Illustration: Sarah Grillo/Axios
Republicans say work requirements are the most likely Medicaid change in a reconciliation bill, though a conservative push for deeper cuts could force more changes to the safety net program.
Why it matters: Medicaid is caught in the middle as House Republicans debate the extent of budget cuts, with conservatives pushing for as much as $2.5 trillion in spending reductions.
Driving the news: Republican lawmakers said after a Wednesday conference meeting that work requirements could be the likeliest Medicaid change to make it into reconciliation and win support across the caucus.
- House Energy and Commerce Chair Brett Guthrie said sentiment within the GOP conference was favorable to tightening eligibility requirements, conditioning work on able-bodied people and equalizing payments for the Medicaid expansion population.
- But Guthrie and some others want to go further and enact per capita caps, which he termed "a better way to go for states."
Guthrie said his committee discussed offering up a minimum of $200 billion in savings during the recent GOP retreat in Florida.
- Medicaid work requirements are estimated to save around $120 billion, per a recent GOP House Budget Committee document.
- A 2023 CBO estimate of work requirements found they would save over $100 billion over 10 years and 600,000 people would become uninsured.
State of play: But hardliners are pushing for deeper cuts in the budget resolution, which could force more Medicaid changes. Conservative Budget Committee member Ralph Norman told reporters Wednesday morning that he wants $2.5 trillion in cuts, a hard target to reach.
- He would impose work requirements in Medicaid and in SNAP. Asked if he wanted to go further and also cap Medicaid spending, Norman acknowledged the political challenge: "That would be my dream. Now the likelihood of that? We struggle with work requirements."
- "That would be my dream," he said. "Now the likelihood of that? We struggle with work requirements."
- House Freedom Caucus policy chair Chip Roy said that "there's a lot of agreement" across the conference on Medicaid work requirements. He added that there's some "general agreement" on dialing back federal matching payments for the expansion population, though the impact would vary across states.
Between the lines: President Trump's comments last week about not wanting cuts to "affect" Medicaid beneficiaries are also complicating the discussion, since major cuts could lead to coverage loss.
- "We're still trying to determine and getting some clarification, that will come today and tomorrow with the president, about exactly what he meant with the Medicaid cuts," Rep. Buddy Carter told reporters.
- Adding to the challenge, Senate Republicans and some in the House are still pushing for two reconciliation bills instead of one, which would likely push any health care cuts to the second bill.
- Rep. Byron Donalds left Wednesday morning's conference meeting pushing for two bills, enabling Republicans to move first on a border and energy proposal.
The bottom line: Winning over conservatives and moderates for any cuts is a major challenge.
- Asked if he had heard moderate concerns about Medicaid cuts, Guthrie acknowledged, "Everybody's concerned about their rural hospitals."
- But he said talking it through with members will help. "It just takes a while to explain it," he said.
