House Republicans aren’t on the same page on Medicaid cuts. But they appear to be reading from an entirely different book than the Senate — and maybe even President Donald Trump.
On Tuesday, Trump told House Republicans not to “fuck” with Medicaid in the reconciliation bill. It should have been a rough wake-up call for conservatives, who want Medicaid rollbacks to pay for their newfound policy initiatives, though many seemed to be interpreting Trump’s comments in creative ways.
But Trump’s warning was welcome news to a number of Senate Republicans already skeptical of the House GOP’s Medicaid provisions.
“I hope congressional Republicans are listening,” Sen. Josh Hawley wrote Tuesday on X.
Still, after a visit from Speaker Mike Johnson to the Senate GOP lunch that same day, Hawley didn’t sound totally assured. He said it “remains to be seen” whether the House and the Senate are anywhere close to alignment on Medicaid.
“Let’s see what the House ultimately does,” Hawley told NOTUS. “We heard from the speaker. My sense is they haven’t quite landed the plane there.”
Hawley seemed hopeful that Trump’s preferences would carry some weight, though House Republicans appear to be moving forward with a bill that includes substantial cuts.
“Johnson just said that the president — as has been reported by all — the president was emphatic this morning, he wanted no Medicaid benefit cuts,” Hawley said. “None.”
Other GOP senators cast Trump’s remarks on Tuesday as a gut check for House Republicans, who are still weighing hundreds of billions of dollars in additional Medicaid cuts, on top of the more than $700 billion their legislation already slashes from the program.
“I think he had to force the point over there,” Sen. Thom Tillis said of Trump. “Go find other ways to cut spending and be deficit neutral, but don’t do it by changing beneficiaries who fit all the qualification criteria.”
As House Republicans inch closer to passing a reconciliation bill, Senate Republicans are looking at the legislation with a mix of fear and bewilderment. Cutting close to a trillion dollars from Medicaid over the next decade would decimate many hospitals. Initial projections have estimated that the House’s current bill would result in 8.6 million people losing Medicaid coverage, on top of another 5 million projected to lose coverage already over expiring tax credits.
House Republicans are trying to move up the implementation date for work requirements for able-bodied recipients, from 2029 — after the next presidential election — to December 2026. Such a change would result in even more people losing coverage, and even more profound political implications.
A number of Senate Republicans have expressed concerns about the Medicaid cuts and suggested those reductions could prevent them from supporting the reconciliation bill. That includes members from high-enrollment states, like Hawley, and moderate swing-voters like Sens. Susan Collins and Lisa Murkowski.
Proposed changes to Medicaid cuts have already become campaign fodder against vulnerable 2026 incumbents, bolstering concerns from holdouts.
Collins said before a closed-door meeting Tuesday that the House’s Medicaid plan “matters a great deal to me.
“I’ll be interested in his report,” Collins said of Johnson. She added that Medicaid details in the bill so far seem like “a moving target.”
After the meeting, NOTUS asked Collins if she found the speaker’s remarks at the lunch encouraging.
“I’m not going to characterize it other than to say it was an interesting lunch, and he did a good job,” Collins responded.
It’s essential for Republicans to find a compromise on Medicaid if they’re going to pass a reconciliation bill that nearly amounts to Trump’s entire legislative agenda.
Conservatives in the House are staking out a hard-line position that anything short of substantial policy changes that alter the trajectory of Medicaid would be unacceptable. Moderates in the Senate have taken the position that anything beyond cutting “waste, fraud and abuse” won’t be palatable.
There are at least three Senate Republicans who seem inclined to vote against the House’s bill over Medicaid provisions — Collins, Murkowski and Hawley — and Sen. Rand Paul all along has seemed unlikely to support the final product over a number of fiscal concerns.
One of those four Republicans would have to budge. Otherwise, the Senate is going to send back a bill shorn of Medicaid cuts and dare House Republicans to hold up Trump’s agenda over it — something conservatives seem more than willing to do.
The reconciliation bill is the GOP’s best chance at passing sweeping changes into law this term. It is one of the only maneuvers that will avoid the 60-vote threshold for a filibuster in the Senate, and Trump and Republicans seem to have given up on the prospect of bipartisan lawmaking.
Exiting lunch on Tuesday, Speaker Johnson told reporters he was simply giving senators an “update” and to “encourage them to stick with us.” When asked about the apparent differences between the House and Senate on the reconciliation bill, Johnson was unconcerned.
“We’ll work it out together,” he said.
But the two chambers seem increasingly far apart on Medicaid.
Several Republican senators emphasized that no one in their conference was looking to strip Medicaid benefits from those who deserve it.
“We’re not looking at actually doing reforms to Medicaid. What we’re looking at is getting the fraud and the waste,” Sen. Markwayne Mullin told NOTUS. “Without that happening, without that being in there, I don’t think that they would pass it.”
How Republicans define “waste, fraud and abuse” is the question. House conservatives suggested Tuesday that changing the Federal Medical Assistance Percentage — how much the federal government pays for certain enrollees — was part of going after waste, fraud and abuse. For most Republicans, that’s nonsense.
But Republicans all seem to have different interpretations of what’s a legitimate area to address with Medicaid.
Sen. Ron Johnson said the bill would not pass without cutting waste, fraud and abuse within Medicaid, suggesting his interpretation of that standard was broader than others.
“The mistake everybody’s making is we’re referring to it as Medicaid. We all want to preserve Medicaid. It’s the Obamacare portion,” Sen. Johnson said. “That’s driven the states to commit all kinds of, from my standpoint, legalized fraud and putting at risk Medicaid for the vulnerable.”
Obamacare was also top-of-mind for the Senate Budget Committee’s chair, Sen. Lindsey Graham, who echoed the message that not all of Medicaid is subject to change. He specifically said he never liked the so-called 90-10 rule, where the federal government pays for 90% of the costs for those who get Medicaid under the Obamacare expansion, while states only pay for 10%.
“I’m definitely opposed to codifying Obamacare, and that’s where we’re headed if we don’t watch it,” Graham said. “Basically, we all ran from the idea that Medicaid was expanded to able-bodied people.”
Hawley said he was “not opposed” to ridding the program of waste, fraud and abuse, “but benefit cuts is a different deal.”
For now, senators seem to think they will produce a bill with a ‘less-is-more’ approach to cuts.
As Sen. Mike Rounds said, “The more you add in, the more opposition you may have.”
“If we can get consensus on some additional cuts that everybody says is truly waste, fraud and abuse, fantastic,” he said. “That’s a positive for the American people, but let’s make sure that it is not something that takes away from votes.”
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Ursula Perano is a reporter at NOTUS. Em Luetkemeyer is a NOTUS reporter and an Allbritton Journalism Institute fellow.