Spotlight shifts to Medicaid, a make-or-break issue for Trump

The adoption of the Republicans’ budget bill has thrown a spotlight onto the hot-button issue that could make or break President Trump’s domestic agenda: Medicaid. 

The massive government health care program is at the heart of the GOP’s plan to slash federal spending in order to trim deficits and make budget space for Trump’s new tax cuts. But the topic is dividing Republicans both within and between the chambers of Congress, where conservatives favor steep cuts to Medicaid, centrists say they’ll oppose any erosion of health benefits for their constituents, and GOP leaders are left straddling the gap in search of a compromise that can appease both camps. 

They have their work cut out for them. 

The 70-page budget plan approved by Republicans in both chambers contains few policy details, and it mentions Medicaid only once. But it instructs the House Energy and Commerce Committee, which has jurisdiction over Medicaid, to locate $880 billion in spending cuts over the next decade. That’s mathematically impossible, the Congressional Budget Office says, without cutting Medicaid, which provides health coverage to more than 70 million people.

Speaker Mike Johnson (R-La.) and other GOP leaders maintain they can reach that number by weeding out waste, fraud and abuse in the program. But Democrats and many health care advocates disagree. And now that the GOP budget has been adopted, they’re vowing to take the Medicaid fight directly to voters — particularly in battleground GOP districts with high numbers of Medicaid patients. 

“Republicans can run from their proposal, which is the largest Medicaid cut in American history, but we will never allow them to hide,” House Minority Leader Hakeem Jeffries (D-N.Y.) told reporters in the Capitol shortly after lower-chamber Republicans passed the budget bill. 

“Now that the committee process has been set in motion,” he continued, “they will have to spell out the very cuts to Medicaid and other programs that we have been making clear for weeks now they are determined to visit on the American people.”

As part of that effort, Democrats are hoping to exploit the sharp GOP divisions over the value of Medicaid and how deeply Republicans should cut its funding. That disagreement extends beyond the House to the Senate, where a handful of Republicans — including Sens. Lisa Murkowski (Alaska), Susan Collins (Maine) and Josh Hawley (Mo.) — have warned that they won’t accept any Medicaid cuts as part of Trump’s tax-cut package. 

The prickly nature of the Republicans’ Medicaid debate was evident on the House floor in the midst of Thursday’s vote on the Senate-crafted budget blueprint that’s designed to guide Trump’s domestic priorities — not only tax cuts, but also an expansion of energy production and a crackdown on immigration — through Congress and on to the president’s desk later this year.

While most of the attention throughout that debate was on conservative spending hawks, who had publicly threatened to kill the resolution over concerns that it doesn’t cut spending deeply enough, moderates were more quietly sounding alarms from the center, warning party leaders that they’re prepared to oppose any final package that curtails Medicaid benefits in their districts. 

On the House floor during that vote, Johnson huddled in a lengthy discussion with some of those moderates in an effort to assure them that Medicaid benefits were not on the chopping block as GOP leaders move ahead with Trump’s “one big, beautiful bill.” 

Those voices want the final package to hew closer to the $4 billion in cuts the budget mandates for the Senate, and not the $1.5 trillion the same plan requires of the House. 

After the vote, some of those centrists said they were encouraged by comments delivered by Senate Majority Leader John Thune (R-S.D.) just a few hours earlier, when he declined to commit the upper chamber to the $1.5 trillion figure. But the moderates also emphasized that their vote for the final bill would hinge on Johnson’s ability to keep his word about leaving Medicaid benefits untouched.

“We made very clear, 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.) said. 

“We want to cut the fraud, waste and abuse, [and] I think there’s significant savings there we could achieve in this final bill [through] work requirements and taking illegal immigrants off of the rolls and cutting back on the actual abuse that we're seeing,” she continued. “We will not do anything that’ll [erode] benefits. And the Speaker’s made that very clear, and the president's made it very clear, that they agree with us.” 

Rep. Jeff Van Drew (R-N.J.), another GOP centrist, delivered a similar warning, saying he won’t support any legislation that cuts benefits under Medicaid, Medicare or Social Security.

“I have been in constant communication with House leadership and the Speaker, making it clear that any bill that threatens these critical programs will not get my support,” he said after Thursday’s vote. 

On the other side of the ideological spectrum, however, conservatives interpreted Thune’s comments very differently, saying they were newly convinced that the House and Senate were, for the first time, on the same page in seeking $1.5 trillion in cuts. Hitting that figure would rely deeply on the $880 billion charged to the Energy and Commerce Committee, which means Medicaid would necessarily be affected. 

Conservatives have, for decades, gone after Medicare, Medicaid and Social Security, hammering the services provided by major entitlement programs as bloated and inefficient — and better left to the private sector. 

Those sentiments are spilling into the current debate over Medicaid, as some conservatives are unapologetic about going after the program — despite leadership’s claims to the contrary — and urging their colleagues to extend the effort beyond the hunt for waste, fraud and abuse.

“Some Republicans are afraid of something that has 80 percent support, which is [a] work requirement for able-bodied individuals who don't have children. Why can't those people go to work? The American people support that,” Rep. Thomas Massie (R-Ky.), one of just two Republicans who opposed the GOP budget, said after the resolution passed. 

“The liberals are calling that: ‘Oh, you're cutting Medicaid,’” he added. “But our [Republican] colleagues really aren't even doing that. And they should be.”

Mychael Schnell contributed reporting.