Illustration: Sarah Grillo/Axios
House Energy and Commerce Committee Republicans met Tuesday to suss out how changes to Medicaid or other health care measures could be used as offsets in a reconciliation bill.
Why it matters: Although no decisions were made, the closed-door discussion showed how controversial cuts to the safety net program are seriously under consideration.
- Rep. Buddy Carter said "everything" in terms of Medicaid options was discussed, including per capita caps and reducing the 90% federal matching share for the expansion population.
- He also said Medicare site-neutral payment policies were discussed. "That's certainly something we're considering," he said.
What they're saying: Energy and Commerce Chair Brett Guthrie told Axios that the purpose of the meeting was to "give a range of options that fit within reconciliation, within health care" and to socialize them to the committee members so they can start thinking about the effects on their districts.
- "Speaker Johnson said committee members are going to drive this, so it was set up to be an organizational educational meeting," Guthrie said.
- He added that the group did discuss Medicaid per capita caps and how to implement them, adding that "there's a myriad of ways to do it, and do it in a responsible way."
- Guthrie also said the committee is using a House Budget Committee menu of possible health offsets that was circulated last week "as a starting point."
Context: That budget document outlined health policy changes that could be used as payfors in the massive tax cut package estimated to cost more than $4 trillion.
- It included estimates for how much policy changes like Medicaid per capita caps could save, as well as changes to the ACA and repealing major Biden administration health rules.
- Health care overhauls were the biggest savers, but could prompt blowback over insurance coverage losses.
The big picture: Carter said he thinks reducing spending on Medicaid is important. "We've got serious fiscal problems up here," he said.
- Still, those changes to Medicaid could stoke worries about millions losing coverage — the same kind of concerns that helped doom Republicans' 2017 repeal-replace plans, which included Medicaid per capita caps.
- "We're still in the process of just throwing mud up against the wall to see what sticks," Carter said. "We don't have a consensus on what we're gonna do yet."
