Miller-Meeks could provide decisive vote on Republican Medicaid cuts

US Rep. Mariannette Miller-Meeks will be a decisive vote in House Republicans’ plan to make massive cuts to Medicaid. Estimates say the cut could leave 8.6 million Americans uninsured by 2034.

House Republicans are working on a controversial budget bill that includes sweeping changes to Medicaid, the health insurance program that one in four Americans rely on. On Tuesday, three major House committees will “markup” or consider the bills including the House Energy and Commerce Committee, which US Rep. Mariannette Miller-Meeks of Iowa sits on. 

Miller-Meeks has a challenging electoral road ahead if she decides to seek reelection. And Speaker Mike Johnson is asking her to sign off on what Democrats are calling “the largest Medicaid cut in American history.” The package is central to President Donald Trump’s domestic agenda, combining extensions of his 2017 tax cuts — which primarily benefited corporations and the wealthiest Americans — with significant spending reductions to programs like Medicaid and SNAP food assistance.

“The things that we’re looking at in Medicaid are trying to reach consensus so that they affect the least number of people,” Miller-Meeks told the Daily Iowan.

The Congressional Budget Office (CBO), a nonpartisan federal agency that provides budget and economic analysis to Congress, projects that the current Republican plan would likely lead to 8.6 million people becoming uninsured by 2034. The CBO estimates the proposals would reduce the deficit by $912 billion between 2025 and 2034, with at least $715 billion of the proposed savings would come from cuts to healthcare.

The legislation includes new work requirements for able-bodied adults, increased eligibility verification, and bars federal funding for several services, including those for immigrants without citizenship verification. 

Despite promises from Speaker Mike Johnson and top Republicans that they won’t cut benefits, a Congressional Budget Office analysis released in March made clear that Medicaid is the only viable source for the cuts that conservative Republicans are demanding.

What’s in the bill

The 160-page health section released by Energy and Commerce Chairman Brett Guthrie of Kentucky, a Republican, includes several major changes to Medicaid:

Work Requirements – Able-bodied adults must complete at least 80 hours per month of work, education, or service to remain eligible.

Increased Bureaucracy – Enrollees would need to confirm their eligibility twice a year rather than once, which is likely to increase churn and lead eligible people to lose coverage for administrative and not eligibility reasons.

Funding Cuts – The bill would eliminate the 5% federal funding boost implemented during COVID-19.

Coverage Restrictions – The proposal bars federal funding that states use to provide services to immigrants who have not shown proof of citizenship, and includes language barring groups and nonprofits offering reproductive services and abortions from receiving Medicaid funds.

The bill also bans federal Medicaid funding for gender transition procedures for individuals under 18 years of age, which are rare.

Miller-Meeks walks a tightrope over cuts

As Miller-Meeks prepares for the vote, the timing couldn’t be more challenging. She has faced two historically close elections and in 2026 is expected to have another close race, one that Democrats are targeting.

“Mariannette Miller-Meeks is getting ready to once again vote to raise costs and gut Medicaid. After months of gaslighting, HMP will make sure IA-01 voters know exactly who is responsible for these devastating cuts,” said Katarina Flicker, a spokesperson for House Majority PAC, a spending group aligned with House Democratic leaders.

Earlier this year, 12 House Republicans in battleground districts sent a letter to leadership stating they “cannot and will not support a final reconciliation bill that includes any reduction in Medicaid coverage for vulnerable populations”. Miller-Meeks did not sign on to the letter.

As the markup process begins Tuesday, the fundamental tension remains: Republicans have promised to protect Medicaid benefits while simultaneously needing to extract hundreds of billions in cuts to pay for their tax bill. How Miller-Meeks resolves this contradiction will determine not just the fate of the reconciliation bill, but potentially the political fortunes of vulnerable Republicans heading into the 2026 midterm elections.