Crunch time on Medicaid, with ACA expansion targeted
Illustration: Sarah Grillo / Axios
Congress is entering a crucial stretch to decide how much to cut Medicaid in reconciliation, and the program's Affordable Care Act expansion is a big target.
Why it matters: The GOP is stuck between an ambitious savings target that is hard to meet without major Medicaid cuts and uneasiness from moderates and even President Trump about major changes that could risk coverage for millions.
Driving the news: Appearing almost certain to be included are work requirements for "able-bodied" enrollees in the expansion population and a policy change allowing states to do more frequent eligibility checks by repealing a Biden-era rule.
- Options still being considered but less certain to make it include placing a per capita cap on program spending for the expansion population, or lowering the 90% share of federal costs, known as the FMAP, for the expansion.
- These changes could result in millions of Medicaid beneficiaries losing coverage.
- There could also be a crackdown on provider taxes, which some conservatives decry as "money laundering."
State of play: The House Energy and Commerce Committee is targeting May 7 for its markup of its portion of the reconciliation bill, giving lawmakers about a week to settle on a plan.
- Lawmakers are returning from a two-week recess during which only a few GOP members held town halls, while Democrats hammered home messaging about the consequences of Medicaid cuts.
- This week, other committees are set to mark up their portions of reconciliation, which may offer clues about whether GOP leadership can stick to its aggressive timeline of passing the reconciliation bill before the Memorial Day recess.
Between the lines: At least some House moderates appear to have left wiggle room for cutting funding for the Medicaid expansion without touching traditional Medicaid.
- A letter from moderates this month called for protecting coverage for "children, seniors, individuals with disabilities, and pregnant women," groups covered by traditional Medicaid, not the expansion.
- Rep. Nicole Malliotakis said in a Bloomberg TV interview last week that per capita caps on traditional Medicaid are a "red line," appearing to leave room for a per capita cap on the expansion population.
By the numbers: Energy and Commerce has an $880 billion target to hit for spending cuts.
- Together, Medicaid work requirements and repealing the Medicaid eligibility rule would save $200 billion to $300 billion.
- Reducing the FMAP for the expansion population could save around $600 billion, per a Raymond James analysis.
