Illustration: Sarah Grillo / Axios
The GOP's massive Medicaid overhaul is on a fast track to the House floor next week, but it still faces substantial obstacles, with conservatives and moderates pulling in opposite directions with proposed changes.
Why it matters: House leaders have to thread a needle, with one of the thinnest majorities ever. And even if they get the package through, Senate Republicans will be waiting with their own fixes.
What they're saying: Sens. Josh Hawley and Susan Collins told reporters this week that they have concerns with the House bill's limits on provider taxes that states use to cover non-federal program costs, and the effect that could have on rural hospitals.
- "It's not that I think that provider taxes are good; it's that the Medicaid reimbursements have been insufficient," Collins said. "Our rural hospitals in my state and across the country are really teetering."
- Hawley also raised concerns with the provision requiring increased cost-sharing, such as copays, for some Medicaid enrollees. He said he wants to "see what that will do to access to care."
- He was even more explicit Wednesday, telling CNN he would not support the House bill in its current form.
Asked about CBO projections that the bill would result in 8.6 million more uninsured people, Sen. Thom Tillis said that "we've got to look at" that, while adding that the bill was "directionally" on the right track.
House Energy and Commerce Chair Brett Guthrie acknowledged that the provider tax provisions in the committee's bill might have to be altered, if enough lawmakers voice concerns.
- "There's some concerns from states where provider taxes are lower [about] getting frozen at a lower level, when other states have a high level," Guthrie told Axios this week.
- "I want people to be able to vote on a bill that they think their states are being treated fairly," he said, adding he was "open to discuss" possible changes.
The other side: In the House, the concerns are mostly from conservative hard-liners arguing that the cuts aren't deep enough.
- One particular concern is that the Medicaid work requirements do not begin until 2029, so it's possible that date could get moved up.
- "Why four years down the road? That's bad math," House Freedom Caucus member Ralph Norman told reporters Wednesday.
- "In theory they have [met their spending target], but where the smoke and mirrors are is delaying this," Norman said, adding that if the bill comes to the floor as is, "I've got a real problem."
Some House moderates said they were largely on board after fighting off proposals like per capita caps and across-the-board changes to the federal share of funds, or FMAP, in the Energy and Commerce Committee.
- "Look at where we started; look at where we are now," said Rep. Jeff Van Drew.
