New reconciliation draft makes Medicaid, ACA changes
Illustration: Gabriella Turrisi/Axios
House Republicans released a manager's amendment to the reconciliation package that would start Medicaid work requirements faster — at the end of 2026 — but doesn't contain significantly deeper cuts to the program.
The big picture: Conservative hardliners largely failed in their push to make bigger changes to Medicaid, though they extracted some other limited wins.
What's inside: The new text notably includes a major change to the Affordable Care Act marketplaces.
- It would fund cost-sharing reduction payments (CSRs) to insurers. That would have the effect of reducing the federal subsidies that defray premium costs, by lowering the benchmark silver premiums used to calculate subsidy amounts.
- Democrats worry that policy change, combined with allowing enhanced ACA subsidies to expire at the end of this year, would lead to major premium increases for patients.
- Funding CSRs will likely also deliver more savings to help pay for the tax package.
The manager's amendment also would block cost-sharing payments to ACA plans that provide abortions, except to save the life of the mother or in cases of rape or incest.
Between the lines: On Medicaid, conservatives did not win cuts to the federal share of costs for the Medicaid expansion, or FMAP, that they were seeking.
- They did get a provision allowing state-directed payments to be higher in states that have not expanded Medicaid than in expansion states. That could theoretically deter holdout states from expanding their programs.
- The bill also broadens a ban on funding for gender-affirming care from children to all individuals.
