House Republicans will need to immediately decide whether to touch the political stove by trying to scale back Medicaid benefits, under the gun to get specific about how to offset President Trump’s domestic policy agenda.
Medicaid is at the heart of the GOP plan to pass “big beautiful bills” and create budget space to extend Trump’s tax cuts. While party leaders were vague about their plans, the topic split up members facing a politically dangerous menu of reductions in programs that provide health insurance to more than 70 million people.
Conservatives are upset by the sudden cuts in Medicaid, but moderates say they oppose the bill that supports compensation and benefits for their members.
“We don’t vote for what deprives us of the benefits of the elderly, disabled and vulnerable people we represent who are reliant on Medicaid,” Rep. Nicole Malliotakes (RN.Y.) told reporters earlier this month after the House adopted the GOP budget plan.
Mario Takis was among a group of 12 vulnerable, moderate Republicans who wrote to House leaders earlier this month warning that they would not support the settlement plan on concerns about Medicaid cuts.
Rubber will meet on the road on May 7th, when the House Energy Commerce Committee plans to mark up some of the reorganization bill.
The Medicaid committee is tasked with finding $880 billion in savings. According to the Congressional Budget Office, that is an impossible task to do without cutting Medicaid.
Democrats and advocacy groups have been struggling Republicans for months on the issue of Medicaid cuts, but recently Republicans have successfully fought back by accusing Democrats of slandering lawmakers.
Swing District Republicans in particular have spent the last two weeks urging advertising to protect Medicaid and warning about the devastating impacts of cuts.
Republican leaders have repeatedly said there are no cuts to Medicare or Social Security, and say they just want to eradicate Medicaid waste, fraud and abuse.
Trump said he would not sign legislation to reduce Social Security, Medicare and Medicaid.
“If that cuts it, I won’t approve it,” Trump said in an interview with Time Magazine released Friday.
“Yeah, I refuse that, but they’re not going to,” Trump added. However, the president pointed out that he is open to measures to reduce “waste, fraud and abuse” in Medicaid.
Still, there are some disagreements about what that “vain, fraud, abuse” looks like.
Some of the more politically flavorful proposals floating around include imposing labor requirements and removing non-citizens from Medicaid, but savings do not approach the amount needed to reach the committee’s goals.
Some Republicans have come to the idea of rolling back additional federal money that goes to the state to pay for the Medicaid expansion.
“The federal government is paying 90% of Medicaid expansion. What we’re talking about is bringing the 90% expansion level back to a more traditional level,” Rep. Austin Scott (R-GA) said in an interview with the FOX business on Monday.
“As long as the governor decided he wanted to continue funding the program, no one could have driven Medicaid off,” Scott said.
It dramatically reduces federal spending, but is a politically dangerous move. Senate Republicans — including Officers Lisa Markowski (Alaska), Susan Collins (Mayne) and Josh Hawley (Missouri) — are likely to oppose that.
If states underwrite more expansion costs, they could save states $626 billion over a decade by eliminating a strengthened federal match of Medicaid’s growing population.
But it forces them to shift these costs to the state and make difficult decisions to the governor about how to offset the costs. That could require a combination of budget cuts and tax increases depending on the state.
Medicaid expansion covers more than 20 million low-income adults and will lose coverage if the state fails to acquire the expansion costs.
Also, 12 states have “trigger” laws that automatically end the expansion or require changes if federal game rates, including eight voted for Trump, fall.
Scott doesn’t sit on the energy and commerce panel, but his comments were not vacuum. Proponents of the idea argue that federal Medicaid spending is rising too much, and that the state no longer pays a fair distribution.
The federal government pays 90% of the cost of working-age adults registered through expansion, a high share that Obamacare architects intended to be national incentives.
House GOP leaders claim that Obamacare has allowed the state to expand Medicaid far beyond those who are truly in need.
“When people are in a program that is running out of resources, they actually take it from those who need it the most and are trying to receive it,” speaker Mike Johnson (R-La.) told Fox News last week.
“You quickly fall into property about young single mothers. People with actual disabilities, elderly people,” he continued. “And we have to protect and preserve that program, so we’re trying to maintain the integrity of it.”
A letter from Republicans in the Swing District did not specifically rule out rollbacks for the strengthened federal game, but said Johnson received a commitment that the refund rate would not be reduced.
