In Washington, Republicans are currently grappling with significant internal divisions regarding Medicaid as they work on a crucial element of their extensive legislative agenda aimed at fulfilling President Donald Trump's priorities. The House Speaker, Mike Johnson, R-La., is under pressure from various factions within his slim majority. On one side, swing-district Republicans are expressing concerns over potential substantial cuts to Medicaid, fearing the political backlash, while on the other side, conservative hard-liners are insisting that any bill must include $2 trillion in cuts to secure their support.
The House Energy and Commerce Committee convened privately on Wednesday to address these discrepancies and is set to meet again on Thursday. This committee has the critical responsibility of identifying $880 billion in savings, predominantly from Medicaid, as indicated by the nonpartisan Congressional Budget Office (CBO). The committee's work has already led to delays in releasing legislative text and scheduling a hearing on the proposed bill.
Despite some optimism voiced by GOP lawmakers following Wednesday's discussions, significant disagreements remain among party leadership regarding the future direction of the bill. Notably, Johnson hinted earlier in the week that two proposed Medicaid cuts—lowering the federal match (Federal Medical Assistance Percentage, or FMAP) for states regarding enrollees added under the Affordable Care Act, and implementing per capita caps on spending—might be excluded from the final proposal. However, after the latest committee meeting, Chair Brett Guthrie, R-Ky., expressed uncertainty, suggesting that per capita caps might still be an option.
Centrist Republican Rep. Don Bacon of Nebraska, who represents a swing district that Trump lost in the previous election, stated that if the changes to FMAP and per-person spending limits are included in the bill, it would likely fail. He voiced skepticism about the bill's chances in both the House and Senate, given the current political climate. With the House majority standing at 220-213, Johnson can only afford to lose three Republican votes before the bill risks failure.
A coalition of 32 Republican lawmakers sent a letter to Johnson, asserting that the reconciliation bill must incorporate at least $2 trillion in verifiable savings, whether through spending reductions or scaling back the size of the tax package. The letter emphasized the necessity for genuine, enforceable spending cuts rather than utilizing budgetary gimmicks to meet deficit reduction targets. This letter was spearheaded by Rep. Lloyd Smucker, R-Pa.
Rep. Scott Perry, R-Pa., a former chair of the far-right House Freedom Caucus, emphasized that he would not support any bill that contributes to the national deficit, underscoring the challenge Johnson faces in uniting the party around a cohesive plan.
As discussions continue, a key point of contention arises around the definition of a benefit cut. Sen. Bernie Moreno, R-Ohio, firmly stated that no cuts to Medicaid benefits for American citizens would be included in the bill. He insisted that this message should be clear in media coverage surrounding the legislation. However, the interpretation of what constitutes a benefit cut varies among Republicans.
Some members argue that any reduction in benefits for current Medicaid recipients or restrictions on access equates to a benefit cut. Sen. Josh Hawley, R-Mo., warned that changes such as lowering the federal match and imposing per capita caps could indeed result in benefit cuts, leading to difficult choices for states regarding program funding. Conversely, fiscal hawks within the party contend that overall Medicaid spending will likely increase in the long term, despite these restrictions, arguing that such measures should not be classified as cuts.
While there is a general agreement among Republicans on certain restrictions to Medicaid, such as work requirements for able-bodied adults, citizenship verification, and more frequent eligibility checks, these measures are expected to yield limited savings. GOP lawmakers are at an impasse over policies that would generate more substantial savings without adversely affecting benefits.
Rep. Kat Cammack, R-Fla., emphasized the importance of ensuring that only eligible individuals remain on Medicaid, arguing that this approach would help maintain program integrity by preventing fraud and waste.
As these debates unfold, Democrats are intensifying their opposition to potential Medicaid cuts. Outside the Capitol, they organized a "24-hour vigil for Medicaid," raising alarms about the severe consequences for vulnerable populations, particularly older adults, should the program face drastic changes. A recent CBO report analyzed various Republican proposals, revealing that lowering the FMAP and implementing per capita caps could save hundreds of billions of dollars but might also result in millions of Americans losing their Medicaid coverage.
Democrats have seized upon these findings, with Justin Chermol, a spokesperson for the Democrats’ House campaign arm, criticizing Republicans for their approach and claiming their words lack sincerity when it comes to protecting Medicaid.
As pressure mounts from both sides, the outcome of this legislative battle over Medicaid will have significant implications for millions of Americans and the future of healthcare policy in the United States.
