Mike Johnson faces GOP centrist revolt on Medicaid
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House Speaker Mike Johnson speaks at a press conference on Capitol Hill on April 29. Photo: Anna Moneymaker/Getty Images
House Speaker Mike Johnson (R-La.) is staring down a growing rebellion from his centrist wing over cuts to Medicaid in the GOP's "big, beautiful bill."
Why it matters: Moderate and swing-district House Republicans are trying to balance their loyalty to Trump with their increasingly imperiled reelection prospects.
- Many centrists are worried that cutting programs like Medicaid too harshly could inflame the already intense backlash they are facing from constituents over DOGE cuts.
Driving the news: Rep. Don Bacon (R-Neb.) confirmed to Axios that he communicated to the White House he won't support more than $500 billion in cuts to Medicaid.
- "Those are the cuts that don't impact quality of care nor hurt hospitals. A bunch of us will have to be convinced that any other cuts won't hurt patients or hospitals," he said.
- Bacon cited a letter he and 11 other Republicans wrote to Johnson warning against "any reduction in Medicaid coverage for vulnerable populations."
- "I will not vote for any bill that cuts eligible legal people," said Rep. Jeff Van Drew (R-N.J.). "That means our working poor."
The other side: Some members of the right-wing Freedom Caucus pushed back swiftly on Bacon's proposed ceiling, arguing there needs to be sufficient spending reductions to offset tax cuts.
- "These same individuals want to keep all these green energy tax credits and ... raise the SALT cap deduction," said Rep. Eric Burlison (R-Mo.). "You can't have your cake and eat it too."
- "You're not going to get the tax cuts that the American people want ... if you're talking about those kind of low numbers, on actual reform to Medicaid," said Rep. Chip Roy (R-Texas).
Between the lines: The dynamic puts Johnson between a rock and a hard place as he tries to cobble together the roughly 218 votes he needs to pass the massive package.
- President Trump and Republicans are desperate to secure roughly $4 trillion in tax cuts, which they hope will stimulate the economy and boost their sagging poll numbers.
- The measure would also raise the debt ceiling, a key priority for Trump in order to deny Democrats potential political leverage.
State of play: House Energy and Commerce Chairperson Brett Guthrie (R-Ky.) told Axios on Monday that the GOP is looking at ways to reduce the federal contribution toward states' Medicaid expansions through the Affordable Care Act.
- "It takes away the open-ended checkbook," Guthrie said of one idea, the "per capita cap," which would place a limit on federal funding per enrollee in the Medicaid expansion.
- But the proposals would likely kick many lower-income enrollees off the Medicaid rolls, leading some moderates to oppose them.
- Rep. Mike Lawler (R-N.Y.), asked about another proposal, to lower the federal share of costs for the Medicaid expansion, replied: "I've been very clear about this. You guys keep asking the same stupid f--king question: No."
- Rep. Nick LaLota (R-N.Y.) said of the per capita cap: "My sense is that would be a cut, and I'm not in favor of that."
What's next: If the reconciliation bill passes the House, it could face an even tougher path in the Senate.
- Members like Sen. Josh Hawley (R-Mo.) have staked out a position that they oppose anything that would cut Medicaid benefits.
