The Scoop
Two of President Donald Trump’s biggest allies in the Senate are sharply criticizing Medicaid policy changes under consideration in the House, a sign of further Republican friction ahead over the health insurance program for low-income Americans.
Sens. Bernie Moreno of Ohio and Josh Hawley of Missouri, both warned in interviews that proposals to cut the federal government’s share of the costs in states that have expanded Medicaid, and to otherwise cap Medicaid expansion spending, could lead to coverage losses. Moreno bluntly told Semafor that both ideas amount to “cutting benefits.”
“We don’t need to cut benefits. And it actually really infuriates me to hear people here talking about that, because it stresses people out. This is life and death for them,” Moreno said.
There’s a growing consensus among Senate Republicans about paring back their party’s pursuit of Medicaid savings, limiting the changes to work requirements for able-bodied people who are eligible for expansion coverage and cutting off benefits from undocumented people. Moreno also said Congress can save money by improving technology and processes within the program and discouraging emergency room visits for relatively minor ailments.
But the current framework for the GOP’s tax cut bill directs the House committee in charge of Medicaid to find $880 billion in savings over 10 years, a difficult target to hit without directly cutting benefits.
Medicaid-protective Republicans like Moreno and Hawley appear to have a notable ally in President Donald Trump.
“President Trump said, ‘We’re not cutting benefits,’” said Sen. Eric Schmitt, R-Mo. “I just don’t think that that’s anything they’re going to contemplate. There could be reforms within the system. I think work requirements are probably the biggest and easiest target to go do.”
Hawley said he personally discussed Medicaid with the president before even supporting the budget blueprint for the tax bill, adding: “The House ought to listen to the president.”
Republicans predict there are more than a dozen senators on their side who are averse to anything that can be construed as a benefit cut.
Moreno said “there’s not 50 votes for any kind of cuts in benefits. That’s just a fact.”
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Many House members and some senators who are comfortable with cutting federal spending on the Affordable Care Act’s Medicaid expansion hail from states that did not expand the program during the Obama administration.
Among the 40 states that did, the federal government pays 90% of the share of the expanded program, which includes people who were not eligible for coverage before Obamacare.
“The toughest thing we have to do is figure out where we can save money. It’s interesting: When I’m back home, everyone wants us to balance the budget, but at the same time, ‘Don’t take away my subsidy,’” said Sen. Roger Marshall, R-Kan.
Rep. Austin Scott, R-Ga., and other Republicans like Gov. Tate Reeves, R-Miss, have discussed gradually lowering the federal share of Medicaid costs. They argue that states could choose to spend more money to continue funding the program rather than see people lose coverage.
House Energy and Commerce Chair Brett Guthrie, R-Ky., told Axios the GOP is also looking at capping federal funding in expansion states. House Speaker Mike Johnson, meanwhile, sounded cool to the idea of cutting the federal share when Politico asked.
Moreno said work requirements, improving technology and innovation and waste, fraud and abuse need to be the focus on Medicaid.
“We don’t need anything more than that. And, look, the whole point of the America First agenda is to make sure that we use your tax dollars to benefit American citizens. So there’s no need to take away benefits from Americans,” he said.
Eleanor Mueller contributed.