Senate Conservatives Reach Deal on Medicaid Spending

Senate Majority Leader John Thune (R-S.D.) and Vice President Vance struck a deal late Saturday with a group of conservative senators aiming to cut Medicaid spending, attempting to slow down President Trump’s expansive bill.

This agreement, formed in Thune’s office, led to Senator Ron Johnson (R-Wis.) switching his vote from “no” to “yes,” which also helped secure support from Senators Rick Scott (R-Fla.), Mike Lee (R-Utah), and Cynthia Lummis (R-Wyo.). Without their votes, the extensive 940-page legislation focused on border security, immigration enforcement, military funding, and tax reductions wouldn’t have moved forward in the Senate, passing by a narrow 51-49 margin.

The vote to advance this hefty budget package lingered for over three and a half hours, initially stalled at 47 votes for and 50 against. During this time, four conservatives—Johnson, Scott, Lee, and Lummis—worked to negotiate additional provisions aimed at further reducing federal Medicaid spending.

A preliminary assessment from the Congressional Budget Office indicates that the revised Senate bill could potentially cut Medicaid spending by $900 billion over the next ten years. Still, Scott and his allies are pressing for deeper reductions, especially concerning healthy adults who signed up for Medicaid in states that expanded their programs as part of the Affordable Care Act, which was a significant achievement of President Obama’s administration.

Scott commented on meeting with the President and Vice President, stating, “We all want to get this sorted out.” He mentioned that conservatives intend to halt the use of federal funds for medical care for undocumented immigrants.

Senate conservatives believe that Thune and Trump have committed to Scott’s initiative to reduce the federal matching share for new Medicaid participants in states that expanded coverage. Johnson noted to reporters that there was a shift from “no” to “yes” among the senators to push discussions forward on the GOP Megabill.

Johnson expressed confidence that leaders would support the modifications to the bill, adding that they are looking to prevent able-bodied, childless adults from enrolling in the Obamacare expansion.

He also mentioned that states will receive substantially lower federal matching funds for children with disabilities in traditional Medicaid programs. Furthermore, Johnson claimed they managed to garner significant support for Scott’s proposal during a recent Senate GOP meeting, suggesting it was “very close” to securing the necessary votes.

Senators plan to deliberate on the settlement package for up to 20 hours before moving toward revised votes, with the final tally possibly occurring on Monday.

There’s a sense of optimism among Senate conservatives that Trump will assist in achieving a majority vote for the proposed cuts to federal Medicaid funding in expanding states. Johnson remarked that leadership shares this interest, highlighting the importance of a recent two-hour meeting with the President.

While a cap on registering new participants in expanded Medicaid will be implemented in the future, facilitating state adjustment, convincing more centrist Republicans in both chambers remains a challenge.

Speaker Mike Johnson (R-La.) had declared earlier that proposals aiming to cut enhanced federal funding for expanded Medicaid were off the table. Meanwhile, Senator Josh Hawley (R-Mo.) negotiated with Thune to boost funding for rural hospitals and increase federal Medicaid flows to Missouri over the forthcoming four years, cautioning colleagues against making substantial cuts to the program.

Hawley expressed concern, stating, “I think this effort to cut Medicaid funds is a mistake. We’ve managed to delay it, but if changes aren’t made, cuts will hit my state from 2030 onward.” He added, “This is a troubling development for Congress. If the party aspires to resonate with working-class individuals, it must prioritize their healthcare needs.”

Senator Susan Collins (R-Maine), who has voiced strong reservations about potential cuts to Medicaid funding, noted that while she voted to proceed on Saturday to support her leadership, this does not guarantee her support for the final bill.