It was always going to be tough for House Energy and Commerce Chair Brett Guthrie to rally his members around cuts to Medicaid; his job could soon get even harder.
The House GOP budget blueprint unveiled Wednesday would direct several congressional committees to achieve at least $1.5 trillion in spending cuts across programs under their panels’ purviews — necessary to offset a party-line, budget reconciliation bill to enact President Donald Trump’s domestic agenda.
The Energy and Commerce Committee has been told to find at least $880 billion in savings, or more than half of that total amount, to pay for a massive package that would extend expiring tax cuts, beef up border security and expand American energy production. It’s a far larger number than many House Republicans had originally anticipated.
The bulk of those savings will have to come from making changes to Medicaid, which currently insures more than 70 million Americans. And, in an interview Wednesday, Guthrie acknowledged that one major savings option probably won’t have the support to pass the House.
That’s per-capita caps, under which the Medicaid would be paid for based on population instead of being an open-ended entitlement. It could lead to hundreds of billions of dollars in cuts, and has been raised in the past as one of the biggest possible cost-saving measures on the table.
“I’d personally love per-capita allotments for Medicaid,” said Guthrie, a Kentucky Republican. “I’m not sure we’re going to be able to get 218 votes for that.”
The House Budget Committee still needs to mark up, and approve, the budget resolution, which it intends to do on Thursday; then, the full GOP-led House needs to advance it, with just two votes to spare. But assuming all goes as planned, it could present an even steeper challenge for Guthrie, who was already preparing for a struggle to get committee members to make cuts to the popular health safety-net program — even at more modest levels.
The task could also expose moderate Republicans, many of whom have been working behind the scenes to avert significant cuts to Medicaid among other social safety-net programs, to Democratic attacks.
“This is a heartless and cruel proposal that will ruin people’s lives so the rich can get richer,” Energy and Commerce ranking member Frank Pallone (D-N.J.) said in a statement Wednesday. “It’s a Republican Rip-Off and Democrats will do everything we can to defeat it.”
Guthrie said Wednesday his members need more time to discuss specifics of what policies could be targeted to reach the $880 billion savings goal, but suggested that changes to Medicaid could be in store for states that have opted to expand the program — including many GOP-led states.
The Energy and Commerce Committee is also weighing repeals of programs in the Inflation Reduction Act and other Biden administration climate spending, though Medicaid cuts will have to make up the lion’s share of the savings.
Options previously floated have included work requirements in Medicaid, which would be among the most politically feasible choices for Republicans, said Rep. Gary Palmer (R-Ala.), who chairs the Energy and Commerce Committee’s oversight subcommittee, in an interview. The nonpartisan Congressional Budget Office has estimated work requirements could save more than $100 billion over a decade.
Palmer said ending enhanced federal subsidies for Medicaid expansion states would need to occur on a “glide path, not all at one time,” but that it could lead to $500 billion in savings. He added that the overall spending cut floor is attainable if measures to take on Medicaid fraud are enacted.
“I don’t think it’s a big lift at all when you take into account improper payments,” Palmer said of the committee’s work ahead. “Just requiring states to do regular eligibility checks would address some of the improper payment problems.”
