House Republicans have yet to reach an agreement on Medicaid spending, with a possible committee vote on the matter less than a week away.
Medicaid has emerged as a central issue in the budget reconciliation bill that will fund President Donald Trump’s agenda. Members disagree on how aggressively to trim the $900 billion program, the cost of which has nearly doubled over the last decade.
Republicans agree that federal spending, which is now exceeding federal revenue by more than $5 billion per day, must be reined in. Most appear to agree that cuts to Medicaid spending must be part of the GOP plan to reduce federal spending by $1.5 trillion over the next 10 years.
Meanwhile, some members adamantly oppose any change that would result in a loss of coverage for beneficiaries or shift additional program costs to state taxpayers.
House Speaker Mike Johnson (R-La.) and Rep. Brett Guthrie (R-Ky.), chair of the House Energy and Commerce Committee, which has jurisdiction over Medicaid, met with the president on May 1 to discuss the reconciliation bill. No resolution was announced.
Guthrie also met with some moderate Republicans on April 30 to discuss possible Medicaid changes.
Here are the primary cost reduction measures under discussion and what some Republicans are saying about them.
First, Republicans are considering cuts to Medicaid funding to states by reducing the Federal Medicaid Assistance Percentage, or FMAP, which is the rate at which the federal government reimburses states for their Medicaid expenses.
The rate varies based on the state’s income level, currently ranging from 50 percent to 83 percent.
For some moderates, a substantial reduction in the FMAP rate “seems to be too far for them to go,” Guthrie told reporters after the April 30 meeting.
Rep. Nick Langworthy (R-N.Y.) told The Epoch Times on May 1: “I don’t support reducing FMAP at all.”
“We have to ultimately bend the cost curve on this program, because it’s spiraling out of control,” Langworthy said, but added that the country should fulfill its duty to traditional Medicaid beneficiaries.
Rep. Mike Lawler (R-N.Y.) raised similar objections.
“Changes to FMAP ... would have a devastating impact on New York, and I’m not doing it,” Lawler told The Epoch Times.
Other Republicans, like Rep. Dusty Johnson (R-S.D.), seemed more open to the idea of lowering federal reimbursement to the states.
“As states’ economies grow at different rates, their FMAP changes,” Johnson told The Epoch Times. “So changes to FMAP are something that states are very comfortable with.”
However, he said that an aggressive change would likely make it difficult to pass the bill.
Another cost-cutting proposal involves reducing the federal reimbursement made to states for beneficiaries who were added to Medicaid through the Affordable Care Act Medicaid Expansion beginning in 2014.
Original Medicaid covers low-income people in certain categories, including children, pregnant women, parents of dependent children, the elderly, and people with disabilities. The 2014 expansion includes most people earn at or below 133 percent of the federal poverty line.
About a quarter of the 86 million people enrolled in Medicaid as of June 2024 joined under the expansion. The reimbursement rate paid to states for the care of people in this group is 90 percent. There appears to be more openness to changing this part of the Medicaid program.
“The expansion population is, comparatively speaking, getting an unfair reimbursement [for their states],” Rep. Russ Fulcher (R-Idaho) told The Epoch Times. “A big percentage of that [group] is working age, able-bodied adults, and that was never the target population for Medicaid.”
Other possibilities also exist to reach the target of cutting $1.5 billion from the federal budget over the next decade.
“That’s about $150 billion on an annual basis. That’s 1.7 percent of total spending,” Lawler said.
The more important number is 218, Lawler said, the number of votes needed to pass legislation in the House. “How you get consensus, obviously, is what we’re in the process of working through,” he said.
Work requirements are another possibility, Langworthy said. An Indiana push to require some Medicaid beneficiaries to work could reduce Medicaid rolls in that state by as many as 100,000, according to some estimates.
“It’s not like a binary choice, A or B. There are different components within the proposals,” Langworthy said, and the key will be finding a combination Republicans can agree on.
Rep. Ralph Norman (R-S.C.) said he is certain Republicans will reach a consensus on Medicaid and the larger reconciliation bill.
When asked what made him so sure, Norman said, “Two words: President Trump.” Once the president weighs in and begins calling reluctant members, they’ll come to an agreement, Norman said.
The House Committee on Energy and Commerce is expected to consider the reconciliation bill on May 7.
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