Modern Healthcare article, 2/19/25 – useful article going backwards to last Thursday and looking ahead:  

The prospect of a Medicaid overhaul has focused new attention on this critical safety net program that serves nearly 73 million Americans and accounts for one-fifth of health care spending.

About 1 in 5 Americans have Medicaid, ranging from about 11% of people in Utah to 34% in New Mexico, per a KFF analysis.

People who qualify for Medicaid based on age or disability account for more than half of spending.

A House budget resolution calling for as much as $2 trillion in cuts to mandatory spending has left moderate House Republicans concerned about possible cuts to their constituents’ Medicaid benefits.

Democratic-aligned groups have launched ads and messaging memos aimed at pressuring some of these lawmakers.

In Washington, Medicaid cuts emerged as an especially sensitive flash point Thursday during the first public debate over a House Republican plan to extend tax cuts and slash federal spending.

Republicans at a House Budget Committee markup insisted they only want to target waste, fraud and abuse in Medicaid, and defended themselves against Democratic assertions that GOP policies would hurt people and medical providers. Democrats said harm is inevitable if Republicans want the Energy and Commerce Committee, which has jurisdiction over Medicare and Medicaid, to find $880 billion in budget cuts over the next decade.

Illustrating the sensitivity of the charges and showing the potential pitfalls they face in being seen as taking healthcare away from people, Republicans insisted they are answering the call of voters who elected President Donald Trump, and that no such calamities would be forthcoming.

“We will right-size this bloated bureaucracy. We will root out the massive waste and fraud in the federal government,” said Budget Committee Chair Jodey Arrington (R-Texas). “What we learned from November’s election, and I think what is abundantly clear to all, the American people want their country back. They want normal. They want to return to common sense.”

Arrington insisted there is none of the cruelty in the budget that Democrats see when they point to the $880 billion Republicans want cut. Voters care about their neighbors, but don’t want to see the system abused, he said.

“They want to help their fellow Americans in their time of need, but they expect their fellow Americans, when they’re able, to help themselves,” Arrington said.

Among the changes Republicans are considering are block-granting Medicaid funding to states and instituting work requirements for beneficiaries.

House and Senate GOP leaders are gearing up for a major push to extend tax policies from the Tax Cuts and Jobs Act of 2017, which Trump enacted during his first term and which are his top priority this year. The nonpartisan Congressional Budget Office projects that renewing these tax cuts for corporations and wealthy households would increase the budget deficit by $4.6 trillion over 10 years.

As such, congressional Republicans are scouring federal programs for spending cuts, and attempting to fulfill the party’s decades-long campaign to shrink the social safety net.

Congress is utilizing an expedited process known as budget reconciliation that allows bills altering taxes and spending to pass the Senate on simple majority votes without being subjected to filibusters that require 60 votes to end. Republicans have a 218-215 majority in the House and a 53-47 advantage in the Senate.

On Thursday, the Budget Committee considered a resolution that instructs other committees to assemble $1.7 trillion in spending reductions, or 37% of what the tax cuts will cost. More than half would come from the Energy and Commerce Committee. Trump has promised not to enact Medicare cuts, leaving Medicaid as the most obvious source of savings.

Nevertheless, some Republicans went so far as to deny the Energy and Commerce Committee will propose healthcare cuts.

“The first thing is, they’re going to make a bunch of claims about what’s in this bill, about what’s being cut, what’s being cut from this Medicaid program or this welfare program,” said Rep. Blake Moore (R-Utah). “This is a framework of dollars about where we’re going. It’s just a balance sheet. It does not have specifics about programmatic changes.”

Another, Rep. Andrew Clyde (R-Ga.), pointed out that the programs the Energy and Commerce Committee oversees are projected to spend about $20 trillion over 10 years, suggesting that even though much of that is for health programs, there is plenty of room to find $880 billion.

Yet Clyde identified Medicaid spending as worth cutting, citing nonpartisan Government Accountability Office estimates of $50 billion a year in improper payments. Clyde also suggested the federal government should crack down on state provider taxes to save more than $300 billion. Many states supplement their share of Medicaid expenses by taxing providers, which has the effect of increasing federal spending.

Rep. Buddy Carter (R-Ga.), who chairs the Energy and Commerce Committee’s Health Subcommittee, said savings would be achieved by targeting providers and abuse, and insisted people would not suffer.

“We will not be kicking people off of Medicaid. That is not what is going to happen,” Carter said. “What we will succeed in doing is making sure that we stabilize, making sure that we secure, making sure that we strengthen Medicaid by eliminating waste, fraud and abuse that is going to a lot of providers.”

Previous GOP attempts to scale back Medicaid, most notably the failed 2017 effort to repeal the Affordable Care Act of 2010, led to widespread backlash from the healthcare sector and the public at large. Republicans lost the House majority in the 2018 midterm elections.

Democrats, aware that hospitals, doctors, health insurance companies and the public react poorly to huge healthcare cuts — and are already criticizing the GOP plans — highlighted the impossibility of extracting major savings without people losing coverage.

“We are letting people know what the real consequences will be. There will be real pain,” said Budget Committee ranking member Brendan Boyle (D-Pa.). “You don’t get $880 billion, as well as the other cuts that are in here, by just saying, ‘Oh, it’s waste, fraud and abuse.'”

“Just be genuine. Say ‘Look, these are going to be the consequences,'” Boyle said. “Just acknowledge that you don’t think the government should be in the Medicaid business, you don’t thing the government should be in the Affordable Care Act business. Because that, in the end, is really what we’re talking about.”

The Budget Committee is expected to approve the resolution Thursday evening. House Speaker Mike Johnson (R-La.) wants committees to finish their work quickly so the House can pass a final bill in May.

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This arrived moments ago from the Congressional Progressive Caucus Center.  Good write up, fairly easy to understand:

This morning, President Trump threw his support behind the House GOP’s plan to advance his legislative agenda, prompting House Republican leadership to announce a key vote next week. Below, we’ll walk through what could happen next and how Congress’ moves relate to Elon Musk’s attacks on services communities depend on. But first…

Trump backs House plan to gut Medicaid and SNAP to fund corporate tax breaks

As a reminder: congressional Republicans aim to use a process known as budget reconciliation to renew and expand corporate-friendly tax policies from the first Trump Administration; greenlight hundreds of billions of dollars for the military and deportations; and defund programs like Medicaid, which provides health care to more than 70 million Americans. To learn more about this process, check out The Basics of Budget Reconciliation.

Right now, the House and Senate—while both GOP-controlled—favor different paths to enacting that agenda. Each chamber’s budget committee approved its respective proposal last week on a party-line vote.

You can read more details about the Senate’s proposal here, and the House’s here, but below is a quick rundown on how the options differ: 

• The Senate’s proposal tees up a two-bill approach to reconciliation, while the House aims to do just one. For more on why that matters, see our January 10 update.
• The House proposal makes room for massive tax cuts for corporations and the ultra-wealthy. The Senate’s proposal does not.
• The House aims to spend a lot more than the Senate does ($4.8 trillion in the House vs. $521 billion in the Senate). Again, this is largely because of taxes. 
• The House’s proposed cuts are way bigger than the Senate’s ($1.5 trillion with a goal of $2 trillion in the House vs. at least $4 billion in the Senate). 
• The House wants to raise the debt ceiling by $4 trillion. The Senate’s proposal doesn’t touch the debt ceiling.

What would the House GOP plan do?

In a nutshell: the budget blueprint House Republicans unveiled last week would defund Medicaid and food assistance to pay for trillions of dollars in tax breaks for the mega-rich and corporations.

Below are just a few of the impacts this could have for American families. 

• 36 million Americans or more could lose their Medicaid health insurance coverage. Data shows that about two-thirds of people who lose Medicaid coverage experience some period without any health insurance in the year that follows. That means more than 20 million people could find themselves without insurance entirely if they’re in an accident or face a cancer diagnosis.
• More than 40 million Americans could see their SNAP assistance (food stamps) shrink, with many losing assistance altogether. Two-thirds of people receiving SNAP assistance are in families with children, and data shows that by making it easier for people to afford healthy food, SNAP has a lasting, positive impact on those kids’ long-term health. However, kids who lose even some of their SNAP benefits become more likely to skip medical care as their families try to make ends meet. 
• Defunding Medicaid and SNAP affects people who don’t use those programs. Even folks who don’t participate in SNAP or have Medicaid coverage could feel these cuts’ effects. For example, states might seek to continue covering people enrolled in Medicaid—but to do so, they’ll need to raise taxes or cut spending elsewhere to shift resources to Medicaid coverage. That, in turn, means folks who aren’t enrolled in SNAP or Medicaid could see higher tax bills or less state investment in education. 

What happens now? 

The Senate GOP was poised to move its plan to a vote in the full Senate tomorrow. However, President Trump endorsed the House’s approach this morning, which could prompt Senate Republican leaders to reconsider their plans. 

Without getting too into the procedural weeds, tomorrow’s vote would have forced Senate Republicans to take a lot of votes that could be politically harmful. The reconciliation process makes those kinds of votes inevitable (more on why in The Basics of Budget Reconciliation). But it’s one thing to take tough votes to advance a proposal that’s likely to be signed into law—the tradeoff calculus changes a bit when the President says he likes another option better. So, keep an eye out for a change of plans on the Senate side. 

This does not mean the House GOP’s plan is a done deal

Reporting indicates that “at least double digits” of House Republicans are wary of voting for their leaders’ budget proposal on the House floor—the next step in this process—given the massive cuts on the table for programs their constituents depend on, like Medicaid. But House GOP leadership can’t afford those defections: if every current House member is voting and every House Democrat opposes the GOP budget proposal, Republicans can lose at most one GOP vote. 

Now that President Trump has publicly thrown his support behind the House proposal, there will be added pressure on Republicans who are still on the fence to get in line behind the President’s agenda. Whether enough of them do remains to be seen—and even then, positions can change. I say that because this isn’t the first time there has been House GOP unease about backing Trump’s agenda, particularly around health care. 

In 2017, the GOP-controlled House had to call off its first attempt to repeal the Affordable Care Act (ACA) given some Republicans’ refusal to back the bill—only for enough of those members to flip and get ACA repeal through the House just over a month later. But, of course, that still wasn’t the end of the story for ACA repeal. 

I raise this example to underscore that there may be lots of fits and starts ahead—even when it might seem like the GOP’s agenda is on a glide path, be it to victory or defeat.

A multi-pronged attack on working families

Republicans in Congress are setting out to defund programs like Medicaid to fund tax giveaways to billionaires and corporations while President Trump and his mega-donor, Elon Musk, are laying waste to services families depend on so our government works in their interest. 

These parallel efforts will have the same result: a government that serves the mega-rich, not working families. 

Take, for example, Trump’s firing of National Labor Relations Board member Gwynne Wilcox, leaving the Board unable to effectively penalize employers who violate workers’ rights. Preventing the Board from upholding workers’ rights benefits Musk, as the Board was leading two dozen investigations into his companies—but it also makes it easier for corporations to put off recognizing unions, illegally fire workers for organizing, and more. For more details, check out What is the crisis at the National Labor Relations Board (NLRB)?

Just like defunding Medicaid to pay for corporate tax breaks, attacks on watchdogs that keep those corporations in check have real, harmful consequences for working people. We’ll continue to share information about what the White House and Congress’ next steps might be, and what they mean for you.