Senate Majority Leader Addresses Republican Concerns Over Medicaid Cuts

Senate Majority Leader John Thune (R-S.D.) has initiated discussions with fellow Senate Republicans who are wary of President Trump’s proposed legislation, fearing it could result in significant cuts to Medicaid.

Sources within the Senate GOP indicate that a small group of five to seven Republican senators are particularly concerned about the Medicaid reforms proposed in the House budget package.

Some senators believe these reforms would restrict states’ access to additional federal Medicaid funding through health care provider taxes, and they are prepared to oppose House bills if more working-class individuals end up paying higher costs for the program.

“There are probably five, six, seven of us. If they cut into profits, that’s going to lead to serious issues. The leader is aware of that,” remarked one Republican senator who preferred to speak anonymously about the ongoing discussions.

Thune is currently working to rally support among Senate GOP members for the extensive 1,116-page House bill, even though it hasn’t yet cleared the lower chamber.

Republican lawmakers have mentioned that Thune is actively listening to his colleagues’ concerns, particularly about Medicaid regulations.

Both Thune and Senate Finance Committee Chairman Mike Crapo (R-Idaho) recognize that any cuts to federal Medicaid funding could have serious implications for states, especially during a meeting held in the Capitol on Wednesday.

Attending this meeting were Senators Ted Budd (R-N.C.), Rick Scott (R-Fla.), Eric Schmitt (R-Mo.), and Jon Husted (R-Ohio).

Senator Jerry Moran (R-Kan.), who voiced worries earlier this year about supporting Medicaid reforms that jeopardize rural hospitals, also participated in the discussions.

After the meeting, Republicans expressed their intention to hold off on any comments regarding the House bill until they reconvene in the Senate.

“Yeah, I think I’ll probably wait on that for now,” Budd stated.

Earlier this week, Thune had a one-on-one meeting with Senator Josh Hawley (R-Mo.), a notable critic of Medicaid cuts. The main goal was for Thune to grasp Hawley’s position on Medicaid reform better, according to insiders.

This group of concerned Senate Republicans, including Hawley, is expected to advocate for changes to the House bill, especially regarding Medicaid cost-sharing and tax reform related to health care providers.

However, such changes could jeopardize the careful political balance that House Speaker is attempting to maintain for the bill’s approval.

Senator Johnson addressed the senators at lunch on Tuesday, cautioning them that significant alterations to the legislation once it reaches the Senate might disrupt the fragile coalition he’s trying to cement.

“When I came into this, he set up a very delicate situation, and I don’t think he wishes for major changes to the product,” Thune remarked, referring to the Speaker’s preference for only minor adjustments to the bill.

Thune acknowledged that GOP senators are indeed seeking changes.

“The Senate will have its own input. We are coordinating closely with them, and the committee is collaborating,” he said.

With a Republican majority of 53 seats, Thune can continue pushing the large budget settlement bill that extends the tax cuts from 2017, even though passing it remains challenging.

Senator Rand Paul (R-Ky.) has stated that he won’t support the bill if it includes a multi-billion dollar increase in the federal debt cap, which may soon reduce Republican votes.

Paul is advocating for immediate cuts to federal spending in exchange for raising government borrowing limits.

Moderate Republican senators, such as Susan Collins (R-Maine) and Lisa Murkowski (R-Alaska), have expressed deep concerns about the potential cuts to Medicaid benefits.

Collins mentioned that she is open to helping with new Medicaid work requirements the GOP has proposed, but raised alarms about how this could impact rural hospitals in Maine, particularly due to proposals to increase federal Medicaid funding through health care provider taxes.

“I’m sure it will be considered carefully, and I recognize there’s still negotiation,” she said regarding the House bill’s Medicaid reforms.

“The work requirements I’ve seen appear to be thoughtfully crafted,” she added, pointing out that these requirements don’t apply to individuals in school or those involved in cost-sharing.

When asked about tax reform and increased cost-sharing for healthcare providers, Collins commented, “We’re still working to understand what the provider tax reform entails, but we remain very worried about rural hospitals in Maine.”

Moran has previously set clear expectations with his colleagues, announcing last month that he wouldn’t support any Medicaid reforms that could jeopardize the financial stability of rural hospitals.

“I want to make sure my colleagues understand my perspective on the essential need for healthcare access in Kansas and the nation,” he stated at that time.

Johnson has also been advocating for raising state and local tax (SALT) deduction limits, a topic currently not on the Senate agenda.

During a Tuesday meeting, a Republican senator suggested that this could create more room for negotiations on SALT deductions with New York State Representative Mike Lawler (R) and others who are also concerned.

Thune clarified to reporters that he doesn’t foresee similar requests for SALT adjustments coming from Republican senators.

“That’s not an issue in the Senate; it doesn’t concern us,” he stated.

Johnson then announced Wednesday morning that he reached a tentative agreement to increase the SALT deduction cap from $10,000 to $40,000 over the next decade, with the cap gradually phasing out for annual incomes above $500,000.