Republicans in Congress are considering significant changes to Medicaid as part of a larger bill supporting President Donald Trump’s agenda. The House Energy and Commerce Committee, chaired by Rep. Brett Guthrie, R-Ky., is exploring ways to reduce federal spending on Medicaid expansion, a key component of the Affordable Care Act (ACA).
Guthrie argues that Medicaid spending is growing at an unsustainable rate. The expansion population receives a 90% federal match while traditional Medicaid recipients, such as disabled children in Kentucky, receive only 72 cents for every dollar spent on their care. According to the nonpartisan Congressional Budget Office, the committee aims to find $880 billion in savings without cutting Medicaid or Medicare. Options under consideration include changes to Medicaid’s Federal Medical Assistance Percentage (FMAP) and implementing a per capita cap on the population covered under the expansion.
Guthrie plans to finalize and vote on the proposal next week. The 90% federal match was crucial to the ACA’s Medicaid expansion, encouraging states to adopt the provision and extend coverage to an estimated 20 million people. Larry Levitt, executive vice president for health policy at KFF, warns that reducing the federal match rate would shift significant costs to states, many of which would struggle to find the extra funding.
Republicans weigh Medicaid funding changes
Medicaid funding has become a major policy issue as Republicans craft their party-line bill for Trump’s agenda, which includes extending his 2017 tax cuts, increasing funding for immigration enforcement and the military, and raising the debt limit. Speaker Mike Johnson, R-La., aims to pass the bill through the House by Memorial Day, with Treasury Secretary Scott Bessent hoping it will reach Trump’s desk by July 4.
Some lawmakers, such as Rep. Austin Scott, R-Ga., support the potential changes to Medicaid, while others, like Sen. Angus King, I-Maine, and Sen.
Lisa Murkowski, R-Alaska, expressed concerns about the impact on states and vulnerable populations. Sen. Susan Collins, R-Maine, suggests supporting work requirements for able-bodied adults without children but opposes cutting benefits. House Minority Leader Hakeem Jeffries, D-N.Y., characterizes the broader GOP package as a significant threat to health care, accusing Trump and Republicans of wanting to take health care away from the American people.
Guthrie acknowledges the challenge of finding consensus within the narrow GOP majority, stating that everything is on the table until they determine where the 218 votes needed for passage lie.
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