House Reconciliation Bill’s Health Care and SNAP Cuts Put Older Adults at Risk

A new analysis from the Center for Budget and Policy Priorities (CBPP) finds the House Republicans’ budget reconciliation bill would directly harm older adults by eroding their access to affordable health care and critical food assistance.

Health Care

More than seven million older adults and nearly five million people with disabilities receive health coverage through Medicaid and Medicare. Medicaid covers over 3 in 5 nursing home residents and pays for community-based long-term services and supports that Medicare does not. It also helps pay premiums, deductibles, and cost sharing for some Medicare beneficiaries.

The House reconciliation bill would make the largest Medicaid cuts in the program’s history, but that would not reduce anyone’s need for care. It would simply shift the full cost of that care onto states, a burden that would ultimately fall on the shoulders of older adults and people with disabilities: Unable to fill the federal Medicaid funding gap, states would be forced to make cuts that would leave Medicare-Medicaid enrollees with higher costs, less health care, and worse outcomes. At the same time, the bill’s changes to Medicare eligibility and expiring Affordable Care Act (ACA) cost assistance would further erode coverage and care. CBPP notes those harms could come in the following ways.

Increasing Medicare Costs

The bill would block recent final rules that streamline access to the Medicare Savings Programs (MSPs). 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. According to the nonpartisan Congressional Budget Office (CBO), roughly 1.4 million people would no longer receive this cost-sharing assistance under the House bill and would therefore face increased out-of-pocket costs that could put Medicare coverage—and with it, health and financial security—out of reach.

Threatening Home- And Community-Based Care

The House bill would create new restrictions on how states can finance their share of Medicaid. States unable to work within those new parameters would face a funding shortfall. To cover those losses, they may reduce Medicaid services they aren’t required to provide, such as home- and community-based care for older adults and people with disabilities.

Imposing Harmful Work Requirements

The House bill’s Medicaid work requirement would create a job loss penalty that would apply to individuals up to the age of 64. CBO finds 5.2 million adults would lose Medicaid as a result, including many who are working or should have an exemption, but who would nevertheless get tripped up by the requirement’s red tape. This provision would likely have a disproportionate impact on older adults, who face outsized barriers to steady employment as well as obstacles to compliance reporting.

Cutting Medicare and ACA eligibility

On top of the Medicaid cuts, the bill would terminate Medicare coverage for many individuals with lawful immigration status who have worked and paid taxes in the US for decades. This is a significant departure from current, longstanding policy, which recognizes eligibility for everyone who has paid sufficient Social Security and Medicare taxes. Further, Medicare already prohibits payment for care for anyone who is undocumented; withholding or revoking Medicare eligibility from legally present older adults and people with disabilities who have paid in, and continuing to collect Medicare taxes on their wages, would be a dangerous precedent and ominous programmatic shift. Many would have nowhere to turn for coverage. The bill would also cut off their access to ACA tax credits and federal law already restricts Medicaid eligibility for people with lawful status who do not have a green card.

Reducing the Quality of Nursing Home Care

The House Republican reconciliation bill would undermine a rule establishing minimum staffing standards for nursing homes. Removing these guardrails would set back efforts to ensure safe, quality care for older adults and people with disabilities who need nursing facility services, endangering their lives due to inadequate nursing facility staffing.

Increasing Costs for Older Adults in the Aca Marketplaces

Despite extending other numerous other tax breaks, the House bill fails to renew the premium tax credits that help more than 22 million people—including many older adults who are not yet Medicare-eligible—afford ACA marketplace plans. Previous AARP analysis found that if these tax credits are allowed to expire, nearly five million adults ages 50 to 64 will face higher ACA premiums next year. Those who can’t pay the thousands in additional costs will likely drop their coverage and become uninsured, eventually leading to worse health and higher Medicare costs.

Food Assistance

Health care is not the only basic need at risk in the House bill: Food assistance is also on the line. SNAP helps more than 40 million people, including eight million low income older adults, purchase the food they need to build and maintain their health. This assistance is vital. Older adults are uniquely susceptible to the consequences of food insecurity, such as hunger, poor dietary quality, and adverse health outcomes. SNAP has a proven track record of helping them live safely and independently. CBPP explains how the House Republican reconciliation bill would cut the program by nearly $300 billion, or 30%, jeopardizing this proven success.

Restructuring SNAP

SNAP benefits have been fully federally funded for 50 years. The House Republican bill would fundamentally change this structure by requiring states to cover up to 25% of those costs. States that couldn’t do so would have limited options: reduce enrollment, cut benefits, or opt out of the program altogether. CBO estimates at least 1.3 million people would lose some or all SNAP assistance each month due to this provision, with cuts likely to deepen based on individual state choices and across the board during recessions, when state budgets are even more stretched.

Doubling Down on Work Requirements

Under current SNAP rules, adults up to age 54 may be subject to a 20-hour-per-week work requirement unless they qualify for an exemption. The House reconciliation bill would expand this harsh restriction, including by applying it to adults ages 55-64. CBO estimates 3.2 million people would lose food assistance in a typical month as a result, one million of whom would be 55 or older.

Cutting SNAP Eligibility and Benefits

As with Medicare and the ACA, the House Republican bill would end SNAP for many currently eligible immigrants. It would also restrict future updates to benefit levels, cutting assistance for all participants by $37 billion.

Take Action: Tell Your Senators No Cuts to Care

The House reconciliation bill would strip food assistance from millions and increase the number of uninsured Americans by 50%, to approximately 16 million people, through changes that would make Medicare, Medicaid, and ACA coverage harder to pay for and maintain. These shifts would create ripple effects across the entire health care system, driving up costs of coverage and care for everyone, devastating families and communities across the country. With Senate discussions on these policies underway, your lawmakers need to hear from you today! Tell your senators that you oppose the House bill and any other harmful rollbacks to programs that help older adults and people with disabilities stay healthy, safe, and independent. Now is the time: Make your voice heard!