WASHINGTON — A group of moderate Republicans is threatening to withhold support from President Donald Trump’s massive tax reconciliation bill if the package includes substantial cuts to Medicaid for vulnerable populations.
In a letter sent to GOP leadership on Wednesday, a dozen House Republicans warned that spending cuts to Medicaid would negatively affect Americans who depend on the welfare program and threaten hospitals that rely on the federal funding for services. The letter marks the beginning of what is likely to be a high-profile fight over what programs to slash as Republicans hunt for spending cuts to pay for Trump’s tax package.
“We support targeted reforms to improve program integrity, reduce improper payments, and modernize delivery systems to fix flaws in the program that divert resources away from children, seniors, individuals with disabilities, and pregnant women — those who the program was intended to help,” the lawmakers wrote, according to a copy of the letter obtained by Deseret News. “However, we cannot and will not support a final reconciliation bill that includes any reduction in Medicaid coverage for vulnerable populations.”
That should raise alarm bells for House Speaker Mike Johnson, R-La., who is working with a historically slim majority in the House and facing a Democratic defense that won’t budge in his direction. Current margins give Johnson a three-seat majority, meaning he can’t afford many holdouts if he wants to ensure its passage.
It’s not yet clear where these lawmakers will draw the line for their support, or if they all have different levels of demands.
But Johnson has already seen some amount of pushback from lawmakers who signed on to the letter. For example, New York Reps. Nick LaLota and Nicole Malliotakis were among a group of moderate Republicans who stalled on a crucial vote to advance Trump’s tax package earlier this month.
The pair were seen talking with Johnson on the House floor as they held back their vote for several minutes before ultimately agreeing to vote in favor of the resolution. Much of that conversation centered on Medicaid cuts, with the lawmakers telling reporters the speaker had promised to take a “compassionate approach,” according to LaLota.
The letter comes as Republicans prepare to draft the massive reconciliation bill, which will seek to extend trillions of dollars in tax cuts while also approving several other components of Trump’s agenda.
However, the package has raised concerns among Democrats and moderate Republicans as some of their hardline colleagues have suggested securing those cuts by paring away at programs such as Medicaid.
Those concerns stem from the budget resolution requiring $880 billion in cuts from the Energy and Commerce Committee, the panel largely responsible for overseeing Medicaid.
A recent study by the Congressional Budget Office, a nonpartisan agency that provides budget and economic information to Congress, showed that lawmakers would likely need to slash Medicaid funding to cover the lost tax revenue from extending the 2017 tax cuts.
In the CBO’s budget projection, Medicaid accounts for roughly 93% of non-Medicare related mandatory spending in that time period. When one removes Medicare, Medicaid, or the Children’s Health Insurance Program from the equation, funding under the committee’s jurisdiction is only $381 billion.
Of that amount, more than half is already paid for by collection programs or user fees, according to The Washington Post, meaning that even if the committee slashed programs under the remaining $135 billion, it would still fall far below the $880 billion target outlined in the budget.
Still, lawmakers have left the door open to root out waste, fraud, and abuse related to Medicaid, giving GOP leaders some wiggle room when it comes to finding spending cuts. However, the moderate Republicans have made clear they will not sign on to something that threatens access to healthcare for low- and middle-income families.
“We are committed to working with you to preserve Medicaid and identify responsible savings through deregulation, streamlining federal programs, and cutting administrative red tape,” the lawmakers wrote. “Communities like ours won us the majority, and we have a responsibility to deliver on the promises we made.”