Republicans have hit a Medicaid blockade that is threatening to derail passage of President Donald Trump’s agenda.
GOP lawmakers are racing to nowhere fast unless the two chambers can find agreement on the major sticking point in rival budget plans.
House Speaker Mike Johnson’s (R-LA) sweeping budget framework would renew $4.5 trillion of Trump’s expiring tax cuts from 2017 coupled with $2 trillion in spending reductions that would include slashing Medicaid by hundreds of billions of dollars over the next decade.
Senate Majority Leader John Thune (R-SD) wants to punt on Medicaid until a second budget bill later this year focused on tax cuts and is instead moving ahead on a narrower $340 billion measure covering the border, energy, and defense.
Meanwhile, Trump and his aides have given Congress whiplash on possible changes to the safety net program that covers 72 million lower-income people. White House officials pledge to slash only “waste, fraud, and abuse.” Trump vowed Medicaid “isn’t going to be touched,” only to endorse hours later the House budget that could jeopardize coverage for millions.
“I’m for whatever can get the 218 [votes] in the House and the 51 [votes] in the Senate,” said Senate Majority Whip John Barrasso (R-WY) after dodging an initial question on Senate GOP leadership’s Medicaid position. “We’ll wait to see what the House is able to do.”
The opposing views on Medicaid present Republicans the greatest threat to passing their conservative priorities, even as many in the party haggle over one mega bill vs. two trimmed-down bills.
“It’s going to be one of the more sensitive issues,” Sen. Mike Rounds (R-SD) said. “If it means cuts to individual services that get passed on to states, it’s probably a bad idea.”
Across the ideological spectrum, Republican senators have heartburn over the House’s proposed Medicaid cuts, an indication that it would be unlikely to pass the upper chamber. Under the 10-year plan, the House Energy and Commerce Committee would have to reduce spending to programs it oversees by $880 billion, forcing hundreds of billions in cuts to Medicaid.
The Medicaid program costs $880 billion alone to provide taxpayer-subsidized healthcare to lower-income Americans in partnership with states.
The reductions are likely needed if Johnson hopes to achieve the level of offsets demanded by the right flank of his party to extend Trump’s tax cuts, but he’s simultaneously alienating Hispanic Republicans and those who have large Hispanic populations in their districts that rely on Medicaid. Johnson holds a one-seat majority due to vacancies and has no room for error.
“Slashing Medicaid would have serious consequences, particularly in rural and predominantly Hispanic communities where hospitals and nursing homes are already struggling to keep their doors open,” House Republicans opposed to the cuts wrote in a letter to Johnson.
Congressional Republicans can pass such proposals with a simple majority under what’s known as budget reconciliation, rendering a Senate filibuster by Democrats off the table. With virtually no legislative power to block Republicans, Democrats are resorting to a wave of messaging that the GOP’s policy agenda will hurt working-class families.
“We’ll expose Republicans’ plan to cut healthcare so that billionaires can have another tax break,” Senate Minority Leader Chuck Schumer (D-NY) said on the chamber floor.
The House advanced its version out of committee last week but has not received a floor vote. The Senate was poised to pass its version on Friday.
Beyond installing work requirements for Medicaid recipients, which would save only about $100 billion, there’s little else Republicans can agree on.
Sen. Ron Johnson (R-WI) described the House’s version as dead on arrival in the Senate because the cuts were inadequate while others said it was off the table for going too far. The largest possible savings, $900 billion, could come from capping the amount the federal government pays states for each beneficiary, which Republicans tried in 2017 when they attempted to repeal Obamacare but are again running into pushback.
“However they structure the formula, I don’t want to see there being steep cuts to benefits,” Sen. Josh Hawley (R-MO) said. “That’s a problem.”
Known as Medicaid per-capita caps, the federal government would place more of the cost burden on states, leading to expected eligibility cuts by states. Sen. Bill Cassidy (R-LA), whose state has one of the highest per-capita Medicaid recipient rates in the country, said it was presumptuous to consider it a cut to healthcare as opposed to “cuts [to] how states are currently gaming the system to generate additional revenue.”
This week, Trump told Fox News’s Sean Hannity in a joint interview with billionaire ally Elon Musk that “Medicare, Medicaid — none of that stuff is going to be touched.”
“It’s going to be strengthened but won’t be touched,” he added.
Trump endorsed Johnson’s plan the following morning, catching Republicans off guard and prompting the White House to clarify the president’s Medicaid position.
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“The American people gave President Trump a mandate to improve healthcare for everyday Americans while streamlining government bloat,” White House deputy press secretary Kush Desai said in a statement. “The Trump administration is committed to protecting Medicaid while slashing the waste, fraud, and abuse within the program — reforms that will increase efficiency and improve care for beneficiaries.”
An earlier version of the statement also mentioned Medicare but was later revised to omit the government healthcare program for seniors.
Haisten Willis contributed to this report.