Medicaid decisions still MIA as key markup looms
Illustration: Brendan Lynch / Axios
The House Energy and Commerce Committee is pressing ahead with plans to mark up its pivotal piece of the reconciliation bill next week without any sign of having narrowed its options for Medicaid cuts.
Why it matters: Lawmakers don't have much time to make some major, politically perilous decisions about the safety net program.
- A markup planned for Wednesday means legislative text would have to be released by Monday night.
What they're saying: "We have not narrowed it down at all," E&C Health subcommittee Chair Buddy Carter said after leaving a meeting of panel members Thursday morning.
- But he said there will be a markup next week. Asked when the narrowing down would occur in that case, he replied simply, "Between now and next week."
- "I would say everything's on the table until we figure out where 218 votes are," Chair Brett Guthrie said Wednesday evening. "We don't have any bill text yet."
But Rep. Jeff Van Drew, who's part of a GOP centrist wing opposed to cuts, warned Thursday morning that moderates would want to review the Medicaid policies before any bill text is released.
- "Now hypothetically, they could have listened to everything we said, and I'm going to reemphasize it again to them, but if it comes out and they don't do essentially what we want … then we're not voting for it," he said.
- Van Drew did express openness to implementing per capita caps for the Medicaid expansion population in the future.
State of play: E&C circulated a list of potential Medicaid policy options this week that could provide savings, per lobbyists, Victoria scooped Wednesday.
- That menu was wide-ranging and showed that lawmakers really hadn't made final decisions on what to include in the reconciliation package.
Between the lines: Some contours of the bill are starting to come into view, though, which would have a major impact on the safety net program.
- Per capita caps on the Medicaid expansion appear more likely than slashing the 90% share of federal Medicaid costs, or FMAP, for the expansion population to match the level for traditional Medicaid.
- Per capita caps, though, would be a tough vote for moderates and could lead to major coverage losses and a rise in the uninsured rate.
- Another option under consideration is lowering the FMAP from 90% to 80% for states that cover undocumented immigrants in Medicaid. Seven states cover some adults regardless of immigration status using state funds, per KFF.
- "I can tell you that if states are covering illegals, there's going to be some kind of penalty," Carter told Axios on Tuesday, though he said the specifics had yet to be worked out.
