal challenges could delay or block the order, resulting in mid-year coverage changes and confusion for families.
As insurers respond to policy changes, patients may face shifts in drug formularies or delays in treatment decisions tied to reimbursement uncertainty.
Budget Request Would Slash the National Institute of Aging 2026 Budget
The Department of Health and Human Services (HHS) has released a summary of President Trump’s budget request for the 2026 fiscal year, which begins on October 1. The document provides the most detailed look yet at how his administration hopes to reshape the National Institutes of Health (NIH) and other federal agencies.
The President’s proposed budget would slash NIH’s discretionary budget to $27.5 billion, an $18 billion or nearly 40% reduction. It also details plans to consolidate the agency’s 27 institutes and centers into just eight.
The president’s proposal would leave just three of the NIH’s current institutes intact: the National Cancer Institute, the National Institute of Allergy and Infectious Diseases, and the National Institute on Aging. But that doesn’t mean these institutes would be spared. If enacted, Trump’s request would slash the budgets of NCI from $7.2 billion to $4.5 billion, NIAID from around $6.6 billion to $4.2 billion, and the National Institute of Aging from $4.4 billion to $2.7 billion- an approximately 61% cut.
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