In the House, even with conservatives and moderates largely aligned on the idea of cutting Medicaid, passing those cuts in the massive reconciliation bill would be a political feat for Republican leaders, particularly when you consider how different factions of the House GOP want different cuts greatly varying in scope.
But in the Senate, passing any substantial Medicaid reductions won’t be so easy.
On Monday, Sen. Josh Hawley penned a blistering op-ed in The New York Times urging Republicans to abandon Medicaid cuts, drawing on President Donald Trump’s declaration last week that Republicans “are doing absolutely nothing to hurt Medicare, Medicaid or Social Security. Nothing at all.”
“If Republicans want to be a working-class party — if we want to be a majority party — we must ignore calls to cut Medicaid and start delivering on America’s promise for America’s working people,” Hawley wrote.
But if Republicans are doing “nothing to hurt” Medicaid, Trump may want to check what lawmakers are proposing in the House.
Rep. Brett Guthrie, chair of the House Energy and Commerce Committee, released a slate of proposed cuts Sunday night that would drastically reduce Medicaid spending and result in 13.7 million people losing their coverage, according to a letter from the Congressional Budget Office. (About 5 million people were already expected to lose coverage as a result of expiring tax credits.)
Guthrie on Monday called the CBO’s projections “incorrect” and said Democrats “claimed an artificially high number in alleged coverage loss just so they can fearmonger and score political points.”
Energy and Commerce, which oversees Medicaid and other key social welfare programs, was responsible for finding $880 billion in cuts. The committee found “north of $900 billion,” Guthrie said on a call with members. (The CBO agreed with Guthrie’s number, projecting that his legislation would cut $912 billion over the next decade.)
Even still, Guthrie’s proposal was widely perceived on Capitol Hill as a Goldilocks attempt to strike a balance between the Medicaid protections that moderates required and the deep cuts that conservatives demanded. Move an inch to appease hard-line conservatives, Guthrie would risk losing moderates; move an inch to the middle, he’d lose the other end of the conference.
Sure enough on Monday — the day before Energy and Commerce’s much-anticipated markup and weeks before Speaker Mike Johnson’s Memorial Day deadline for passage — plenty of Republican lawmakers blasted Guthrie’s balancing act as either too hot or too cold.
“I sure hope House & Senate leadership are coming up with a backup plan,” influential Freedom Caucus member Rep. Chip Roy posted Monday on X.
The bill stops short of the most drastic cost-cutting measures that worried moderates — namely reducing the Federal Medical Assistance Percentage, or FMAP, which governs how much the federal government pays for certain enrollees and how much states contribute. Adjusting the FMAP breakdown, or instituting per capita caps on Medicaid benefits, would blow up many state budgets, and moderates made it clear they wouldn’t tolerate those cuts.
But the legislation includes three changes Republicans have pushed for from the start: work requirements for able-bodied adults, decreasing federal support in states that provide coverage for undocumented immigrants and conducting more frequent eligibility checks.
The work requirements wouldn’t go into effect until 2029, however, and most of the other reforms wouldn’t go into effect for at least two years. That timeline is a big problem for some conservatives.
Freedom Caucus members posted streams of messages on X that, while conspicuously vague, hardly celebrated the proposed Medicaid changes. Rep. Andy Ogles, for example, wrote that “Congress must fix it—no more excuses, no more freeloaders.”
Rep. Scott Perry told WHP 580 radio station in Harrisburg, Pennsylvania, on Monday that he, too, thinks the cuts in the Energy and Commerce bill don’t go far enough.
“I’m not going to be bamboozled with crazy growth projections,” Perry said. “They always do kind of voodoo math to get what they want.”
Perry added that conservatives would “push hard to get us in the right place.”
Conservatives in the House have to contend with Republican senators, however. And early indications were that, rather than not going far enough, the House’s Medicaid cuts had gone too far for senators.
“I’m all for work requirements, all the kind of stuff like that, all the abuse and everything, get rid of all that,” Sen. Jim Justice told NOTUS. “But as far as cutting in the bone, no, I’m not gonna go for that.”
Exactly what constitutes “cutting to the bone” for Justice and other Republicans remains to be seen. But Sens. Lisa Murkowski and Susan Collins — moderates who have expressed discomfort with cuts — both seem like they may not go along with the House’s proposal.
Hawley’s New York Times op-ed also puts him in that doubtful category.
Those three members are all that Senate Majority Leader John Thune can afford to lose with his tight majority. Just one more opponent would topple the whole endeavor, restarting what’s already been a grueling reconciliation process.
But Sens. Rand Paul and Mike Lee have also expressed deep concerns about the Energy and Commerce bill, both telling NOTUS that the cuts weren’t steep enough.
“I do fear that all the really large-ticket items reducing spending have sort of been excluded, so I have a feeling it’s going to be wimpy on the spending cuts,” Paul said. “They aren’t going to cut any spending that’s significant.”
Sen. Ron Johnson also wrote in a Wall Street Journal op-ed Monday that he is prepared to outright oppose the reconciliation package in its current state.
“It’s essential that Congress deviate from its current path,” Johnson wrote.
All of these challenges are before the political reality of cutting benefits — and simply extending current tax rates — sets in.
Throughout reconciliation talks, vulnerable Republicans have repeatedly made clear they think Democrats will use Medicaid cuts to attack them in the 2026 midterms. Those suspicions were confirmed Monday when Democratic campaign brass were already pouncing on the proposed cuts to paint Republicans as “extremists.”
“Enough with the empty rhetoric from the so-called moderates,” Democratic Congressional Campaign Committee spokesperson Justin Chermol said in a statement. “Their latest bill makes it crystal clear: these extremists are targeting Medicaid, threatening essential health care and plotting to hike costs — all to bankroll massive tax handouts for billionaire donors like Elon Musk.”
Still, key moderate Republicans largely stayed quiet on Monday.
Without House votes, most of those vocal moderate House Republicans didn’t have to confront the onslaught of reporters asking for their reaction. And hardly anyone was leaping to comment on the legislation on social media.
Of course, moderates staying quiet might mean they’re preparing to swallow the legislation. While they are loath to celebrate a bill that limits Medicaid, they also aren’t likely to hammer a bill they know they might ultimately support.
After all, despite raising concerns about the budget reconciliation blueprint in April — including during a tense confab with Johnson on the House floor during the vote — they ultimately backed the resolution.
But even if House and Senate Republicans can rally behind the Medicaid reforms as they stand, there are plenty of other messes GOP leadership has to clean up.
House members seeking an increase to the state and local tax deduction cap — known as the SALT caucus — are already swinging against the Ways and Means Committee’s tax proposals. Rep. Nick LaLota, for one, has already declared himself a “hell no.”
And then there are the fights outside of Medicaid and SALT. The reconciliation bill is also expected to cut the Supplemental Nutrition Assistance Program and clean energy tax credits, as well as raise the debt ceiling.
“It’ll be ironic and sad in a way that conservatives will be voting for the largest increase in the debt ceiling,” Paul said. “And so I’m just not for that.”
—
Katherine Swartz is a NOTUS reporter and an Allbritton Journalism Institute fellow. Riley Rogerson is a reporter at NOTUS.