Health Advocates Warn Budget Reconciliation Will Strain The State Health Care System

By Danielle J. Brown, Maryland Matters

July 11, 2025

Deep cuts to Medicaid in the One Big Beautiful Bill Act will likely force thousands of Marylanders off the Medicaid rolls, creating ripple effects that advocates fear could strain and disrupt the state’s overall health care system.

“The whole situation is incredibly frustrating and a lot of harm has been done to the Maryland health care system with this bill,” said Gene Ransom, CEO for MedChi, the Maryland State Medical Society.

President Donald Trump (R) signed H.R. 1, known as the “One Big Beautiful Bill Act,” last week. In addition to permanently extending some tax cuts and slashing food stamp benefits, the new law aims to cut $1 trillion in Medicaid spending over the next 10 years by reducing aid to states, imposing work requirements on benefit recipients, tightening registration rules and more.

Federal budget analysts say that 11.8 million people across the country could lose health care coverage over the next decade as a result of the changes during that time.

While the final version of the budget reconciliation act gives states more time to implement the changes than in previous versions, advocates still fear the massive cuts to funding and changes to Medicaid eligibility will disrupt Maryland’s overall health care system.

New Medicaid work requirements

An overarching concern for providers are the increased eligibility requirements under the law, particularly a stiffer work requirement. Any Medicaid recipient whose income exceeds the federal poverty level would have to work 80 hours a month, or 20 hours a week, in order to maintain coverage.

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Maryland is one of 40 “expansion states” that accepted a Biden-era policy that let states expand Medicaid coverage to those making up to 138% of the federal poverty level. About 330,000 Marylanders are part of the “expansion population” and would be subject to the work requirement, which would take effect no later than 2028.

Supporters of the work requirement say it will cut back on wasted taxpayer dollars by ensuring that Medicaid recipients are contributing to the workforce. Opponents argue that most recipients are already working, and that they are more likely to be tripped up by the increased paperwork that will be needed to prove that they are fulfilling the 80-hour per month requirement.

Some people would be able to opt out of the work requirement, including families with children under age 14, those who are pregnant, and some people who have disabilities.

U.S. Rep. Andy Harris (R-1st), the only Maryland lawmaker to vote in favor of the bill, recently said that Medicaid coverage will continue for the “people who need it the most.”

“No one is taking Medicaid from those who truly need it,” he said in social media posts Monday. “Women, children, the elderly, and the disabled are protected. Period.”

The legislation also requires that the expanded Medicaid population prove eligibility every six months, beginning in 2027. Critics see that as just another hurdle for recipients, who will struggle to keep up with the frequent eligibility checks and will lose coverage as a result.
U.S. Rep. Andy Harris (R-1st), (Photo by Danielle J. Brown/Maryland Matters).

With both of those provisions going into effect in the coming years, health care advocacy group KFF estimates that around 130,000 Marylanders will lose coverage.

Analysts from the Maryland Department of Legislative Services say that the two provisions could slash $1.1 billion in Medicaid costs in Maryland, $112 million of which would be state dollars. Those savings would be slightly offset by the increased administrative costs of having to conduct more-frequent eligibility checks.

But Ransom, with MedChi, said those would be short term savings for the state that would be quickly eaten up by the increase in uninsured Marylanders who would lead to more expensive care and a greater strain on the health care system as a whole.

“All of these things are going to mean that we have more people who either don’t have access to a physician or don’t have insurance, so they end up not getting preventative care,” Ransom said. “They end up not getting their regular primary care visits, then they’re going to wait until they’re really bad, they’re going up in the emergency room and then we all end up paying for it.

“There might be some savings in the short run, because you throw people off – in a very mean-spirited way by making them fill out forms every six months to make sure that they’re eligible,” he said, “but the reality of it is that it’s going to hurt all of us.”

Reproductive health care

Reproductive rights advocates warn that a provision that prohibits Medicaid funding for any reproductive health care at a facility that also provides abortions — such as Planned Parenthood — will reduce access for low-income people to receive services like cancer screenings and testing for sexually transmitted infections.

Karen Nelson, president and CEO of Planned Parenthood of Maryland, said that about one-third of the patients at its seven centers located throughout Maryland are Medicaid recipients.

“What it effectively did was eliminate Planned Parenthood from participating in the federal Medicaid program … and [made it] ineligible to receive payments from Medicaid,” Nelson said.” These are vulnerable populations and people are coming to us for wellness visits, cancer detection, STI testing and treatment, birth control and all of the preventative health care that keeps the community healthy.”

State analysts estimate that it would cost the state about $2.5 million to make up for federal funds lost as a result of that provision.

Planned Parenthood is often thought of as just an abortion provider, and is often the target of anti-abortion attacks. The organization believes the budget reconciliation unfairly targets it, and it filed a lawsuit to block the provision. A federal judge in Massachusetts issued a temporary restraining order this week, meaning that for the time being, Medicaid recipients can still be covered for services rendered in Planned Parenthood.

Nelson explained that even if Medicaid recipients could continue to seek care at Planned Parenthood, the anticipated loss in health coverage due to the increased eligibility requirements will further reduce access to reproductive health services in the state.

“It is going to be devastating,” Nelson said. “The big fear is that people are not going to be receiving the life-saving cancer detections. They’re going to not have their STI treated, and people won’t be able to access birth control.

“You have an already stressed system and the amount of uncompensated care that’s going to be needed is going to be very taxing on the providers, not just Planned Parenthood, but across the board,” she said.

Maryland Health Benefit Exchange

Michele Eberle, executive director of the Maryland Health Benefit Exchange, said that the state insurance marketplaces, where people can shop for individual private insurance through the Affordable Care Act, fared better than originally anticipated under the budget reconciliation legislation, though it will also face challenges.

The legislation will create barriers for certain immigrants to purchase health care on the marketplace and receive tax credits to help bring monthly costs down for coverage. Some changes in Marketplace rules that were implemented outside of the budget reconciliation bill will also narrow the time that people can sign up for new health plans.

She is more worried about something that was absent from the legislation – an extension on the federal tax credits that have boosted enrollment through the exchange.

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“We’ve had huge success in enrollments,” Eberle said of the federal tax credits. “It makes it affordable for people to use their tax credit to pay for their health care that they’re purchasing in their own right.”

Insurance companies have already warned state officials that those who bought health insurance on the state marketplace could see the cost of coverage increase an average of 17% next year unless Congress extends those federal subsidies.

Eberle said that Congress still has time to act.

“It’s got to be solved or we’re going to lose enrollees — we know that,” she said.

Eberle warns that all of these factors together will likely reduce the size of the insurance pool, which could lead to increased costs for everyone, even those on private insurance through employers.

“That will affect not only on the exchange but off-exchange, individual marketplace,” she said. “That will affect the doctors that are providing those services, the hospitals where the people go. All of that trickle-down effect the small business employer who has lost coverage and now gets sick and can’t be at work – I mean all of those things.”