Johnson. Photo: Tasos Katopodis/Getty Images
The House GOP conference at a weekend retreat discussed using a Medicaid overhaul as a potential payfor in reconciliation, several House leaders told Axios.
Why it matters: Republicans may use health care offsets to help cover tax cuts in a reconciliation package, and the impact could be Medicaid coverage losses — as well as other changes, like an overhaul of how Medicare pays providers or even PBM reform.
Driving the news: Medicaid work requirements are seen as perhaps the most likely change to the safety net program, though even more far-reaching options like per capita caps on spending are also being discussed.
- "There's some talk about work requirements and various aspects, but we haven't determined the final parameters of it yet. That'll be a bicameral discussion," Speaker Mike Johnson told Axios on Tuesday.
- "We have to have savings," House Energy and Commerce Chair Brett Guthrie told Axios. "I'm sure Medicaid reform is going to be a part of it."
- Guthrie said the issue was discussed at the retreat and that changes could also include more stringent checks on eligibility as well as "the question of whether we go to per capita allotments."
Still, although Medicaid changes are often a popular topic among Republicans, it doesn't appear the subject has been widely discussed on the Senate side.
- Newly named Senate Finance Chair Mike Crapo said he hasn't heard about the discussion of Medicaid work requirements from the House GOP side, and he didn't know whether senators would support it.
- "I didn't hear that, but I've heard it before," Crapo said Tuesday. "You name the issue, it's been talked about" in reconciliation.
- He added: "I'm not involved in negotiations on that right now."
Between the lines: Any Medicaid cuts or work requirements are sure to be controversial and lead to concerns about millions of people losing coverage.
- With extremely slim margins, Republicans may not be able to get the votes for major changes, especially if Republican governors raise alarms that their state budgets would be hurt.
- The Democratic group Protect Our Care is holding "Hands Off Medicaid" events in the districts of vulnerable House Republicans on Wednesday.
- "Leading Republicans are ramping up threats to cut Medicaid in order to pay for tax cuts for the wealthiest Americans, which would rip away health care from millions of families who count on it," the group said.
The intrigue: But Medicaid program changes may not be the only health care policy on the table in reconciliation.
- New E&C health subcommittee Chair Buddy Carter told Axios that in reconciliation there "are certainly opportunities to have payfors through health reform," and the options were a topic of discussion at the weekend meeting.
- Options include "site-neutrality, PBM reform and 340B reform," he said.
The bottom line: The discussion on what to include in reconciliation remains fluid, as do conversations about the way a package gets done.
- President-elect Trump has signaled support for both the one-bill and two-bills approach in recent days.
- Trump is on the Hill meeting with Senate Republicans today, including on reconciliation strategy.
