Medicaid isn't out of the woods in debt talks

Between the lines: The early read from our interviews is that while some Republicans are likely to push for changes, they're not all on the same page — and there are some surprising dissenters, including the head of the Republican Study Committee.

What they’re saying: Asked about Medicaid work requirements, Energy and Commerce Chair Cathy McMorris Rodgers told Axios: “Yes, we're just beginning to have those conversations, but certainly members have talked to me about looking at work requirements for some of the able-bodied in Medicaid.”

• Rep. Matt Gaetz has formally called for work requirements as a way to cut Medicaid spending.
• Rep. Warren Davidson said work requirements are “definitely one of the topics circulating,” and said they could apply to a range of “means-tested programs” including Medicaid.
• So did Rep. Don Bacon, who is one of the more moderate Republican members in the caucus and has political sway. “The one thing I’ve heard is that we’re looking at work requirements,” said Bacon.
• Bacon said he would support work requirements depending on the details of the proposal and if there were exceptions to it.

Reality check: Harvard researchers studying Arkansas’s brief implementation of Medicaid work requirements found the policy led to coverage loss without increases in employment.

Yes, but: There are also some significant House Republicans who did not express interest in Medicaid changes in the debt ceiling talks.

• RSC Chair Kevin Hern noted states are already set to re-evaluate eligibility for Medicaid amid the unwinding of pandemic rules. “Let the states do their work, we don’t have to do everything,” he said.
• The RSC's 2023 budget does include a proposal to turn Medicaid and CHIP into block grants.
• Rep. Buddy Carter said he thinks Medicaid is “off the table as well” along with Medicare and Social Security.
• “There’s been no discussion really on where we’re going with Medicaid,” said Rep. Brett Guthrie, chair of the Energy and Commerce Health subcommittee. Though he added, “there are different things we can look at without changing benefits.”
• Rep. Andrew Clyde said he didn’t know yet whether Medicaid would be on the table and that other House Freedom Caucus members were discussing the debt ceiling and still crafting their own budget.

The big picture: Any Medicaid cuts are sure to be controversial, and Democrats are already pivoting from focusing on potential Medicare cuts to going on the offensive for Medicaid.

• “If MAGA Republicans try to take away people’s health care by gutting Medicaid and the Affordable Care Act, I will stop them,” President Biden said in a speech hammering the GOP over potential health care cuts this week.

• There’s also an active advocacy community that’s fought Medicaid cuts before and is ready to do it again.
• “It is truly demoralizing, as an advocate and as a family member of somebody who relies on these services for his independence,” said Nicole Jorwic, chief of advocacy and campaigns for Caring Across Generations. "But I'm also emboldened that the communities that will come together again to fight to protect [Medicaid].”

If Republicans are going to leave out Medicare and Social Security and still want to put forward a balanced budget, other areas like Medicaid could have to take some heavy cuts.

• “My assumption is when they talk about Social Security and Medicare, that’s kind of what they're excepting from this, and then I'm sure a lot of folks over there will probably want to except defense too, which doesn’t leave a lot to work with,” Sen. John Thune told Axios.
• “There are a lot of ideas about how to reform Medicaid,” Thune added.
• Advocates worry lawmakers could also bring back Medicaid per capita caps. The policy option, a key piece of ACA repeal-and-replace, would limit how much federal Medicaid funding states can get per enrollee, slowing the growth of Medicaid spending.
• “Anything that would fundamentally change the structure of Medicaid… is something that has to be opposed,” Jorwic said.