GOP Medicaid debate intensifies as Republicans search for cuts

House Republicans are under the gun to get specific on how they will offset President Trump's domestic policy agenda, and they will soon need to decide if they will touch the political stove by trying to scale back Medicaid benefits. 

Medicaid is at the heart of the GOP plan to pass a “big beautiful bill” and make budget space for an extension of Trump’s tax cuts. Party leaders have been vague about their plans, but the topic has divided members who are facing a menu of politically perilous cuts to the program that provides health coverage to more than 70 million people. 

Conservatives are agitating for steep cuts to Medicaid, while moderates have said they would oppose any bill that rolls back coverage and benefits for their constituents.  

“We won't vote for something that takes away benefits from seniors, disabled and vulnerable people that we represent who rely on Medicaid,” Rep. Nicole Malliotakis (R-N.Y.) told reporters earlier this month, after the House adopted the GOP budget plan. 

Malliotakis was among a group of 12 vulnerable and moderate Republicans who earlier this month wrote a letter to House leaders warning that they would not back the reconciliation plan over concerns about cuts to Medicaid. 

The rubber meets the road on May 7, when the House Energy and Commerce Committee is planning a markup of its portion of the sweeping reconciliation bill.   

The committee, which has jurisdiction over Medicaid, has been tasked with finding $880 billion in savings. According to the Congressional Budget Office, that's an impossible task to do without cutting Medicaid. 

Democrats and advocacy groups have been hammering Republicans on the issue of Medicaid cuts for months, though recently Republicans have successfully fought back by accusing Democratic campaigners of defaming lawmakers. 

Swing district Republicans in particular have spent the past two weeks seeing ads urging them to protect Medicaid and warning about the devastating impact of cuts.  

Republican leaders have repeatedly said there will be no cuts to Medicare or Social Security, saying they only want to root out waste, fraud and abuse in Medicaid.  

Trump said he would not sign legislation that cuts Social Security, Medicare or Medicaid.  

“If it cuts it, I would not approve,” Trump said in an interview with Time magazine published Friday, where he was repeatedly asked about cuts to Medicare, Medicaid or Social Security. 

“I would veto it, yeah. But they’re not going to do that,” Trump added. But the president noted he is open to measures that reduce “waste, fraud, and abuse” in Medicaid. 

Still, there’s some disagreement about what that “waste, fraud and abuse” looks like.   

Some of the more politically palatable proposals that have been floated include imposing work requirements and removing noncitizens from Medicaid, but the savings wouldn’t come close to the amount needed to reach the committee’s target. 

Some Republicans have floated the idea of rolling back the extra federal money going to states to pay for Medicaid expansion.  

“The federal government is paying 90 percent of the Medicaid expansion. What we have talked about is moving that 90 percent level of the expansion back toward the more traditional level,” Rep. Austin Scott (R-Ga.) said in an interview Monday on Fox Business.  

“Nobody would be kicked off Medicaid as long as governors decided they wanted to continue to fund the program,” Scott said.  

It's move that would dramatically reduce federal spending but is also politically risky. Senate Republicans — including Sens. Lisa Murkowski (Alaska), Susan Collins (Maine) and Josh Hawley (Mo.) — are likely to oppose it. 

Eliminating the enhanced federal match for the Medicaid expansion population would save the federal government $626 billion over a decade if states assumed more of the expansion costs, according to an analysis by health policy nonprofit KFF. 

But it would also shift those costs to the states, forcing governors to make difficult decisions about how to offset costs. That would likely require some combination of budget cuts and tax increases depending on the state.  

The Medicaid expansion covers more than 20 million low-income adults, who would lose coverage if states were unable to pick up the expansion costs.  

Twelve states also have “trigger” laws in place that would automatically end expansion or require changes if the federal match rate were to drop, including eight that voted for Trump.  

Scott doesn’t sit on the Energy and Commerce panel, but his comments didn’t come in a vacuum. Proponents of the idea argue federal Medicaid spending has grown too much and states no longer pay their fair share. 

The federal government pays 90 percent of the costs for working-age adults who enroll through the expansion, a high share that the architects of ObamaCare meant to be an incentive for states. 

House GOP leaders argue ObamaCare allowed states to expand Medicaid far beyond those truly in need.  

“When you have people on the program that are draining the resources, it takes it away from the people that are actually needing it the most and are intended to receive it,” Speaker Mike Johnson (R-La.) said on Fox News last week.  

“You’re talking about young, single mothers, down on their fortunes at a moment — the people with real disabilities, the elderly,” he continued. “And we’ve got to protect and preserve that program. So we’re going to preserve the integrity of it.” 

The letter from swing district Republicans did not specifically rule out rolling back the enhanced federal match, though some have said they received a commitment from Johnson that the reimbursement rate won’t be lowered.