Secretary of Health and Human Services Robert F. Kennedy Jr. testified before congressional budget committees on April 23, 2026, to defend the administration’s healthcare spending priorities. During the hearings, Kennedy repeatedly challenged assertions from lawmakers that the 2025 tax and spending legislation signed by President Donald Trump resulted in significant cuts to Medicaid. The Secretary maintained that the program is slated for a 47% increase in total spending over the next ten years, characterizing the debate as a disagreement over accounting methods rather than a reduction in actual care.
The controversy centers on the fiscal impact of the 2025 tax and spending law, which introduced structural reforms to the Medicaid program. These changes include the implementation of federal work requirements for able-bodied adults and revised eligibility criteria for state-level participation. According to nonpartisan budget analysts and the Congressional Budget Office, these reforms are projected to reduce Medicaid’s federal spending baseline by approximately $1 trillion over the coming decade compared to previous legislative trajectories.
Kennedy’s testimony on Thursday focused on nominal spending figures. He argued that because the total dollar amount allocated to Medicaid is projected to rise annually, the administration’s policies cannot be classified as a cut. "There are no cuts to Medicaid," Kennedy stated during a heated exchange with Democratic committee members. "We are increasing Medicaid spending by 47% over the next 10 years. That is only a cut in Washington, D.C." This 47% figure refers to the projected growth in costs driven by an aging population and rising medical inflation, which analysts argue would have occurred regardless of the new policy changes.
Democratic lawmakers and healthcare advocates raised concerns during the hearing regarding the impact of these fiscal adjustments on rural healthcare infrastructure. They cited internal reports suggesting that the $1 trillion reduction in projected spending could lead to the closure of rural hospitals that rely heavily on Medicaid reimbursements. Furthermore, the eligibility changes are expected to result in millions of Americans losing coverage, a point that Kennedy countered by emphasizing the administration's focus on economic self-sufficiency through work mandates.
The 2025 legislation represents a significant shift in federal fiscal policy, aiming to offset revenue losses from sweeping tax cuts enacted earlier in the Trump administration. By tightening Medicaid eligibility, the administration seeks to reduce the federal deficit while shifting more administrative responsibility to individual states. This policy has created a divide between the executive branch and healthcare analysts, who maintain that failing to meet projected baseline needs constitutes a functional reduction in the social safety net. Analysts noted that the 47% increase cited by Kennedy is actually lower than the 60% growth rate projected prior to the 2025 legislative changes, confirming a net reduction in the program's long-term funding trajectory.