What we know and don't know about potential changes

No president can straightforward eliminate Medicare or Medicaid by executive order. Both programs are created by federal law, and changing or ending them would require Congress to pass new legislation and the president to sign it. That said, administrations do have power to reshape how these programs work through regulation, funding decisions, and how they enforce existing rules.

Political proposals about Medicare and Medicaid change with each election cycle and each Congress. Rather than predict what will or won't happen, it's more useful to understand what tools exist to change these programs, what changes have been proposed in the past, and what you should monitor if you rely on either program.

Key Takeaways

  • Congress, not the president alone, has the power to change or end Medicare and Medicaid through new laws.
  • Administrations can reshape programs through regulation, funding levels, and enforcement without new legislation.
  • Proposed changes to Medicare often focus on may be able to access age, cost-sharing, or how much the government pays providers.
  • Proposed changes to Medicaid often involve work requirements, may be able to access limits, or shifting costs to states.
  • If you receive either benefit, staying informed about policy proposals and contacting your representatives is the most direct way to protect your coverage.

What Congress would need to do to change these programs

Medicare was created by the Social Security Act Amendments of 1965. Medicaid was created at the same time. Both are permanent federal programs written into law. To end either program, Congress would have to pass a bill that repeals the relevant sections of the Social Security Act, and the president would have to sign it. To significantly change either program—such as raising the may be able to access age, cutting benefits, or changing who qualifies—Congress would also need to pass legislation.

This is a high bar. It requires a majority in both the House and Senate, plus a president willing to sign. If the president vetoes a bill, Congress would need a two-thirds majority in both chambers to override the veto. Because Medicare and Medicaid cover tens of millions of people, including many who vote, major changes face political obstacles even when one party controls both chambers and the presidency.

Changes an administration can make without Congress

Even without new legislation, an administration can reshape Medicare and Medicaid through regulation and enforcement. The Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) write detailed rules about how the programs operate. An administration can change these rules within the bounds of existing law.

Examples of changes that don't require Congress include: how strictly to enforce work requirements in Medicaid (where states have the option to impose them), how much flexibility to give states in designing their Medicaid programs, what documentation to require from people renewing coverage, how much to pay hospitals and doctors, and what drugs or treatments Medicare will cover. An administration can also propose changes to regulations and ask Congress to pass legislation to support them, but the regulation itself takes effect without a new law.

Funding levels also matter. Congress sets the total amount of money available to Medicare and Medicaid each year, but an administration controls how that money is spent and allocated. For example, an administration could shift resources toward certain types of care or certain regions, or could increase or decrease how aggressively it pursues fraud.

Medicare changes that have been proposed in recent years

Proposals to change Medicare come from both parties and vary widely. Some focus on reducing costs to the government, others on expanding coverage, and others on changing how beneficiaries pay for care.

Common proposals include raising the may be able to access age from 65 to 67 or higher; increasing the amount beneficiaries pay out of pocket through higher deductibles or copayments; means-testing benefits so that higher-income seniors receive smaller benefits; changing how much Medicare pays hospitals and doctors; allowing Medicare to negotiate drug prices more directly (this was included in the 2022 Inflation Reduction Act); and restructuring the program to give beneficiaries a fixed amount of money to buy coverage from private plans rather than traditional Medicare. Proposals also sometimes include changes to how long someone must have worked to may have access to, or changes to spousal and survivor benefits.

Medicaid changes that have been proposed in recent years

Medicaid is jointly funded by the federal government and the states, and states have significant flexibility in how they run their programs. This means proposals to change Medicaid often focus on giving states more or less freedom, or on changing the federal government's share of the cost.

Common proposals include adding or expanding work requirements (which some states already do); lowering the income limits for who qualifies; allowing states to impose time limits on coverage; shifting more of the cost to states; converting the federal funding to a fixed block grant rather than matching what states spend; and narrowing what services Medicaid must cover. Some proposals would allow states to charge higher copayments or premiums. Other proposals focus on expanding Medicaid to cover more people or services.

How to stay informed and protect your coverage

If you receive Medicare or Medicaid, the most practical step is to stay informed about policy proposals and to contact your elected representatives when changes are proposed that affect you. Your representatives in Congress—your two senators and your House member—have direct power over these programs.

You can find your representatives at house.gov and senate.gov. Many offices have staff dedicated to constituent services who can answer questions about how a proposed change would affect you, and who track constituent calls and letters when voting on legislation.

Reliable sources for information about proposed changes include the Kaiser Family Foundation (kff.org), which tracks Medicare and Medicaid policy; the Centers for Medicare and Medicaid Services (cms.gov), which publishes proposed regulations; and your state's Medicaid agency, which can tell you how state-specific proposals would work. Local Area Agencies on Aging can also help you understand how changes might affect you and can connect you with advocacy resources.

What to watch for if you're concerned about changes

Pay attention to news about bills introduced in Congress that would change Medicare or Medicaid may be able to access, benefits, or cost-sharing. These bills are public and searchable on Congress.gov. You can also sign up for alerts from organizations that track health policy, such as the Kaiser Family Foundation or AARP.

If a bill passes one chamber of Congress, it will receive significant media coverage. At that point, you have time to contact your representatives before a final vote. Many people find that a personal phone call or letter describing how a change would affect them is more effective than a form email, because congressional offices track the volume and tone of constituent contact.

If you receive Medicaid, also monitor your state's Medicaid program, because states can make changes within federal rules. Your state Medicaid office will notify you of major changes, but you can also check their website regularly or sign up for email updates.

Frequently Asked Questions

Can the president end Medicare or Medicaid with an executive order?

No. Both programs are created by federal law, and only Congress can repeal or significantly change them. An executive order cannot end a program that Congress created. An administration can change how the programs operate through regulation and enforcement, but cannot eliminate them without legislation.

If Congress passes a bill to change Medicare or Medicaid, how much time would I have to adjust?

That depends on what the bill changes. Major changes to may be able to access usually take effect on a specific date set in the law, often six months to a year after the bill is signed. Changes to benefits or cost-sharing may take effect sooner. Your Medicare or Medicaid office will notify you of changes that affect your coverage, usually with at least 30 days' notice, but it's wise to stay informed about proposed changes before they become law.

What if my state makes changes to Medicaid that I disagree with?

States have flexibility to design their Medicaid programs within federal rules. If your state proposes a change, you can contact your state legislators and your state Medicaid agency to voice your concerns. You can also contact your federal representatives, because Congress sets the rules that states must follow and controls federal funding. Local advocacy organizations focused on health care or aging can also help you understand your options.

How would I know if a proposed change would affect my specific coverage?

Read the bill or proposal carefully, or ask your Medicare or Medicaid office directly. You can also contact a patient advocate or a legal aid organization in your state. Many Area Agencies on Aging offer free counseling about Medicare changes. If a proposal would change your may be able to access or benefits, the bill will specify the income limits, age requirements, or services affected.

Is there a way to protect my Medicare or Medicaid coverage if I'm worried about changes?

The most direct way is to stay informed and contact your representatives when proposals are made. You can also document your current coverage—keep copies of your Medicare card, Medicaid card, and any letters about your benefits—in case you need to prove your coverage status later. If you're near the age of may be able to access for Medicare, enrolling before any changes take effect may protect your coverage under current rules.