After Rep. Juan Ciscomani voted for President Donald Trump’s Big Beautiful Bill, critics accused the congressman of going back on a promise to protect Medicaid for vulnerable constituents.
The bill narrowly passed through the U.S. House of Representatives in the early hours of May 22 on a 215-214 vote.
The broad tax and spending legislation would reduce federal Medicaid spending by around $700 billion and result in at least 8.6 million people losing coverage over a decade, according to an analysis by the nonpartisan Congressional Budget Office.
It does that by implementing new work requirements for “able-bodied adults” who use the public health care system for low-income, elderly and disabled people, according to NPR. The bill would also introduce new rules requiring Medicaid users to re-enroll twice per year and provide other income and residency verifications.
Ciscomani joined most of Arizona’s Republican delegation in voting for the bill, despite signing a letter earlier this year urging House Speaker Mike Johnson to back Medicaid reforms that wouldn’t reduce coverage for “vulnerable populations.”
“We support targeted reforms to improve program integrity, reduce improper payments, and modernize delivery systems to fix flaws in the program that divert resources away from children, seniors, individuals with disabilities, and pregnant women — those who the program was intended to help,” according to the letter. “However, we cannot and will not support a final reconciliation bill that includes any reduction in Medicaid coverage for vulnerable populations.”
Ciscomani defended his decision after the vote, echoing Republican claims that the changes are needed to combat Medicaid waste and fraud.
“It also strengthens and protects Medicaid for those who rely on it by tackling waste, fraud, and abuse through sensible work requirements and stronger eligibility verification,” Ciscomani said in a statement.
Democratic representatives, including Congressman Greg Stanton, disagreed.
“House Republicans have spent months lying and hiding from their own plan, but here’s the truth: This bill makes the largest cuts to Medicaid in history, kicking 300,000 Arizonans off their health insurance and raising prices for the rest,” Stanton said in a statement.
Will Humble, executive director of the Arizona Public Health Association, said some of the bill’s requirements could result in people losing Medicaid coverage even if they are working.
That’s because the added layer of bureaucracy will likely result in some people failing to file the proper paperwork proving they are meeting those requirements.
“And so, like, it basically throws people off, not because they're not working, and not because they're not actually meeting the requirements, but because they're not able or know how to tell their Medicaid agency how they're meeting the requirements,” said Humble, a former director of the Arizona Department of Health Services.
Humble said that requiring Medicaid users to re-enroll every six months instead of once per year could have a similar impact.
“Number two is doubling the number of eligibility moments, so we'd go from once a year to twice a year, which gives people more chances to lose their eligibility because they didn't fill out the forms right,” he said.
Democrats also criticized Republicans, because the bill would actually add to the federal deficit despite cuts to programs like Medicaid and federal food assistance programs. According to a Congressional Budget Office analysis, changes in the bill, including extending Trump’s 2017 tax cuts, would increase the deficit by $3.8 trillion.
Congressman David Schweikert was the only member of Arizona’s Republican delegation not to vote for the bill, though he says he supported it. Schweikert said he missed the vote because he fell asleep in his office.
