WASHINGTON — Republicans on Capitol Hill are scrambling to resolve intense divisions over Medicaid as they hammer out a key piece of their massive bill for President Donald Trump’s agenda with hopes of advancing it through a House committee next week.
Speaker Mike Johnson, R-La., is facing new conflicting pressure from within his narrow majority: Swing-district Republicans are growing increasingly wary of significant Medicaid cuts as they face political heat, while conservative hard-liners are threatening to torpedo the bill unless it contains $2 trillion in cuts.
Republicans on the House Energy and Commerce Committee met behind closed doors Wednesday to try to resolve their differences, and will meet again Thursday. The panel is tasked with finding $880 billion in savings, most of which will have to come from Medicaid, according to the nonpartisan Congressional Budget Office, and it has already delayed releasing legislative text and holding a hearing.
While GOP lawmakers sounded upbeat as they exited Wednesday’s meeting, disagreements persisted at the highest levels about the path forward.
Most notably, Johnson told reporters on Tuesday he believed two major Medicaid cuts under discussion — lowering the federal match (the Federal Medical Assistance Percentage, or FMAP) to states for enrollees added under the Obamacare expansion, and slapping per capita caps on spending — were off the table.
But after Wednesday’s meeting, House Energy and Commerce Committee Chair Brett Guthrie, R-Ky., wasn’t so sure.
“I’ll hopefully get to talk to leadership about it a little later. My understanding — what I saw, though, was per capita caps were still kind of alive,” Guthrie told reporters. “So we’ll see.”
Rep. Don Bacon, R-Neb., a centrist who represents a swing district Trump lost last fall, said that if FMAP changes and per person spending caps are included in the bill, it will probably fail.
“I don’t think these measures will pass the House, let alone the Senate,” Bacon told NBC News on Wednesday.
The House majority is 220-213, meaning Johnson can spare just three Republican votes before the bill risks collapsing. Johnson has set a goal of passing the bill through the House by Memorial Day.
Meanwhile, a group of 32 Republicans sent a letter to Johnson on Wednesday insisting that “the reconciliation bill must include at least $2 trillion in verifiable savings either through spending reductions or scaling back the size of the tax package” in order to win their votes.
“Critically, the deficit reduction target must be met with real, enforceable spending cuts — not budget gimmicks,” the GOP lawmakers wrote in the letter, led by Rep. Lloyd Smucker, R-Pa.
Ahead of the letter’s release, Rep. Scott Perry, R-Pa., a former chair of the far-right House Freedom Caucus, said in an interview he simply won’t vote for a bill that adds to the deficit.
“I’m not worried. I got a vote, and if somebody’s gonna ask me to vote to bankrupt the country — I don’t know what that coalition is, but I’m not going to be in it,” said Perry, a rare GOP hard-liner in a competitive district who narrowly won re-election last fall.
What is a ‘benefit cut’? Republicans disagree
Sen. Bernie Moreno, R-Ohio, insisted categorically that there will be no cuts to benefits under Medicaid in the bill, which Republicans are aiming to pass on a party-line basis in both chambers.
“We’re not going to cut benefits to American citizens. That should be the headline of every news article you guys ever do. The Republicans are not going to cut benefits to American citizens,” Moreno said in an interview. “So you can talk about anything you want in the other chamber, but if it comes here with a cut of benefits, it’s not going to pass.”
But what constitutes a “benefit cut”? Republicans have different views on how that should be defined.
Some Republicans say anything that cuts benefits for those who are lawfully on Medicaid today — or restricts their access to the program — amounts to a benefit cut. Sen. Josh Hawley, R-Mo., said lowering the federal match to states and imposing per capita caps may well be benefit cuts, leaving Missouri with a choice of slashing programs, raising taxes or throwing residents off Medicaid. If so, he’d vote no.
But GOP fiscal hawks see it differently: Rep. Chip Roy, R-Texas, argued that aggregate Medicaid spending is likely to rise in the long term even if those restrictions are implemented, therefore it should not be construed as a cut.
And Perry defended the idea of reducing the federal payment to states, saying the Medicaid expansion created by the Affordable Care Act went too far.
“The policy as it currently exists incentivizes states to add people to the rolls that are decidedly not within the design of Medicaid as envisioned. Medicaid is for the poor,” Perry said. “We’re disadvantaging the poor even more for the sake of those who don’t really qualify for the program.”
Republicans broadly agree on some new limits to Medicaid, like work requirements for able-bodied adults, citizenship verification and more frequent eligibility checks. They say those provisions are about program integrity and rooting out fraud and waste.
But that saves a limited sum of money — probably not enough to meet their targets. GOP lawmakers are at loggerheads over policies that would save larger sums of money, while not affecting benefits.
“We’re making sure that anyone who is eligible remains eligible, and people who should not be on the program, aka illegals, are not on the program,” Rep. Kat Cammack, R-Fla., said after Wednesday’s Energy and Commerce Committee meeting.
Meanwhile, Democrats are turning up the political heat over Medicaid. Outside the Capitol, prominent Democrats and outside allies held what they termed a “24-hour vigil for Medicaid” as they warned of horrific consequences, including to older adults, if the program gets the ax.
A new report Wednesday by the Congressional Budget Office analyzed some of the ideas Republicans are considering. The report, requested by Democrats to score GOP ideas that have been floated, found that lowering the FMAP under Medicaid and slapping on per capita caps would save hundreds of billions of dollars, while removing millions of Americans from Medicaid.
“No more bulls— letters or cable TV appearances from the fake moderates. If they really wanted to save Medicaid, they had the opportunity to vote ‘no’ on their extreme budget — twice — but refused,” said Justin Chermol, a spokesman for the Democrats’ House campaign arm, which has focused on Medicaid. “This new CBO report is further proof that their words are meaningless.”