Photo illustration: Sarah Grillo / Axios. Photo: Roberto Schmidt / AFP via Getty Images
House Republicans are entering a pivotal week for decisions on the future of Medicaid, after delaying a key House Energy and Commerce markup.
Why it matters: While the committee staff has been working behind the scenes, the panel is feeling pressure from wary moderates, conservative hardliners and now the White House.
Driving the news: President Trump, who met with key House GOP leaders last week before the markup was delayed, is pushing for a "most-favored nation" drug pricing policy in Medicaid.
- That move flies against GOP orthodoxy on keeping the government out of drug pricing decisions and could be a heavy lift for the Hill GOP.
What's next: Energy and Commerce members are set to continue meeting to try to finalize a plan, with the markup originally intended for this week now targeted for next week.
- A group of conservatives including Rep. Chip Roy wrote in a letter that they're pushing for "structural Medicaid reform that achieves desired Republican outcomes."
- That includes lowering the 90% federal matching rate, or FMAP, for the Medicaid expansion population to match the lower traditional Medicaid rate, an idea that has received pushback from some moderates.
- They also call for cracking down on provider taxes, which they call "money laundering."
- Moderates, meanwhile, are worried about proposals that go beyond their baseline of work requirements and tightening eligibility checks.
Between the lines: CMS hinted at another payfor option on the table in a notice Friday calling for insurers to plan for the possibility that Congress funds Affordable Care Act cost-sharing reduction payments.
- Funding CSRs would actually save money for the reconciliation bill by translating into a reduction in subsidies that help people afford premiums.
What they're saying: Trump, appearing on "Meet the Press" on Sunday, repeated his frame of going after "waste, fraud and abuse" in Medicaid, which could give some wiggle room to the Hill GOP. But there is also the drug pricing request.
- "The Trump administration is protecting Medicaid while proposing to slash the waste, fraud and abuse within the program," said White House spokesperson Kush Desai. "These reforms, along with our push for a most-favored nations policy to reduce drug prices in Medicaid, will increase efficiency and improve care for beneficiaries."
