The budget resolution that passed the US House by two votes last night is a long way from becoming law. It still has to be reconciled with the Senate’s bill, then go back through the House, and given how narrow last night’s margin was, there’s a good possibility the bill won’t get through both wings of Congress in current form. But last night’s passage was a major step toward enactment—and that’s causing major concern among amputee-serving organizations such as the Amputee Coalition, as well as doctors, prosthetists, and other medical professsionals who deliver healthcare for amputees.
They fear the budget approved last night will require deep cuts in Medicaid funding, leaving many amputees with diminished access to healthcare—or no access at all.
“Access to Medicaid is a matter of life, death, and independence for millions of Americans with disabilities,” wrote a consortium of 400+ patient organizations (including the AC) in a letter sent last week to Congressional leaders. “We strongly oppose per capita caps, block grants, work requirements, restrictions on eligibility, barriers to enrollment and any other cuts or harmful changes to the Medicaid program. The result is the same: taking away coverage from people with disabilities, older adults, and others who cannot otherwise afford health care and long-term services and supports.”
AARP and the American Association of People With Disabilities joined 100+ organizations in a similar letter of concern, warning that “cuts to Medicaid would cause millions of Americans to lose access to care, destabilize rural hospitals and wreak havoc on state budgets.” The American Orthotic and Prosthetic Association, while declining to take a position either opposing or supporting the budget bill, did advise prosthetists that ”if states have Medicaid programs reduced, programmatic cuts are likely and may reduce benefits for O&P care.”
House speaker Mike Johnson and other Congressional leaders insist that the budget won’t force a reduction in Medicaid services, but will merely eliminate fraud, waste, and abuse. But that math doesn’t add up, even for some members of Johnson’s own caucus, who’ve expressed concerns both to Johnson and to the White House that the current bill will negatively affect their constituents—and cause a voter backlash in 2026.
Despite their misgivings, those representatives voted “aye” last night anyway after intense lobbying. But since the legislation hasn’t crossed the finish line yet, there’s still a chance to alter the text and strengthen the protections for Medicaid funding. If you have concerns, contact your federal representatives. We’d like to hear from you as well, so email us at editor@livingwithamplitude.com if you’re worried that Medicaid cuts will affect you personally.
If Medicaid does experience significant funding cuts, here’s what the impact might look like—and why so many people are sounding the alarm.
1. Medicaid cuts will probably increase amputation rates
According to multiple studies, Medicaid funding increases provided under the Affordable Care Act led to a reduction in diabetes-related limb loss. It’s logical to infer that Medicaid cuts would have the opposite effect, ie an increase in amputations. One paper, published in 2020 by diabetic foot expert David Armstrong, found that patients “in states that expanded Medicaid experienced a significant reduction in the number of uninsured with [diabetic foot ulcers] and a reduction in major amputations.” A 2022 study published in the Journal of the American Medical Association reached an almost identical concluson: “Medicaid expansion was associated with decreased major amputation and hospitalization rates,” especially among minority patients. Researchers at the University of Pittsburgh found that Medicaid expansion enabled more people with peripheral artery disease to receive vascular bypass surgery; a paper published last fall in the journal Diabetology found that “Medicaid coverage of podiatry services might be associated with lower rates of major amputation and reduced risk of hospitalization for foot infection.”
To reiterate: None of these findings conclusively proves that Medicaid funding cuts will lead to increased amputation rates. But they do help explain why healthcare providers, patients, and amputee advocacy organizations are so deeply concerned about last night’s House vote.
2. Medicaid cuts will disproportionately affect amputees
According to the last fall’s General Accounting Office report on amputees’ access to prosthetic devices, rehabilitation services, and other forms of long-term care, amputees’ rates of eligibility for Medicaid were more than twice the national average. Nearly 40 percent of the amputees in that study’s cohort (which was limited to Medicare recipients) qualified for Medicaid.
Those stats are consistent with other findings that examine Medicaid reliance among people with any disability, not just limb loss. In a survey of Medicaid recipients published last year by the Robert Wood Johnson Foundation, one-third of respondents reported having some kind of disability. Only 11 percent of those people qualified for Medicaid because of their disability; the rest were eligible because of low income or another factor. Medicaid’s own beneficiary profile from 2023 noted that people with disabilities account for one-third of the program’s overall spending.
3. Some amputees may be required to work to qualify for Medicaid
In 2023 the House of Representatives (then led by Kevin McCarthy) passed a bill requiring some Medicaid enrollees to find a job in order to remain eligible for coverage. The bill never became law, but the same Medicaid work requirements are among many cost-cutting proposals that the current Congress is considering. In an analysis of the 2023 law, the Kaiser Family Foundation estimated that work requirements would force about 1.7 million people off the Medicaid rolls. The Congressional Budget Office came in with a slightly lower estimate of 1.5 million.
In an earlier analysis (2022), the CBO found that work requirements for Medicaid “would substantially increase the amount that people who lost Medicaid coverage would pay out of pocket for medical services.” The CBO cited disability as one of the primary barriers to work for Medicaid recipients. And Kaiser raised an important caveat last week, noting: “While proponents of Medicaid work requirements often describe these policies as applying to ‘able-bodied’ adults, people with disabilities may be subject to the requirements—as many people with disabilities do not meet criteria to receive Supplemental Security Income (SSI) and therefore qualify for Medicaid based on income (vs. disability status).”
4. People might lose Medicaid eligibility due to confusing paperwork
Both the CBO and Kaiser studied state-level work requirements that were implemented in Arkansas (2018) and Georgia (currently). In Arkansas, about 20,000 Medicaid recipients who were already working, and therefore should have remained eligible, lost their coverage anyway because they didn’t properly file the paperwork documenting their work status. A Medicaid investigation found that such compliance requirements were most burdensome for the most vulnerable Medicare recipients, including people with disabilities.
In addition, both Arkansas and Georgia tried to exempt people with disabilities from the work requirement. However, claiming the exemption required paperwork that was so confusing and onerous that fewer than one-fourth of those eligible for the exemption actually claimed it. “Although Arkansas’s program included safeguards intended to protect coverage for people with disabilities,” Kaiser noted, “few people used these safeguard measures.”
