As Republicans race to find hundreds of billions of dollars in spending cuts for their massive budget bill providing trillions in tax cuts, House Speaker Mike Johnson and party leaders have ruled out at least one controversial possible cut to Medicaid.
Johnson told reporters Tuesday evening that the GOP plan would not lower the share of Medicaid costs borne by the federal government for people enrolled in the program under the Affordable Care Act’s expansion. The Federal Medical Assistance Percentage, or FMAP, rate for that group is 90%, and there had been talk of reducing that rate to match the lower rates applied to other Medicaid enrollees.
The speaker reportedly also downplayed the possibility of imposing per capita caps on Medicaid funding for the expansion population. “I think we’re ruling that out as well, but stay tuned,” he told reporters.
Johnson said work requirements for healthy adults remained part of the GOP plan, but that alone won’t generate the savings Republicans are targeting. The House Energy and Commerce Committee, which oversees Medicaid, has been tasked with finding $880 billion in 10-year savings as part of Republicans’ budget reconciliation bill.
Johnson’s comments came after he met with GOP moderates who raised concerns about potential cuts to Medicaid. As Republicans race to settle on a plan to pay for their party-line bill enacting President Donald Trump’s tax and spending cuts, Medicaid has been a central focus, but some in the party have pushed back against deep cuts that would affect their constituents and give Democrats a juicy political line of attack. House Democrats on Tuesday introduced a discharge petition that would force a vote on a resolution to block cuts to enrollment or benefits in Medicaid or the Supplemental Nutrition Assistance Program.
CBO projects millions would lose coverage: The nonpartisan Congressional Budget Office said Wednesday that millions of Americans would lose Medicaid coverage as a result of changes like those that had been on the Republican menu of options.
The CBO analyzed the effects of five different options for reducing Medicaid spending:
- cutting the federal matching rate for enrollees who became eligible for the program under the Affordable Care Act – the idea that Johnson ruled out;
- limiting state taxes on healthcare providers. States use these taxes to essentially game the Medicaid system and get more money from the federal government;
- establishing per capita caps on Medicaid spending – the other idea Johnson ;
- or establishing per capita caps on just those Medicaid enrollees who became eligible under the Affordable Care Act’s expansion;
- repealing new rules that streamlined certain Medicare and Medicaid applications and renewals.
The nonpartisan budget office estimated that the possible changes would each cut the federal deficit, with savings ranging from $162 billion for option 5 above to $710 billion for option 1. But the changes would also all reduce Medicaid enrollment, with the coverage losses ranging from 2.3 million for option 5 above to 8.6 million for option 2.
The CBO estimates were requested by Sen. Ron Wyden and Rep. Frank Pallone, the top Democrats on the Senate Finance Committee and House Energy and Commerce Committee.
“This non-partisan Congressional Budget Office analysis confirms what we’ve been saying all along: Republicans’ Medicaid proposals result in millions of people losing their health care,” Pallone said in a statement. “It’s time for Republicans to stop lying to the American people about what they’re plotting behind closed doors in order to give giant tax breaks to billionaires and big corporations.”