House Republican Reconciliation Bill Targets People with Medicare

The House-passed reconciliation bill takes direct aim at Medicare in several ways, including by delaying recent final rules that streamline access to the Medicare Savings Programs (MSPs) for low-income older adults and people with disabilities.

Medicaid Helps People Afford Medicare, Other Necessary Expenses

The MSPs are Medicaid benefits that help people with Medicare who have limited income and savings afford their Part B premiums ($185.00 per month in 2025). These Medicare-Medicaid enrollees automatically get the Part D Low Income Subsidy (LIS)/Extra Help, which helps pay their out-of-pocket prescription drug costs, saving them an average of $6,200 per year. Combined, these programs make health care costs more manageable, allowing enrollees to maintain Medicare coverage, afford medications, and better meet daily living expenses like food and housing.

House Reconciliation Bill Threatens Access to MSPs, Extra Help

Despite these successes, MSPs and Extra Help have long been under-enrolled. This may be due to lack of information about the programs and how to sign up, as well as difficulty navigating an enrollment process that is notoriously complex. Recognizing these challenges, the Centers for Medicare & Medicaid Services (CMS) issued rules easing administrative burdens. The House reconciliation bill would pause these modernizations—blocking beneficiary access in order to save federal dollars.

This would cause substantial harm. Notably, the rules did not expand program eligibility or benefits; they simply reduced red tape to help people get and stay enrolled. Halting these common-sense changes would cut low-income older adults and people with disabilities off from help for which they qualify, ultimately putting their health, economic security, and well-being at risk.

Millions Could Lose Coverage and Financial Assistance

The Congressional Budget Office (CBO) projects nearly 1.4 million low-income people with Medicare—more than 10% of the dually eligible population—would lose MSP and Extra Help under this policy. While CBO notes this would yield $162 billion in savings over the 10-year period, the analysis does not contemplate realities that could undercut those amounts: Affordability barriers have long been found to reduce treatment adherence, driving up care needs and spending in the long run.

Short-Sighted Policies Drive up Financial and Health Costs

Indeed, there is substantial research connecting health care and prescription drug unaffordability with worse individual outcomes and higher Medicare spending. A timely new study in the New England Journal of Medicine links the loss of Medicare cost assistance with significant increases in mortality among low-income beneficiaries. Its authors issued a memo applying that research to the House reconciliation bill’s streamlining rule delay, warning that Medicaid coverage losses of the magnitude CBO expects “could result in 18,200 additional deaths among Medicare enrollees every year” primarily because “losing Medicaid also leads to the loss of prescription drug assistance through the Low-Income Subsidy (LIS) program.”

As they explain, their research “adds to the growing body of evidence that access to affordable insurance is essential for protecting the health of low-income Americans. We show that losing prescription drug subsidies tied to Medicaid leads to increased mortality among low-income Medicare beneficiaries. Policies that cause low-income Medicare beneficiaries to lose Medicaid—and, as a result, the LIS—could lead to thousands of preventable deaths.”

All Medicaid Cuts Take Away Health Insurance Coverage

Medicaid cannot be cut without kicking people out of their coverage and reducing benefits. This includes people with Medicare.

At Medicare Rights, we oppose cuts to Medicaid. Preventing people with limited resources from accessing coverage they qualify for is still a cut. Any “savings” from driving up the cost of care may save dollars temporarily, but it will ultimately lead to higher spending as they need more expensive care later. We urge all policymakers to abandon these short-sighted and damaging ideas and work to help everyone access high-quality, affordable care and coverage.

Take Action

The reconciliation bill is now headed to the Senate, where it will face further deliberation and votes. Your Senators need to hear from you now about the dangers of this bill. Contact your lawmakers today.