House Republicans have communicated to their leaders that they won’t support cuts to Medicaid in what they’ve dubbed the party’s “big beautiful bill,” just to watch the Senate potentially strip those provisions away.
Previously, GOP leaders have held conferences to discuss more conservative legislation, utilizing high-level meetings to persuade centrists and navigate tough political waters, hoping to create a more unified and trustworthy outcome. Speaker Mike Johnson (R-La.) introduced this approach in February during budget negotiations, following a similar path taken by former Speaker Kevin McCarthy regarding the 2023 debt ceiling discussions.
This time, however, moderates are backing away, indicating they don’t support the more conservative agenda pushed by Trump, specifically concerning significant changes to Medicaid.
“That’s the vote we want to avoid,” Rep. Nick LaLota, RN.Y., mentioned about the mediation efforts. “More than 20 Republicans are eager to vote only on legislation that can realistically pass, rather than on something conservative that may not even get a vote.”
“The members I chat with most often aren’t interested in pursuing that route,” he continued, reflecting on his earlier support for a conservative measure. “It feels like we’re already facing too many heavy issues. Members like me prefer backing legislation that could actually become law.”
Rep. Jeff Van Drew (RN.J.), a former Democrat, remarked that this situation might lead to a series of unfavorable outcomes.
“The worst-case scenario is if the House approves the bill, sends it to the Senate, and then the President says no, calling it a bad bill.” “I believe we’ve made this clear to the speakers. At this point, we need to stay aligned to ensure we’re on the same page—or at least close.”
The ongoing debate about potential Medicaid cuts is a significant sticking point in discussions about a broader package that includes Trump’s domestic priorities. The House Energy and Commerce Committee, which oversees Medicaid, has been tasked with identifying at least $880 billion in reductions. The Congressional Budget Office has indicated that reaching this figure without impacting the social safety net is unfeasible.
This issue is causing tension within House GOP meetings. While some hard-line conservatives advocate for Medicaid changes due to concerns over increasing deficits, moderates are hesitant about reforms that could negatively impact beneficiaries in their districts.
Meanwhile, many Senate Republicans are anxious about the possibility of sudden Medicaid cuts, a situation that appears to benefit centrist members.
Disagreement persists, complicating efforts to advance Trump’s agenda. The Energy and Commerce Committee had aimed to proceed with parts of the package this week, but this was postponed amid ongoing disputes over Medicaid adjustments.
Rep. Don Bacon (R-Neb.), a moderate who opposes significant Medicaid changes, suggested that leadership is trying to secure centrist support alongside Medicaid revisions by sending the bill to the Senate with expectations that problematic provisions will be removed.
“Their tactic seems to be: ‘Don’t worry about the Senate; they’ll fix it.’ And now we’re preparing for a third vote on this,” he stated. “It feels like we’re being pushed towards a cliff.”
When asked if he was concerned about backing a package that includes Medicaid cuts prior to Senate negotiations, Rep. Mike Lawler (RN.Y.) simply stated, “No, because I’m not doing that.”
What the final Medicaid changes will entail remains uncertain. Parties appear united in their intent to restrict access to the safety net for individuals who have entered the country without approval, as noted by Johnson in remarks to reporters on Tuesday evening.
However, lingering questions remain, including whether the bill will adopt a “per cap” structure. “I think we’re making a collective decision,” Johnson mentioned, but Brett Guthrie (R-KY.), chairman of the House Energy and Commerce Committee, indicated Wednesday that the concept is “still alive.”
When confronted with the inconsistencies regarding the approach, Johnson responded defensively.
Meanwhile, hardliners express concern regarding the Senate’s handling of the final package after it passes through. If unforeseen Medicaid cuts are included in the end, deficit-minded Republicans fear they might be left vulnerable.
“That’s always a concern, which is why we sought early commitment from Thune and included it before the vote,” Rep. Eric Burlison (R-Mo.) stated, referencing comments made by Senate Majority Leader John Thune (R-S.D.) just before the House approved the compromise budget resolution, during which Thune promised to aggressively reduce spending.
“His verbal assurance and subsequent public remarks provided us with a bit of reassurance,” Burlison added.
Johnson is also aware of the concerns regarding Senate negotiations. At a recent House GOP meeting, Rep. Cliff Benz (R-Ore.) questioned whether House leaders are coordinating with their Senate counterparts. Johnson replied that the Senate would consider the House bill and might make minor adjustments.
During a press conference, when asked how much the Senate could potentially alter the proposal, the chairman emphasized the collaboration between the two chambers.
“We are proud of the product we’re putting out there. I don’t believe it requires extensive modifications. I hope minimal changes will be necessary,” Johnson concluded. “But I assure you, our colleagues are fully aware of our intentions. We are communicating thoroughly both with each other and with the White House team.”
