WHAT TO KNOW ABOUT MEDICAID WORK REQUIREMENTS

A Congressional Budget Office report found the committee met its target of at least $880 billion in cuts through fiscal 2025 and 2034. It did so, in part, by imposing the first federal work requirements on Medicaid and other changes to the healthcare program for lower-income people that would reduce the number of people with health insurance by 8.6 million by 2034.

But in a win for centrist Republicans, the bill leaves out per capita caps on federal Medicaid payments to states.

Although the committee reached its target on deficit reduction, the cuts to Medicaid and green energy programs did not go as far as many fiscal hawks wanted, setting up trouble for leadership, who have few votes to spare to pass the bill through the House along party lines.

“I’m not happy with it,” Rep. Tim Burchett (R-TN) told the Washington Examiner on Monday. 

“To me, we’ve got to keep working on cutting,” Burchett said before making a car analogy. “If you imagine a car speeding at you, and it needs to be going the other direction, it’s got to stop at some point. So I would hope one of these times we get to a stopping point and then start going the other direction on spending, and this is getting us closer to the stop.”

Burchett is not the only fiscal hawk who has expressed disappointment in the bill.

Rep. Chip Roy (R-TX), who has been a critic of the legislation at each of its stages, outlined in a post on X why the cuts don’t go far enough to garner his support. 

Roy argues the bill does not provide any “transformative changes” to Medicaid, and still leaves more than $20 trillion in additional debt over the next ten years. The Texas firebrand was also the first to call for using the budget reconciliation process to fully repeal the Inflation Reduction Act, the 2022 bill passed by Democrats and signed by President Joe Biden.

“I sure hope House & Senate leadership are coming up with a backup plan … because I’m not here to rack up an additional $20 trillion in debt over 10 years or to subsidize healthy, able-bodied adults, corrupt blue states, and monopoly hospital CEOs,” Roy wrote on X. 

Sen. Mike Lee (R-UT) expressed his support of Roy’s sentiment by commenting back a bullseye emoji, showing discontent in the Senate as well. 

Federal Medicaid spending has skyrocketed since the expansion of eligibility under President Barack Obama’s Affordable Care Act. Total Medicaid spending was $333 billion in fiscal 2008 (before Obama became president) and jumped to $860 billion by 2023. The federal share of the costs also increased from 60% to 72% in that time frame, according to analysis from the Paragon Health Institute.

“Medicaid waste and abuse threatens the well-being of America’s most vulnerable as the looming expiration of important 2017 tax reforms throws a shadow over U.S. industry,” Energy and Commerce Chairman Brett Guthrie (R-KY) wrote in an op-ed published in the Wall Street Journal.

“Republicans’ best chance to secure the president’s inaugural promise is this year’s reconciliation bill,” the chairman continued.

The House GOP released its plan late Sunday evening, after weeks of closed-door meetings, to reduce Medicaid spending and much of Biden’s Inflation Reduction Act, which included billions on climate spending. 

The markup of the bill this week could take close to 30 hours on the Energy and Commerce Committee. The House Ways and Means Committee will also hold its hearing on Tuesday on the tax provisions of the bill, after both committees delayed the hearings following a meeting with the White House. 

The committees have intense pressure to complete the markups due to House leadership’s ambitious timeline to pass the bill in the lower chamber before Memorial Day, with the Senate’s final passage by the Fourth of July.

The energy committee reached its $880 billion goal largely through cuts to healthcare. It added “community engagement requirements” of at least 80 hours per month of work, education, or service for able-bodied adults who do not have dependents. It would also require them to verify their eligibility twice a year instead of once. 

The legislation also sunsets the 5% boost to expand Medicaid that was put in place during the COVID-19 pandemic for future states that expand coverage. It also could increase out-of-pocket costs for patients of up to $35 per service for those above the federal poverty line.

Democrats have slammed the GOP proposal from the start. Much of the party’s messaging over the last few months has consisted of talking about proposed Medicaid cuts by holding “days of action” and standing aside those who rely on such benefits. Energy and Commerce Democrats plan on putting up a hard fight in committee on Tuesday.

“Republicans are proposing the biggest health care cut in history so billionaires can pay less in taxes.” Rep. Greg Casar (D-TX) wrote on X, “Hell no.”

Trump expressed his support for the bill on Truth Social, “This bill is GREAT. We have no alternative, WE MUST WIN!” 

Centrist Republicans, who have been outspoken during this process, have remained quiet for the most part on social media since the bill was dropped, with many people claiming this as a win for them.

THE FOUR FACTIONS SPEAKER JOHNSON MUST PLEASE TO PASS TRUMP’S BUDGET MEGABILL

Rep. Nicole Malliotakis (R-NY) spoke about their successes on Monday morning after breaking with some of her colleagues last week over the cap on the state and local tax, or SALT, deductions. 

“We’ve successfully, as a group of moderates, have pushed back on some of those cuts that could have hurt the beneficiaries, and we’re focused really on rooting out that waste, fraud, and abuse,” Malliotakis said on Good Day New York. “Again, we’ll get there, that balance that is needed.”