Congress
Energy and Commerce Committee’s Medicaid problem just got tougher
It was always going to be tough for House Energy and Commerce Chair Brett Guthrie to rally his members around cuts to Medicaid; his job could soon get even harder.
The House GOP budget blueprint unveiled Wednesday would direct several congressional committees to achieve at least $1.5 trillion in spending cuts across programs under their panels’ purviews — necessary to offset a party-line, budget reconciliation bill to enact President Donald Trump’s domestic agenda.
The Energy and Commerce Committee has been told to find at least $880 billion in savings, or more than half of that total amount, to pay for a massive package that would extend expiring tax cuts, beef up border security and expand American energy production. It’s a far larger number than many House Republicans had originally anticipated.
The bulk of those savings will have to come from making changes to Medicaid, which currently insures more than 70 million Americans. And, in an interview Wednesday, Guthrie acknowledged that one major savings option probably won’t have the support to pass the House.
That’s per-capita caps, under which the Medicaid would be paid for based on population instead of being an open-ended entitlement. It could lead to hundreds of billions of dollars in cuts, and has been raised in the past as one of the biggest possible cost-saving measures on the table.
“I’d personally love per-capita allotments for Medicaid,” said Guthrie, a Kentucky Republican. “I’m not sure we’re going to be able to get 218 votes for that.”
The House Budget Committee still needs to mark up, and approve, the budget resolution, which it intends to do on Thursday; then, the full GOP-led House needs to advance it, with just two votes to spare. But assuming all goes as planned, it could present an even steeper challenge for Guthrie, who was already preparing for a struggle to get committee members to make cuts to the popular health safety-net program — even at more modest levels.
The task could also expose moderate Republicans, many of whom have been working behind the scenes to avert significant cuts to Medicaid among other social safety-net programs, to Democratic attacks.
“This is a heartless and cruel proposal that will ruin people’s lives so the rich can get richer,” Energy and Commerce ranking member Frank Pallone (D-N.J.) said in a statement Wednesday. “It’s a Republican Rip-Off and Democrats will do everything we can to defeat it.”
Guthrie said Wednesday his members need more time to discuss specifics of what policies could be targeted to reach the $880 billion savings goal, but suggested that changes to Medicaid could be in store for states that have opted to expand the program — including many GOP-led states.
The Energy and Commerce Committee is also weighing repeals of programs in the Inflation Reduction Act and other Biden administration climate spending, though Medicaid cuts will have to make up the lion’s share of the savings.
Options previously floated have included work requirements in Medicaid, which would be among the most politically feasible choices for Republicans, said Rep. Gary Palmer (R-Ala.), who chairs the Energy and Commerce Committee’s oversight subcommittee, in an interview. The nonpartisan Congressional Budget Office has estimated work requirements could save more than $100 billion over a decade.
Palmer said ending enhanced federal subsidies for Medicaid expansion states would need to occur on a “glide path, not all at one time,” but that it could lead to $500 billion in savings. He added that the overall spending cut floor is attainable if measures to take on Medicaid fraud are enacted.
“I don’t think it’s a big lift at all when you take into account improper payments,” Palmer said of the committee’s work ahead. “Just requiring states to do regular eligibility checks would address some of the improper payment problems.”
Amid an ongoing tiff with President Donald Trump, Senate Majority Leader John Thune recently joked that public service might be losing its thrill.
“If he could find somebody else to do this job, it might be a big relief,” he told reporters last week after Trump declined to voice confidence in Thune as Senate GOP leader.
But Thune said in an interview that he, for now, anticipates continuing his three-decade congressional career by seeking reelection in 2028.
“My assumption is, going in, that I am,” he said last week after he was asked when he would make a decision about a fifth Senate term representing South Dakota.
But he also left open the possibility things could change as he deals with a mercurial president, a precarious political environment for Republicans and questions that have bubbled up within corners of the GOP about whether he would pursue reelection.
“You know, every election has an impact on that, so we’ll see how it comes out in November,” he added, before reiterating that “the assumption” is that he will run.
Thune’s early assessment of his 2028 plans come as he fights to win elections set to take place this year — the midterm contests that will determine if Republicans keep the Senate majority and the subsequent closed-door, secret-ballot leadership elections that will determine if he remains top leader for another two years.
Thune, according to most GOP senators, is secure in that job, even as Trump sowed doubt in an Oval Office gaggle last week when he was asked about his views of Thune’s leadership.
“We’re going to find out, and I’ll let you know,” said the president, who has repeatedly pushed Thune to pass legislation, the SAVE America elections bill, that does not have the votes to advance.
Even before the latest back-and-forth between the two men, private speculation has swirled around the Capitol about whether Thune might decide to give up his Senate seat just a few years after realizing his long-fought dream of leading the Senate GOP.
“I wouldn’t be surprised if John Thune has had enough,” said one GOP senator who added that “no one would blame him” if he decided to retire in 2028. Like others quoted in this story, the senator was granted anonymity to speak candidly.
Two other Senate Republicans, who both claimed no special knowledge of his intentions, predicted that Thune would retire in 2028. Another GOP senator accused Thune’s right-wing critics in the GOP of trying to use the SAVE America Act controversy to drive down his popularity back in South Dakota, while another Republican chalked any talk of retirement up to “gossip and speculation” versus credible information coming from inside Thune’s orbit.
That’s not to say that Thune isn’t mindful of the obstacles he could face should he choose to seek another term. One is the possibility that Trump could endorse against incumbents in 2028 as he has this year, essentially driving Sens. Bill Cassidy of Louisiana and John Cornyn of Texas out of Congress.
The 2028-cycle Republican thought to be most at risk is Alaska Sen. Lisa Murkowski, but Thune in the interview jokingly acknowledged his own potential vulnerability.
“I mean, if it were today, he probably — I’d probably be on that list,” he said with a laugh.
Speaking about 2028 incumbents generally, Thune said that while Trump’s endorsement “makes a huge difference … a year from now, we could be in a totally different political footing than where we are now, and the world could look a lot different, so it’s hard to say” what effect the president might have.
Without prompting, Thune also made note in the interview of his state’s history for high-profile Republican retirement announcements. President Calvin Coolidge, he recounted, traveled to South Dakota in 1927 and announced there he would not seek reelection to a second full term in 1928.
“I’m not hinting that that’s something impressive that I might follow,” he added.
Some Senate Republicans are openly encouraging Thune to run again.
His GOP delegation mate, Sen. Mike Rounds, described Thune’s standing in South Dakota as “positive.”
“You’ve got two things: You’ve got social media out there, which is driven by a lot of outside sources and some real whack jobs,” Rounds said. “And then you’ve got normal people that see John, respect him, know him, and know what he’s all about — and those are the people that vote.”
“If he decides to run again, and I hope he does, if he does, [the] people of South Dakota will support him,” he added.
Michael Card, a professor emeritus at the University of South Dakota, predicted that Thune would have to spend more time back in the state but that he was in “good shape” if he decides to run for reelection.
“As long as he is seen as pushing the farm bill forward, I don’t think there will really be any real strong candidate,” he added. “And even if they were a strong candidate, they wouldn’t be as strong as John … who knows everybody.”
It’s not the first time fellow Republicans have wondered privately about Thune’s future.
Frustrated by Thune’s lack of support for his efforts to challenge the 2020 presidential election, Trump backed a primary challenge to Thune ahead of the 2022 midterms. After Thune made comments to the Black Hills Pioneer in December 2021 that his wife wanted him back home and he was seriously considering retirement, GOP senators made a crash lobbying effort to convince him to run for reelection.
Thune decided to run, no credible primary challenger emerged, and he earned nearly 70 percent of the vote in the November 2022 general election.
Thune and Trump repaired their relationship in the lead-up to the 2024 election, with Trump staying out of the race to choose Mitch McConnell’s successor as Senate GOP leader. The two worked closely last year to pass Trump’s “big, beautiful bill” and confirm hundreds of presidential nominees — including by changing the chamber’s rules to approve them faster.
But the two men’s relationship has since seen public splits as Trump has applied a single-minded focus to passing the SAVE America Act — including by nuking the filibuster, something Thune claims is off the table for most Senate Republicans.
Trump told reporters last week that his relationship with Thune was “fine” and that they have a “good relationship” even as Trump hammered him to “get his job done” and pass the GOP elections bill. Some GOP senators have privately predicted that Trump will continue to ramp up the pressure on Thune, though they believe how far he goes will depend on what happens in the midterms.
Some online conservative activists have floated the idea of trying to recruit a 2028 primary challenger for Thune. But the South Dakota Republican Party rejected an attempt earlier this summer to censure Thune over his “failure in regards to the SAVE America Act.”
Thune told reporters Tuesday he had spoken to Trump earlier in the day about “issues that he cares about.”
“I wouldn’t say I’m isolated, no,” Thune said, while adding that he has “been very clear about the prospects for the SAVE America Act.”
Sen. Susan Collins said Tuesday she will vote against Todd Blanche’s confirmation as attorney general.
The Maine Republican, who is facing a difficult race for reelection, said in a statement she would oppose Blanche, citing “several actions that have further eroded the Department’s independence.” She specifically mentioned his role in a controversial IRS settlement with President Donald Trump and over having “promised an anti-abortion organization that he would seek to prohibit the mailing of abortion medication to women nationwide.”
Two other Republicans — Bill Cassidy of Louisiana and Lisa Murkowski of Alaska — are known to still be undecided; Blanche needs one of their votes to secure confirmation.
Rep. Ayanna Pressley (D-Mass.) has once again broken ranks with House Democratic leadership over endorsements, this time to support former Missouri Rep. Cori Bush over incumbent Rep. Wesley Bell.
In a post to social media Tuesday, Pressley called on voters to elect “champions” like Bush, who is in a heated primary rematch Tuesday in a contest that lays bare the party’s divide over Israel.
“Whether in Massachusetts, Michigan or Missouri, we all need politicians who fight for us, not corporations,” Pressley said. Her endorsement comes as voters head to the polls for primaries in both Michigan and Missouri, where progressive challengers are taking on moderate incumbents.
It marks the second time this primary cycle Pressley has endorsed against candidates backed by Minority Leader Hakeem Jeffries (D-N.Y.). Last month, she joined a handful of other Congressional Black Caucus members to support Michigan state Rep. Donavan McKinney in his bid to unseat Democratic Rep. Shri Thanedar.
A spokesperson for Jeffries did not immediately respond to a request for comment.
Pressley’s endorsement also sets her squarely against the establishment wing of the party: both Bush and McKinney have been endorsed by their local Democratic Socialists of America chapters.
But the endorsement is unsurprising: she and Bush served as members of the progressive “Squad” in the last Congress and often worked together on legislation. In a previous interview with POLITICO, Bush said she and Pressley continued to talk regularly, even after Bell unseated her in 2024.
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