Guthrie. Photo: Bill Clark/CQ-Roll Call, Inc via Getty Images
House Republicans are considering a per capita cap that would apply to the Medicaid expansion population to generate savings in reconciliation, House Energy and Commerce Chairman Brett Guthrie told Axios on Monday afternoon.
Why it matters: Putting such a lid on Medicaid funding would be a significant change to the safety net program and potentially result in major coverage losses. But it could also go a long way toward reaching House Republicans' budget savings target.
What they're saying: "It takes away the open-ended checkbook," Guthrie said of the per capita cap idea.
- "I told hospitals this week if we don't do responsible reforms, eventually our debt is going to have a debt crisis and there's going to be a lot different conversation then than we can have now in getting on the right path," he added.
Between the lines: Guthrie said no final decisions have been made, but that the per capita caps are "more likely" than lowering the 90% federal share of costs for the Medicaid expansion, known as the FMAP.
- Lowering the FMAP would risk setting off "trigger laws" in nine states that would end the Medicaid expansion altogether.
- "If you start lowering the FMAP somebody could make the argument that states will have to change programs," he said. "We're trying to keep the trigger laws from going into effect."
Guthrie said some GOP factions want a per capita cap on all of Medicaid, not just the expansion population, but "we got to see which gets to 218" votes for passage.
- On Medicaid in general, he said, "there's no final [decision]. We've got to figure out what can get 218."
