With Medicaid spending cuts looming, where do Kentucky’s congressmen stand?
What form the requested $880 billion in cuts to federal health care spending over 10 years will take isn’t yet clear.
But Kentucky’s members of congress are in the middle of it as the U.S. House continues to mull a reconciliation budget bill.
The 5th Congressional District in Eastern Kentucky, represented by Hal Rogers, is among the most Medicaid-reliant districts in the country.
Rep. Brett Guthrie, the newly anointed chair of the powerful House Energy and Commerce Committee from Kentucky’s 2nd District, is the one tasked by House Republican leadership with figuring out how to enact those cuts in his chair role.
Medicaid is a government-funded health insurance program that provides free or low-cost healthcare to individuals and families whose take home pay is below a certain threshold.
About one-third of all Kentuckians — and four in nine Kentucky children — are Medicaid recipients. More children are covered by federal-funded sources because the threshold for Medicaid to cover a child has a higher income eligibility threshold and the threshold for the Children’s Health Insurance Program is even higher. About 1.4 million Kentuckians are covered in total.
Medicare is the government-funded health insurance program for people aged 65 or older. Medicaid and Medicare make up about three-quarters of total federal health care spending.
The discussions in Washington have ebbed and flowed, and may continue to do so before the Memorial Day deadline House Speaker Mike Johnson has set to pass the bill out of his chamber.
At first, lowering the federal share of certain Medicaid costs and instituting per capita caps on the Medicaid expansion population under the Affordable Care Act, which Kentucky has utilized for years, were on the table. Tuesday night, Johnson ruled those out, narrowing the set of actions the House can take to the chagrin of certain fiscal hardliners like the House Freedom Caucus.
Now the focus has shifted toward work requirements for able-bodied adults, more frequent eligibility checks and cutting off avenues for undocumented immigrants to access Medicaid coverage, according to Punchbowl News.
The dispatches from Washington paint a thorny picture of how the House GOP might push through such cuts and get to $880 billion over 10 years.
One GOP congressman from New York told POLITICO last week that Republicans could rack up $370 billion savings by adding work requirements, kicking noncitizens off rolls and implementing more frequent eligibility checks. The Congressional Budget Office has said the desired reduction could not take place without cutting Medicaid, Medicare or the Children’s Health Insurance Program in some way.
A dozen of the House’s 220 Republicans penned a letter last month stating they won’t support “any reduction in Medicaid coverage for vulnerable populations.” None of those members hail from Kentucky.
In the slim seven-member majority, those votes would be needed for a budget bill to pass.
Rep. Morgan McGarvey: Strongly opposed
The state’s lone Democrat in Congress, Louisville-based 3rd Congressional District Rep. Morgan McGarvey, is clear on the issue: he’s against the cuts, pointing out that around one-third of Kentuckians rely on Medicaid.
“I strongly oppose the Republican budget that would cut Medicaid by up to $880 billion… Trump and Republicans in Congress don’t care — they want to take health care away from veterans, people with disabilities, and our most vulnerable kids. It’s wrong, and I am fighting back,” McGarvey said in a statement.
McGarvey’s district, which is entirely within the bounds of Jefferson County, is about 27% enrolled in Medicaid according to KFF, a nonpartisan health policy group.
Rep. Hal Rogers’ Medicaid-reliant district
Republican responses vary between zealous support, mild optimism and an assurance that, no, benefits will not be cut for “people who need them.”
Rogers, whose Eastern and Southern Kentucky district is 54% enrolled in Medicaid, is playing defense so far.
“I want to set the record straight on the fear tactics that have people worried about their benefits being taken from them,” Rogers said in a statement. “Nearly half of the people living in my congressional district are recipients of Medicaid benefits, so I have no intention of cutting benefits for the people who need them.
“In fact, I want to protect our benefit programs for years to come, and the best way we can do that is to remove the waste, fraud and abuse of Medicaid, Medicare and Social Security.”
Out of all 435 House districts in the country, Rogers’ district has the 11th-most people on Medicaid. Excluding children covered by Medicaid, it has the most of any district in the country, according to KFF.
Rogers also mentioned the roughly $101 billion in “improper payments” via Medicaid and Medicare that the U.S. Government Accountability Offices estimates were made last year.
“Those mandatory programs make up two-thirds of our entire federal budget, so we can’t afford for those programs to bleed out vital taxpayer dollars that are desperately needed for our most vulnerable Americans. I’m here to protect those programs for people who really need them, and we can’t do that without getting rid of the waste, fraud and abuse.”
Rep. Andy Barr & Sen. Mitch McConnell
Rep. Andy Barr’s Central Kentucky-based 6th Congressional District has about 26% of its residents enrolled in Medicaid. A spokesperson for the office expressed strong support for the Republicans’ plans, framing the cuts over the next 10 years as an effort to “reform and save Medicaid for the people who need it.”
“Only in Washington can reductions in proposed spending increases be called cuts. We must reform and save Medicaid to preserve it for the people who need it. Andy Barr and President Trump are focused on expanding tax relief for families, small businesses, and seniors,” the spokesperson wrote.
Barr is currently running to replace Sen. Mitch McConnell, who after decades of service announced he would not run again for his seat in 2026. Former attorney general Daniel Cameron is also running for the GOP nomination, and both men are courting the coveted Trump endorsement.
McConnell struck a similar chord. He tipped his hat to Guthrie, who has led several tense, late-night meetings as the shepherd of these cuts.
“We should all be against waste, fraud, and abuse,” McConnell said in a statement. “As Congress continues work to ensure Kentucky’s providers can continue to provide essential care in a challenging environment, and that there are safety nets in place for people who actually need it, I appreciate Chairman Guthrie for his work to deliver on the president’s agenda by ensuring federal health care programs are working efficiently while protecting access to health care.”
Spokespeople for Guthrie, Rep. Thomas Massie, Rep. James Comer and Sen. Rand Paul did not respond to Herald-Leader inquiries on where they stood on the potential health care spending cuts.
Kentucky reaction
Democratic Gov. Andy Beshear has toed the same line as McGarvey, harshly criticizing the proposed $880 billion cut.
“Half of Kentucky’s kids are covered by Medicaid. Gutting Medicaid would impact families in a substantial way. It would devastate and potentially end rural health care, (which) cannot survive without Medicaid,” Beshear said.
But Kentucky’s Republican legislative leaders, the ones tasked with enacting the state budget every two years, aren’t worried. House Speaker David Osborne, R-Prospect, said he was hopeful in discussions with Guthrie that nothing would be “dropped on” the state without significant runway.
“Because of the reserves that we have, we have the ability to react,” Osborne said. “But obviously, the more time that we have, and depending upon the structure in which they send down to us, it’s going to make a vast difference in how we construct a budget this next year.”
Correction: A previous version of this story incorrectly stated a New York congressman’s claim on how much savings would result from adding work requirements, kicking noncitizens off rolls and implementing more frequent eligibility checks for Medicaid. That mark is actually $370 billion.
This story was originally published May 8, 2025 at 5:00 AM.
