Republican Rep. Ken Calvert has been getting a lot of calls from people concerned about Medicaid recently.
His southern California district is one of the most competitive in the House, and over 20% of those in his district under 65 — and over a third of the children — rely on Medicaid.
His message to those calling his office: “It’s going to be fine, don’t panic.”
“We’re talking about a budget agreement that has nothing to do with Medicaid,” Calvert told NOTUS. “Not one word of Medicaid in the bill.”
The House budget resolution doesn’t explicitly call for Medicaid cuts. But it does call for at least $880 billion in mandatory spending cuts to programs under the Energy and Commerce Committee’s purview. To get to that number, Medicaid cuts would almost certainly be a necessity.
In the end, despite days of growing uncertainty from front liners, Speaker Mike Johnson got all Republicans concerned about Medicaid on board. The only GOP holdout was Rep. Thomas Massie, who voted against the budget because it didn’t cut enough.
After some drama on the House floor, the budget resolution was ultimately adopted Tuesday night 217-215.
Over the last couple of days, Johnson and Republican leaders met repeatedly with the members who have expressed concerns about Medicaid cuts, and President Donald Trump also made calls to push the undecideds toward the plan. The argument? This is a framework to get negotiations started, and spending cuts will ultimately be lower than what this resolution states.
“It will not be 880 when it’s all said and done,” Rep. Don Bacon said. “I’ve been assured the number is going to be a lot better.”
While hardly a firm commitment, that reassurance was enough for all of the Republicans who have publicly expressed concerns about potential Medicaid cuts.
But even though the resolution got across the line, Johnson still has a major issue: Any Medicaid cuts — beyond addressing work requirements and supposed fraud within the program — will lead to lost votes from more moderate Republicans. And a reduction in the spending cuts will dissuade conservatives from supporting a final resolution.
It’s a classic legislative dilemma: Move one inch in one direction and you lose an inch of the conference in the other direction.
“If it has fewer cuts, it may not be able to pass,” Freedom Caucus Chair Andy Harris said of the budget.
Rep. David Valadao, a Republican whose district lies in California’s Central Valley, has more constituents who rely on Medicaid than any other district in the country. He was undecided on the budget resolution in the lead up to the vote after meeting repeatedly with leadership.
In the end, Valadao supported the resolution.
“This bill doesn’t have a path to become law in its current form, it’s gonna get changed at some point,” Valadao said Tuesday afternoon.
Valadao added that Johnson is doing “the best he can” in navigating a one-seat majority, and that the speaker has “got to look at the path of least resistance.”
The question is whether that path requires upsetting moderates or conservatives more.
Traditionally, conservatives have proven you have to cater to them — and moderates have proven that you can largely disregard their demands.
“Maybe for moving it out of the House, it is,” Valadao said of a path upsetting moderates, “but ultimately, it’s not going to be the path of least resistance for the bill to become law.”
For instance, Trump called Rep. Jeff Van Drew twice on Tuesday and once on Monday. Van Drew, a former Democratic member who switched parties at the end of 2019, said he still had concerns.
“There’s not specific mention of Medicaid itself, obviously, but Energy and Commerce takes over an $800 billion cut,” Van Drew said.
“I want some guarantees and commitments that we’re going to make sure that we don’t harm Medicaid,” he said. “The president has reassured me, which is very good in itself, but nevertheless I want to hear it from leadership.”
Leadership slowly moved the needle by talking to these members, winning over more vulnerable Republicans this week. New York Rep. Nicole Malliotakis, for example, was leaning no last week. But she and a handful of other holdouts met with Majority Leader Steve Scalise and Energy and Commerce Chair Brett Guthrie on Monday night. And after the meeting, Malliotakis said she was leaning yes.
Rep. Rob Bresnahan — a front line freshman Republican who flipped his northeastern Pennsylvania district — came out early and strong this month in opposition to gutting Medicaid. More than a quarter of his constituents are recipients, he’s noted.
“I don’t want to be in a position where we get this train out of the station and run out of railroad track. So I want to make sure the math adds up and we have a comprehensive plan to getting this across the finish line,” Bresnahan told NOTUS on Monday afternoon.
Then he met with Scalise and Guthrie.
“We’re not going to gut Medicaid or Social Security under any circumstances. Nothing has changed since we spoke earlier today,” Bresnahan told NOTUS.
But he also emphasized that the House resolution “is just what begins this process,” and that “it’s certainly not the final piece of legislation.”
Bresnahan ultimately voted for the resolution.
Even outside of the front line Republicans, other GOP members who were already in support of the resolution are feeling the backlash to the potential Medicaid cuts.
Wisconsin Rep. Scott Fitzgerald faced protests at a town hall last week when he was largely questioned about Medicaid. Wisconsin is one of a handful of states to have not adopted a Medicaid expansion, but plenty of his constituents are still recipients.
When asked if he was concerned about the potential for Medicaid cuts, he was emphatic that you have to “watch the numbers.”
“Even though, you know, they’re making a point right now in the room that there is zero description of Medicaid in the resolution itself, that’s going to be what’s discussed after we get this thing through,” Fitzgerald told NOTUS.
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Katherine Swartz is a NOTUS reporter and an Allbritton Journalism Institute fellow.