Medicaid is not a safety net for a narrow slice of the population. It is the primary source of coverage for nearly half of all births in the United States, for millions of women in rural communities without employer-sponsored insurance, and for low-income women who rely on it for contraception, cancer screenings, prenatal care, and postpartum follow-up. Any serious analysis of proposed Medicaid cuts must start there.
What H.R. 1 Proposes
The reconciliation bill passed by the House in 2025 includes significant structural changes to Medicaid financing — among them work requirements, per capita caps, and restrictions on state directed payments. Each of these mechanisms, individually and in combination, would reduce federal Medicaid spending. The nonpartisan Congressional Budget Office estimated that the package would result in millions losing coverage over the next decade.
For women specifically, the consequences would be concentrated and severe.
The Postpartum Coverage Gap
One of the most significant recent expansions of Medicaid was the option for states to extend postpartum coverage from 60 days to 12 months following birth. This change, enabled by the American Rescue Plan, was designed to address the fact that pregnancy-related deaths disproportionately occur in the weeks and months after delivery — a period when millions of women previously lost coverage.
As of this writing, not all states have adopted the 12-month extension. Federal funding cuts would put even existing extensions at risk and further reduce state capacity to finance the longer coverage window.
Work Requirements: What the Evidence Shows
Proponents of Medicaid work requirements argue that they encourage self-sufficiency. The evidence does not support this claim. When Arkansas implemented work requirements in 2018, studies found no measurable increase in employment — but did find a significant increase in the number of people losing coverage. Many who lost coverage were already working, in school, or serving as caregivers — activities that qualifying rules did not recognize.
For women disproportionately engaged in unpaid caregiving work, the structure of work requirements is not neutral. It reflects a set of assumptions about what labor counts and whose circumstances are legible to the administrative state.
The Rural Dimension
Rural women face compounding coverage challenges: fewer providers accept Medicaid, distances to care are greater, and hospital closures have eliminated obstetric units across dozens of rural communities. Medicaid financing reductions that cut payments to rural providers — already operating on thin margins — would accelerate the collapse of access in precisely the places where alternatives do not exist.
This is not a projection. It is a pattern already visible in states that have pursued aggressive Medicaid cost-containment strategies.
What Advocates Are Saying
The Society for Women’s Health Research, the American College of Obstetricians and Gynecologists, and a broad coalition of maternal health organizations have issued statements opposing the Medicaid provisions in H.R. 1. Their argument is not simply that cuts are harmful in the abstract — it is that the specific populations most dependent on Medicaid for reproductive, maternal, and preventive care are the populations least able to absorb a coverage disruption.
The policy choice being made, if these provisions become law, is a choice about which women’s health outcomes we are willing to accept as preventable but not prevented.
