Editor’s note: CHN sent the letter below to the all members of the U.S Senate on June 29, 2025.

Dear Senator:

On behalf of the Coalition on Human Needs, I strongly urge you to reject the Senate budget reconciliation package before you this weekend.  This letter focuses on the deep cuts to health coverage and policies outlined by the Senate Finance and HELP Committees in their revised proposals along with our overarching concerns about additional cuts to basic needs programs. We outline many of our reasons for opposing this package below.

The Coalition on Human Needs is made up of human service providers, faith groups, policy experts, and civil rights, labor, and other organizations concerned with meeting the needs of people with low incomes.  We strongly oppose the Senate package given the historic cuts to Medicaid and the Affordable Care Act (ACA), along with the overall impact of this package – the Senate budget bill will raise costs and take other assistance from people with low incomes with harsh reductions in SNAP, the Child Tax Credit, and other human needs programs.

Medicaid is not just a line item in a budget ― it’s a lifeline for millions of people and families. Medicaid is critical to the well-being of older adults, children, people with disabilities, family caregivers, care workers, and families in EVERY community and each state. The Medicaid funding cut proposed is at least four times the size of any previous cut in history. CBO’s latest projections show that this legislative package would kick 11.8 million people off their health insurance by cutting health coverage over $1 trillion (note the visual showing increased percentage of the population without health insurance). Another 5.1 million Americans would lose health coverage because this bill allows the ACA enhanced premium tax credits to expire, and the overall number of uninsured people resulting from the Senate bill is nearly 17 million — more than the 16 million whom CBO found would lose coverage under the House bill. This will have a substantial impact on the health system as a whole, and these could lead to a substantial loss of jobs in your state. The harsh cuts proposed for Medicaid will put local health care providers at risk and force rural hospitals and nursing homes to close, shutter drug treatment programs and reduce access to mental health services, and make it harder for everyone to access the health care they need.

We urge you to reject any attacks on health coverage or other basic needs programs, including amendments that shift even more costs to the states – including potential amendments that attack health coverage for very low-income adults covered through the Affordable Care Act expansion. Please oppose any amendments to end the 90 percent federal cost-share for new enrollees under the ACA, or other amendments that shift even more costs to states.

We were alarmed that the Senate draft included a penalty for 14 states – that cover some immigrants using their own funds! – threatening that they would lose Medicaid matching funds. These smart policies are in place because providing health care to all residents is the right thing to do and saves money, and not a dime of federal dollars is used to fund these programs; they are entirely state funded. States would lose billions of dollars in Medicaid funding for U.S. citizens on Medicaid if they don’t comply with this potentially unconstitutional coercion. Overruling the Parliamentarian’s ruling on this provision would set a terrible precedent: we should not allow the Federal government to use Medicaid or other funding to coerce states into ending their own lawful, state-funded medical coverage. This policy is about imposing the federal government’s will on state funding decisions, not dollar and cents changes allowed under reconciliation. We urge you to oppose Vote No on any vote to waive the point of order to keep this state budget coercion in despite the Parliamentarian’s ruling, and urge a NO VOTE on including any provisions already found in violation of the Byrd Rule that would hike up costs for people including immigrants, and put vulnerable immigrants in danger.

We have deep concerns about the impact of this budget package on state budgets, including the ripple effect on “optional” services that allow seniors and people with disabilities to live with dignity and independence in their own homes (more on the evidence that Medicaid cuts impact Home and Community Based Services). Proposed Medicaid cuts could cost states $201.3 billion over ten years with reduced flexibility along with federal funding for states to finance their Medicaid programs. Researchers have found that more than 300 rural hospitals would be at disproportionate risk of closing, reducing services, or ending inpatient care, and the latest proposals to delay implementation of the provider tax and add a $25 billion rural hospital fund fall far short of the conservative estimate from the American Hospital Association that these changes “would result in a $50.4 billion reduction in federal Medicaid spending on rural hospitals over 10 years,” while others including researchers at the Urban Institute have found that hospitals and other providers could lose upwards of $300 billion. In other words, this “compromise” is a band-aid solution for a much bigger problem. The Senate package will decimate rural communities and many others while shifting costs to states at a level even more severe than the House-passed version, which is why many senators are hearing loud and clear from governors and state officials opposed to this budget package.

These deep cost shifts come on top of the Senate Agriculture Committee proposal to cut $186 billion from SNAP, the largest cut to SNAP in history, which includes a new and radical proposal to shift the cost of SNAP benefits to the states for the first time, with most states forced to cover 5-15 percent of the federal funding for SNAP benefits going to families in the state (noting that these new costs could cause states to opt out of participating in SNAP completely). Deep cuts to basic needs programs including massive cost shifts to states can have ripple effects and far-reaching unintended consequences. For example, this past week Gov. Abbott of Texas vetoed funding for summer feeding programs because of fears and uncertainty around the additional cost-burden due to this budget package (for more, see: FRAC Warns Cuts to SNAP Will Negatively Impact Child Nutrition Programs). State investments in other basic needs programs – K-12 education, mental health and substance abuse services, child welfare, public safety, and much more – could be on the chopping block, as states grapple with choosing which vital services to cut. We also want to note that cuts to Medicaid and SNAP could mean 7.5 million children lose access to school meals and families with young children lose access to WIC.

We know that the cuts and paperwork requirements proposed will deny health care to people who need it. CHN strongly opposes penalizing people facing job losses by taking away Medicaid through harsh work reporting requirements that ensnarl people in bureaucratic red tape — taking away Medicaid’s health services does not help people find jobs and instead makes it more difficult for people to find work, especially in a tough economy. In addition, people with conditions like severe pain, fatigue, or mental illness may not qualify as ‘disabled enough’ to be exempted from these new work requirements. The Senate goes farther than the House by removing the exemption for parents of children over age 14 to document their work. This broadened scope will result in anywhere from 160,000 to 380,000 additional Medicaid enrollees losing their coverage due to red tape – part of the millions losing coverage in every state because of “job loss penalties.” We want to underscore that the red-tape denials that will occur because of work reporting rules will ensnare many people who are actually eligible:  people who are working or who are exempt because of disability or having a young child, but do not manage to supply documentation.  Evidence shows that millions of eligible Medicaid participants, including children and people with disabilities, could lose coverage with complicated and frequent eligibility checks along with other paperwork requirements.  A recent analysis by Kaiser Family Foundation found that nearly 70% of people who lost Medicaid between April 2023 and September 2024 were terminated for procedural reasons alone—most often due to missed paperwork. Additionally, research from the HHS Assistant Secretary for Planning and Evaluation shows that, based on pre-pandemic data, 72% of children dropped from Medicaid during redeterminations were actually eligible for coverage.

As CHN member Justice in Aging wrote for our blog (Broken Promises: Budget Reconciliation Bill Would Cut Medicare), nearly 1.4 million low-income people with Medicare—more than 10% of the dually eligible population—would lose critical cost-sharing assistance that covers Medicare’s $185/month Part B premium and helps them afford needed care. People who would lose this financial assistance are already living on limited incomes. Their dollars would be stretched even further, forcing some to choose between paying for health care and other basic needs like food and rent and increasing risk of evictions.

The large loss of health coverage comes from massive cuts to Medicaid combined with failing to extend expiring Affordable Care Act marketplace premium credits. We also oppose ending ACA and Medicare eligibility for many lawfully present, taxpaying immigrants, as proposed in this bill. We all want a more efficient government. But cutting the heart out of basic needs programs including SNAP and Medicaid doesn’t eliminate fraud — it creates bigger problems down the road, shifting the burden to service providers, local governments, and taxpayers, and will lead to higher costs and more strain on American taxpayers.

Breaking a longstanding bipartisan tradition, the Senate budget proposal bars lawfully present refugees, asylees, victims of trafficking and domestic violence, and others from receiving Medicaid along with Medicare, ACA marketplace coverage, and the Children’s Health Insurance Program (CHIP), breaking with guidelines in place dating from 1996. Current policy limits eligibility for Medicaid to “qualified immigrants” as defined under PRWORA.  Adults who are qualified immigrants are generally subject to a five-year waiting period before they can access health coverage, but the five-year bar does not apply to children, refugees, survivors of domestic violence or trafficking, and certain other humanitarian immigrants. The House bill includes extremely harsh new eligibility restrictions to Medicare and Affordable Care Act (ACA) subsidies that will leave more than 1.3 million lawfully present people in our nation uninsured, and the Senate plan incorporates the House bill’s restrictions and adds them to Medicaid and Children’s Health Insurance Program (CHIP) — taking away federal funding for these programs if states use them to cover people in the newly excluded immigration categories.  Because people without a documented status are already ineligible for these federally-funded supports, the federal savings come from taking help away from people here lawfully. All other immigrants, including humanitarian immigrants, would be ineligible – and this move to take health care away from legal immigrants will reduce health outcomes for their families, which often include U.S. citizen children. The latest guidance from the Senate Parliamentarian appears to allow this proposal to be included in reconciliation. That does not change the reality that it breaks a decades-long promise to cover a limited group of people here lawfully, with costs that will be far-reaching for most states.

Recent polling shows widespread opposition to cutting Medicaid along with other basic needs programs, with 4 out of 5 registered voters including nearly 60% of Republicans, 88% of Independents, and 92% of Democrats opposing cuts to Medicaid and SNAP.

Many of the millions of families who will lose health coverage will also lose access to SNAP or face higher grocery costs given the reduction in their family’s benefits. Approximately 1 in 3 children nationwide, living in communities across the country, would not receive the expanded Child Tax Credit (CTC) because their families make TOO LITTLE money―an average of $23,000 a year – and over 2.6 million citizen children (see data on how many children from your state) along with 1.3 million children with Individual Tax Identification Numbers lose out on the CTC altogether.

The Senate bill reduces the amount of funding available to the Consumer Financial Protection Bureau (CFPB). Without adequate funding for the CFPB to ensure the agency can protect consumers by stopping unfair, deceptive, and abusive practices and enforcing consumer protection and civil rights laws, more families could struggle to make ends meet. And many families will grapple with higher energy costs, which will disproportionately hurt people with low incomes, with rollbacks in IRA clean energy programs.

These cuts to Medicaid and other basic needs programs will be used partly to fund seizures of people without due process, and will fund family separation, border enforcement, detention, and deportation of immigrants, many of whom have legal status the Trump Administration is now attempting to overturn. These new policies are wasteful, inhumane, and destructive to our communities and economy. Unprecedented levels of funding for immigration enforcement, which, in conjunction with the rescinding of the sensitive locations guidance, will allow more ICE raids at hospitals, homeless shelters, food pantries and other social service locations, and will cause immigrants to fear participating in society. One in four children in the U.S. has an immigrant parent and immigrants paid $651 billion in taxes. Immigrants work disproportionately in in-demand industries, such as agriculture, construction, and long-term care. These attacks harm the country’s badly needed workforce – and our overall economy and society.

We note that millions of people with low incomes will lose access to basic needs programs all to give $4.45 trillion in tax breaks that primarily benefit the wealthy and corporations – with the size of these unfair tax provisions meaning the Senate package adds about $3.3 trillion to the federal deficit vs. $2.4 trillion in the House bill. Just two examples: the cost of exempting even more multi-million-dollar estates from the estate tax is estimated at $200 billion, and another over-the-top windfall allows corporations to deduct their research and experimentation expenses immediately and to take a retroactive break back to 2022, at a cost of $141 billion over 10 years. These benefits to the rich and corporations are most of the cost of imposing “job loss penalties” (otherwise known as work requirements) on Medicaid participants in order to continue their health coverage. We cannot keep allowing the passage of these unfair tax policies that disproportionately benefit the wealthy while making low-income and vulnerable communities suffer, including by taking food assistance and health care away from millions.

Many families are being squeezed by rising prices — and this gets worse if we unexpectedly fall on tough times. We know that the cuts and even harsher paperwork requirements will deny health care and other basic needs to people who need it – including those who are eligible for these programs. We are deeply concerned that the combination of uncertainty over tariffs and deep cuts to food assistance and health care will increase the number of families struggling to make ends meet, who will face the loss of jobs, rising prices, and signs of economic downturn.

When families suffer economic reverses, smart, targeted support can keep people in their homes, children fed and in school, disabled veterans cared for, and workers on the job. We all want a more efficient government. But cutting the heart out of basic needs programs including SNAP and Medicaid doesn’t eliminate fraud — it denies help and creates bigger problems down the road, shifting the burden to service providers, local governments, and taxpayers, and will lead to higher costs and more strain on American taxpayers.

In summary, families and communities will feel the compounding impact of cuts to SNAP, Medicaid, and other health assistance along with other basic needs programs – making the combined budget package even more reckless.  That’s not good for our society or economy. Now more than ever, it’s critical that the Senate acts to protect health care, nutrition, and other essential services that help millions of families meet their basic needs. We should strengthen support for these programs — not take them away.

It is not too late to change course. We lament the rushed nature of deliberation on this mammoth budget proposal – and the dangers of fast-tracking huge budget legislation without time for Senators and their staff to understand how extreme and damaging structural program changes and historic cuts to Medicaid and the Affordable Care Act will inflict unprecedented harms.  We strongly urge you to reject the Senate budget package based on these extreme and harmful health provisions, as well as its other destructive cuts and inequitable tax policies, oppose amendments that will make the health provisions even worse, and urge Leadership along with colleagues to instead protect and strengthen basic needs programs.

Sincerely yours,

Deborah Weinstein,
Executive Director