What's behind Brett Guthrie's targeting of Medicaid
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Rep. Brett Guthrie (R-Ky.) in the Capitol in February 2022. Photo: Bill Clark/CQ-Roll Call via Getty Images
New House Energy and Commerce Chair Brett Guthrie (R-Ky.) has pushed for changes to Medicaid since his days as a state legislator. Now he's one of the main drivers behind what could become a sweeping overhaul of the safety net program.
Why it matters: Guthrie is pushing for spending limits that will be controversial as the House crafts a budget package. However, they could provide almost $900 billion to help extend the Trump 2017 tax cuts.
Catch up quick: He's pushing for "per capita caps," which would give states a fixed maximum amount of money for each person on Medicaid.
- The federal government now covers a percentage of states' Medicaid costs, so the amount reimbursed goes up or down depending on how much a state spends on the program.
- Per capita caps would likely result in less money for states, forcing them to make up the difference by raising taxes or cutting spending elsewhere.
What he's saying: Guthrie told Axios he saw how the Medicaid program affected state budgets firsthand while serving in the Kentucky Statehouse.
- "I dealt with it. That's why I care about this, I was on the budget committee in state government, and it just overwhelmed state budgets," he said.
- "What I've learned is as we keep subsidizing health care, the price keeps going up. So my idea with per capita allotments has always been that'll control costs."
He says per capita caps are the right way because they set a ceiling on federal spending but still allow for some flexibility because medical inflation can be accounted for.
- "It allows [the program] to grow at medical inflation," Guthrie said. "Every state gets the same money they get this year, plus medical inflation."
Still, he acknowledges the political difficulty of the situation, especially if it means people might fall off Medicaid.
- "I've talked to a lot of providers, other groups, and they're concerned," Guthrie said. "I'm not saying they're not, but I think we can do it in a way that people get service. The president's clearly said everybody's going to get their service they need in a way that's responsible to the budget."
- President Trump recently said he didn't want people's Medicaid benefits "affected," and instead wanted to target "abuse or waste" in the program.
- House Speaker Mike Johnson this week stated "Medicaid has never been on the chopping block."
- This is all amid House GOP moderates warning they could have issues with voting for deep cuts to Medicaid.
Flashback: Guthrie also pushed for per capita changes to Medicaid during the 2017 Affordable Care Act repeal debate.
- The House's repeal bill included a measure that would have set a cap on how much states received in funding based on their estimated number of beneficiaries, with adjustments for inflation.
- The late Sen. John McCain famously blocked that effort.
The bottom line: Even if Medicaid policy changes don't make it into this tax package due to political unfavorability, Guthrie isn't ready to give up.
- "I've always said that we need to reform Medicaid, even if it wasn't part of reconciliation, because the program is unsustainable," he said.
- "That's what we're working on. It depends on what we can get 218 votes for."
