Republican lawmakers all say their reconciliation bill should target waste, fraud and abuse in Medicaid.
But that unity only lasts as long as members don’t interrogate the definition of “waste, fraud and abuse” too closely.
In interviews with NOTUS this week, Republicans gave very different answers as to what constitutes waste, fraud and abuse within Medicaid, the joint federal-state health care program for low-income and vulnerable people. Some of them believe Medicaid waste, fraud and abuse includes coverage for immigrants. Most Republicans feel there are many able-bodied adults who are on the Medicaid rolls unnecessarily, and that new work requirements would cut costs. At least one member thinks the whole health care system is one big pile of waste, fraud and abuse.
“The entire health care system is broken, in my view, because of government regulation and then the pile-on of Obamacare,” said Rep. Chip Roy. “Waste, fraud and abuse, for me, is that whole corrupted system.”
Rep. Troy Nehls of Texas claimed the program encourages people not to look for work — his version of waste, fraud and abuse.
“A guy would rather sit out on the porch and drink his beer than go to work today because we provide so many, all these damn entitlements,” Nehls complained.
This debate is central to the GOP’s agenda: The House Energy and Commerce Committee is supposed to find $880 billion in cuts from the agencies it oversees, which includes Medicaid, as part of Republicans’ reconciliation package. But some Republican lawmakers are alarmed by the plan, because federal Medicaid cuts would cause a budget crunch for their states and likely a steep reduction in coverage.
In a letter to congressional Democrats on Wednesday, the nonpartisan Congressional Budget Office estimated that reducing federal spending on Medicaid would cause states to spend more of their budgets on the program, reducing spending on other priorities or requiring them to raise revenue through other methods, like increased state taxes. CBO estimated that certain changes to Medicaid would likely mean millions of people would lose coverage by 2034.
“Twenty-one percent of my state is on Medicaid or CHIP,” Sen. Josh Hawley of Missouri told reporters Tuesday. “They’re on Medicaid because they can’t afford anything else. They’re not on Medicaid because they’re lazy. They’re on Medicaid because health insurance is so dadgum expensive.”
“I don’t understand the argument that says, ‘Yes, congratulations working folks, you voted for Donald Trump, and now we’re going to take away your access to health insurance,’” he continued. “It seems insane to me.”
Hawley told NOTUS he is “all for getting rid of waste and fraud,” but not anything that would “actually cut benefits for working people who are dependent on the program.”
He, like a group of more centrist Republicans who met with House Speaker Mike Johnson on Tuesday night, is willing to consider new work requirements. But he said he’s uncertain about targeting Medicaid provider taxes, which boost the amount of federal money states receive under the program, and he’d rely on feedback from officials in his state about how it would affect their work.
Conservatives who want to slash federal spending argue the states should have to take a larger role in providing for residents anyway, rather than relying on the federal government.
“Texas is the eighth-biggest economy in the world,” Roy told reporters last week when asked about going after Medicaid provider taxes. “If Texas can’t figure out how to take care of its own people, then what the hell are we doing?”
“Yes, there would be an impact on rural hospitals and clinics,” Roy acknowledged. “But you know what? I think we can figure it out.”
Republicans tried to cut federal spending for Medicaid in their 2017 effort to repeal the Affordable Care Act, but moderate members feared it would strip health coverage from vulnerable populations — and they faced fierce pushback in their districts. GOP leaders have a smaller margin for disagreement now than they did then. The House majority is so slim the entire conference has to remain unified to pass the bill over Democratic opposition.
Rep. Zach Nunn, an Iowa Republican, is trying to prevent cuts that would affect seniors, children, pregnant women, and people with disabilities by offering a resolution blocking any such changes in the budget reconciliation process. Nunn said in a press release that he would prefer his party to focus on improper payments and scammers.
“The mission we have in front of us in the budget process is to find and eliminate fraud while protecting benefits for those who deserve them,” he said.
Other members are trying to stay out of it until they know more details.
“I’m going to wait and see what they come up with,” Rep. John Moolenaar of Michigan told NOTUS of the committees drafting the legislation.
Rep. Jodey Arrington, who chairs the House Budget Committee tasked with creating instructions for the reconciliation bill, said he wants the legislation to target provider taxes, end coverage for immigrants who entered the country unlawfully, and for the government to review Medicaid rolls twice per year instead of only annually.
“It is one of the most wasteful, fraudulent and broken programs here, of all the entitlements in the federal government,” Arrington said.
He brushed off concerns from states: “Everybody wants their money.”
“Those people who found a way to game the system, both states and other stakeholders who have drawn down money outside of the services provided to Medicaid beneficiaries, they all want to keep their money,” he said. “And they’re all descending on this town to try to prevent the changes that would take that money away from them.”
—
Haley Byrd Wilt is a reporter at NOTUS.