Congress

States bear the brunt of House GOP Medicaid plan

Published

1 year ago

May 12, 2025

House Republicans opted against some of the most dramatic changes they had been considering for Medicaid, the joint federal-state program covering nearly 80 million Americans. But they are plowing forward with other major initiatives that could leave millions without coverage as the GOP starts laying out key provisions of its party-line domestic policy megabill.

The House Energy and Commerce Committee proposal released Sunday night attempts to strike a balance between satiating conservatives’ thirst for deep cuts to the program and placating moderates wary of major coverage losses for low-income Americans.

It does not include the most controversial ideas, including per-capita caps on federal Medicaid payments to states, but it incorporates new mandates that will likely force states to revamp how they finance their programs or cut benefits. It also includes new work requirements that are expected to lead many people to lose coverage, as well as a new cost-sharing requirement for some beneficiaries in the program, not to exceed five percent of a patient’s income.

The Energy and Commerce plan also hits on hot-button social issues — proposing, for instance, to cut federal funding for groups like Planned Parenthood and ban the use of Medicaid dollars for gender-affirming care for youth. It also scales back funding from states that use their own funds to offer coverage for undocumented people.

“Democrats will use this as an opportunity to engage in fear-mongering and misrepresent our bill as an attack on Medicaid,” Chair Brett Guthrie (R-Ky.) wrote in a Wall Street Journal op-ed Sunday. “In reality, it preserves and strengthens Medicaid for children, mothers, people with disabilities and the elderly — for whom the program was designed.”

The panel has been tasked with finding $880 billion in savings to help finance a massive portion of the GOP’s party-line package of tax cuts and extensions, border security investments, energy policy and more. Committee Republicans have been under significant pressure to make politically difficult cuts to Medicaid as part of that effort. Guthrie told committee Republicans on a call Sunday that the package will create more than $900 billion in savings.

Moderate Republicans have been hesitant to make major cuts to the popular safety net program for vulnerable Americans, while fiscal hawks have been angling for transformative “structural” changes. Democrats and many players in the health care industry, including hospitals — which are major employers in many districts — are expected to fiercely oppose the proposal.

“Republican leadership released this bill under cover of night because they don’t want people to know their true intentions,” Rep. Frank Pallone (D-N.J.), the top Energy and Commerce Democrat, said in a statement. “Taking health care away from children and moms, seniors in nursing homes, and people with disabilities to give tax breaks to people who don’t need them is shameful. Democrats have defeated Republican efforts to cut health care before and we can do it again.”

Guthrie worked behind the scenes to placate both moderates and conservatives to get to a deal that both sides can live with, but it remains to be seen whether he and his leadership have in fact landed on a winning strategy. Energy and Commerce is scheduled to meet Tuesday at 2 p.m. to debate and advance the bill.

One of the largest potential sources of savings will come from a policy curbing states’ ability to levy taxes on providers, which could force states to make major changes since the taxes can pay for a state’s share of Medicaid costs. The legislation would freeze state provider taxes at their current rates and prohibit them from establishing any new taxes.

Conservatives argue that states use the taxes to boost their federal share of Medicaid payments without having to use their own revenue. Doctors and hospitals don’t mind because a state can direct the extra funds back to them, making up for the tax hike.

Every state except for Alaska relies on a provider tax of some form, an analysis from the research firm KFF found. Last year, 32 percent of states’ contributions to Medicaid costs came from other sources such as local government funds and the provider taxes. States cannot levy more than 6 percent of a provider’s income and must tax those on and off Medicaid.

Some states have already warned Washington about what would happen if they can’t levy Medicaid taxes. New Jersey’s Medicaid agency released a model of potential changes back in February and would lead to an estimated $2.5 billion in cuts to federal funding.

It also will mandate every state to install a work requirement for certain beneficiaries. Able-bodied adults without any dependents would have to work at least 80 hours a month or perform other activities such as community service. It would not apply to pregnant women and only adults from 19 to 64. Tribal members are also exempt as well as those with serious medical conditions.

Congress would leave it up to states to verify compliance with the work requirement.

The bill would also target state-directed payments, which gives states more power over provider payments and allows some providers to get reimbursed more in line with what commercial insurers pay them. The goal of the payments is to bolster pay rates for providers and encourage them to enter value-based payment arrangements where doctors are paid based on the quality of care delivered. Conservatives have argued there isn’t enough transparency in the payments.

Here’s what else the package would — and wouldn’t — do:

Non-health care policies: The package would allow the federal government to auction off wireless spectrum in a move that is expected to generate $88 billion, Guthrie said. It would also claw back Biden-era green energy spending, including climate spending under the Inflation Reduction Act.
Take on some parts of Medicaid expansion: The package would lower the federal share of payments to states that have expanded Medicaid under the Affordable Care Act if the state allows undocumented immigrants to get Medicaid coverage. It is illegal for undocumented immigrants to get coverage, but several states take on the full amount of coverage without any federal match.
Stricter eligibility checks: The legislation would roll back Biden-era rules limiting Medicaid eligibility checks to once annually, allowing them to be made twice a year. Savings would ensue as more are kicked off the rolls.
Address cuts to doctor pay in Medicare: Doctors have been angling to reverse payment cuts mandated by a formula that lawmakers on both sides of the aisle say doesn’t account for rising costs. The package aims to blunt that.
Pharmacy benefit manager reform: The package includes an overhaul of the business practices in Medicaid of the pharmacy intermediaries, which pharmaceutical companies argue have driven up the cost of prescription drugs. PBMs have argued they help negotiate lower drug prices and the reforms would limit their ability to do so.
Drug price negotiation: The package would also soften Medicare’s new power to negotiate drug prices under the Inflation Reduction Act for certain drugs.

Congress

Top Commerce Committee Democrat releases AI framework

Published

28 minutes ago

October 7, 2026

Blue Light Newsroom

Sen. Maria Cantwell, the top Democrat on the Commerce Committee with vast jurisdiction over artificial intelligence policy, outlined six AI safety principles Wednesday morning — tenets she believes should underpin any legislation to stave off the greatest threats posed by the rapidly-evolving technology.

“To manage risks from advanced AI systems we need clear safety standards, continuous testing, and reporting of serious failures,” the Washington Democrat said in a statement. “America can lead the world in AI by building systems that are not only more capable, but safer and more secure.”

Cantwell’s framework would encompass six priority areas: enforceable safety standards for frontier models, continuous testing, disclosure and oversight, public-private partnerships, protection for children and workers and adherence to U.S.-led global standards.

To directly address risks posed by the technology, her framework would have federal experts at the National Institute of Standards and Technology and other agencies establish clear federal rules to address harms, with specialized standards for open-source AI models to reduce risks of catastrophic misuse.

The senator is also recommending that the federal government provide developers with guidance on how to accelerate U.S. leadership on AI without sacrificing basic safety protocols.

On testing, Cantwell argues the government and independent experts should provide constant oversight and “continually scrutinize and stress test covered AI models,” particularly when sensitive information or secure facilities are involved.

She also says AI systems must have built-in safeguards to ensure they halt self-modification that could bypass safety controls. And she states that advanced models should not be released until they have undergone an independent, comprehensive audit — similar to outside auditors examining a company’s financial statements.

Cantwell, a former tech executive, has for years pursued similar priorities. But her new framework comes ahead of a midterm election that could return control of the Senate to Democrats, handing Cantwell back of the Commerce Committee gavel.

It also comes as lawmakers are under pressure to regulate the AI industry but are showing few signs that they will be able to reach consensus, across the aisle or even within their own party.

Senators had hoped for hearings, markups and briefings on AI legislation before leaving Washington until after the November elections, but little progress was made. Sen. Ted Cruz (R-Texas), the current Commerce Committee chair, has continued to say he intends to hold a markup on AI-related bills but has punted multiple times, saying senators have yet to reach agreement on any bipartisan measure.

Senate Majority Leader John Thune and Sen. Amy Klobuchar (D-Minn.) have been trying to cut a deal on legislation to prevent and contain catastrophic risk from runaway AI technology, but bill text has so far failed to materialize.

Cantwell’s approach laid out Wednesday morning would be stricter and more comprehensive than what Thune and Klobuchar are expected to ultimately produce, based on similar legislation they have offered in the past.

Her approach of “constant oversight and vigilance” would also serve as a contrast to that of GOP leaders, who have consistently called for a “light touch” regulatory regime.

Congress

Capitol agenda: GOP braces for SCOTUS fight that may not come

Published

2 hours ago

October 7, 2026

Blue Light Newsroom

Senate Republicans are privately ready for a post-election Supreme Court nomination fight that may never come.

There aren’t too many signs from the two oldest justices — 78-year-old Clarence Thomas and 76-year-old Samuel Alito — that either plans to retire in the coming months and force Republicans to spring into action to fill a vacancy.

But the two men would face a mountain of pressure to step down in the lame-duck period if Democrats retake the Senate, which could essentially shut down confirmations of President Donald Trump’s favored nominees.

Such a retirement announcement would kick off a chaotic sprint on Capitol Hill, giving Republicans just five scheduled session weeks to cobble together 50 votes for a Trump nominee.

Republicans in a position to act said in recent interviews they would certainly try to rapidly confirm any Trump pick.

“We would proceed quickly with such a vacancy,” said Senate Majority Leader John Thune.

Senate Judiciary Chair Chuck Grassley said “of course” they would. Sen. Thom Tillis, a frequent Trump critic who could single-handedly bottle up a nominee in Judiciary, said he would “absolutely” support a post-election confirmation.

“You’ve got to use your majority position to take that vote,” Tillis said.

Several senators, including Thune, are skeptical a vacancy even happens. Alito told Bloomberg News in an interview published Tuesday he would “stick around” at least until the court’s current term ends early next summer. Thomas hasn’t publicly addressed his retirement in years and has otherwise given no signs of imminent plans to quit.

“I don’t know why you assume there will be one,” said Sen. Susan Collins, another potentially pivotal vote who left the door open to filling any vacancy, pointing to her longstanding position that “as long as it’s not close to a presidential election that we should proceed.”

Still, some lawmakers on both sides of the aisle with battle scars from prior confirmation fights over Brett Kavanaugh, Amy Coney Barrett and Ketanji Brown Jackson aren’t ready to entertain the thought of a lame-duck confirmation sprint.

“Oh, gosh,” said Sen. Lisa Murkowski. “You’re giving me the chills.”

What else we’re watching:

— INSIDE COONS’ ISRAEL TURNABOUT: Sen. Chris Coons is likely to chair Foreign Relations if Democrats win the Senate, and — in what he describes as a “fairly sharp break” in his thinking — he’s not ruling out sanctions on Israel’s prime minister. The Delaware senator’s evolution matches that of other moderate Democrats in the three years since Hamas’ deadly Oct. 7 attack triggered a military response that Israel’s critics have said amounted to genocide against Palestinians in Gaza.

— TRUMP COLLEGE TAX RULES WORRY DEMS: Democratic lawmakers are worried proposed Trump administration rules targeting diversity initiatives on college campuses could threaten universities’ finances over commonplace activities. “What if a university has Black History Month?” Sen. Sheldon Whitehouse, who sits on the tax-writing Finance Committee, said in a recent interview. “Is that going to cause them to lose their tax-exempt status?” The IRS regulations proposed Sept. 3 are slated to go into effect next June. Supporters say the rules should be used to prevent schools from considering race in decisions over who they admit, hire and promote, for example.

Jordain Carney, Daniella Cheslow and Brian Faler contributed to this report.

Congress

‘Use your majority’: In the unlikely event of a Supreme Court vacancy, Republicans are ready to act

Published

5 hours ago

October 7, 2026

Blue Light Newsroom

Senate Republicans are unlikely to get a Supreme Court vacancy this year. They’re privately prepared for one, just in case.

A Democratic midterm triumph would carry massive implications for the final years of President Donald Trump’s presidency, including the prospect that the Senate could essentially shut down confirmations of his favored nominees. That’s a nightmare scenario for Republicans, who have viewed their reshaping of the federal judiciary as a crown jewel of Trump’s legacy.

The two oldest Supreme Court justices — 78-year-old Clarence Thomas and 76-year-old Samuel Alito — are both Republican appointees and reliable Trump allies, and key Senate Republicans said in recent interviews with Blue Light News they would support filling a high-court slot this year if one opens up.

“We would proceed quickly with such a vacancy,” said Senate Majority Leader John Thune.

Signs that Republicans will need to spring into action are scarce. Alito told Bloomberg News in an interview published Tuesday that he would “stick around” at least until the court’s current term ends early next summer. Thomas, meanwhile, hasn’t publicly addressed his retirement plans in years and has otherwise given no signs of imminent plans to quit.

But if the GOP loses control of the Senate in the midterms, both men would face a mountain of pressure to consider stepping down, given the stakes. Democrats remain bitter over the Republican blockade of President Barack Obama’s final Supreme Court nominee, Merrick Garland, and could block a fourth Trump justice.

Senate Minority Leader Chuck Schumer said in an interview over the summer that part of his pitch to recruit candidates was “two words that make a huge difference: Supreme Court.” Speaking to reporters last week, Schumer indicated that Democrats would use their majority to block judicial nominees they view as too extreme.

“One of the reasons we need to make sure that we do everything we can to take back the Senate is [to] not let Trump put such horrible justices, MAGA justices, on the Supreme Court and the lower courts,” he said.

A post-Nov. 3 announcement would be the first time since the 1922 retirement of Mahlon Pitney that a Supreme Court justice announced his or her departure in the lame-duck period after a midterm election, according to the Congressional Research Service.

Such an announcement would kick off a chaotic sprint on Capitol Hill, giving Republicans just five scheduled session weeks to cobble together 50 votes for a Trump nominee.

Those in a position to act said recently they would certainly try — and there is recent precedent for doing it quickly: Amy Coney Barrett was confirmed just 38 days after Justice Ruth Bader Ginsberg’s September 2020 death.

Like Thune, Senate Judiciary Chair Chuck Grassley (R-Iowa) said “of course” Senate Republicans would try to fill a post-election vacancy.

Sen. Thom Tillis (R-N.C.), a frequent Trump critic who could single-handedly bottle up a nominee in the Judiciary Committee, said he would “absolutely” support filling an end-of-year vacancy.

“You’ve got to use your majority position to take that vote,” he said.

But Tillis was among many in the GOP who doubt senators will have a slot to fill. “I can’t think of anything other than health,” he said, that would cause a justice to quickly step down.

Thune said that if a justice had plans to retire, “They would have done it already.”

Sen. Susan Collins of Maine, another potentially pivotal vote, also left the door open to a post-election confirmation. The only Senate Republican running this year in a state won by Kamala Harris, Collins pointed to her longstanding position that “as long as it’s not close to a presidential election that we should proceed to consider nominees.”

“I don’t know why you assume there will be one,” she added. “I haven’t heard that will happen.”

Collins knows as well as anyone the perils of taking up high-court nominations in an election year. She cited the too-close-to–Election Day rule in voting against Barrett’s nomination as she stood for reelection in 2020.

But Democrats are still hammering her decision to vote for Brett Kavanaugh a month before the 2018 midterms — even after his nomination was thrown into turmoil by allegations of sexual misconduct and assault which he denied.

Troy Jackson, Collins’ Democratic opponent, posted on X this week that Collins “cannot be trusted with voting on our next Supreme Court Justice.”

The campaign-trail sparring reflects just how partisan and contentious high-court nomination battles have grown, and plenty of senators are hoping to avoid a knock-down-drag-out fight on the heels of a similarly nasty midterm campaign.

In a sign of the battle scars left from the fights over Kavanaugh, Barrett and the most recent Supreme Court confirmee — Ketanji Brown Jackson — some lawmakers said they weren’t ready to even entertain the thought of a lame-duck confirmation sprint.

“Not a hypothetical I’m ready to talk about,” said Sen. Sheldon Whitehouse of Rhode Island, who is expected to lead Democrats on the Judiciary Committee next year.

Sen. Lisa Murkowski (R-Alaska), who would be a closely watched vote, made a quick escape when she was asked about the scenario.

“Oh, gosh,” she said. “You’re giving me the chills.”

Chris Marquette contributed to this report.