Congress
GOP leaders snubbed the hard right on Medicaid. They’re vowing to fight back.
House Republican leaders appear to have won support from key moderates by backing off the most controversial proposals to overhaul Medicaid — but it has created new risks for the GOP’s domestic policy megabill.
Fierce pressure is now building from hospitals and clinics to the Medicaid cuts that have survived while conservative hard-liners are threatening to withhold their votes if they don’t get deeper trims to the safety-net program.
It adds up to a bumpy road ahead for the House Energy and Commerce Committee as it prepares for a marathon meeting to advance the legislation Tuesday afternoon.
The proposal unveiled by Chair Brett Guthrie (R-Ky.) would not slash federal reimbursement rates in most cases or impose per-capita caps on payments to states, but it would likely force states to revamp how they finance their programs or cut benefits. A preliminary Congressional Budget Office estimate requested by Democrats found that more than 8.6 million people would go uninsured if the health portions of the GOP’s party-line package become law.
While such significant changes to Medicaid could face significant resistance in the Senate — Sen. Josh Hawley (R-Mo.), for example, wrote in a New York Times op-ed Monday that big Medicaid cuts are “morally wrong and politically suicidal” — Guthrie appears to have the votes he needs to make progress this week.
Rep. Nick Langworthy (R-N.Y.), an Energy and Commerce member who had been wary of deep cuts to Medicaid, praised the “bold” proposal in a social media post Monday, saying it “achieves our top priorities: protecting Medicaid for those who genuinely need it.”
So did Rep. Gabe Evans (R-Colo.), another panel member who said the legislation, “follows through on Republicans’ promises to cut waste, fraud, and abuse while protecting coverage for Colorado’s most vulnerable populations.”
“The critics will spread fear about cuts for political purposes, so let me clear: this bill allows Medicaid spending to increase year-over-year for the next ten years,” he added.
Once past the committee, however, the legislation faces a whirlwind of threats on the House floor, where opposition from any three Republican members could sink the entire sweeping package of tax cuts, border security enhancements, defense plus-ups and more.
A key leader of the hard-right bloc, Rep. Chip Roy (R-Texas), said in social media posts Monday that Guthrie’s proposal doesn’t offer “ANY transformative changes” to Medicaid, “among MANY [other] problems.“
“We will need SIGNIFICANT additional changes to garner my support,” Roy added.
And it remains to be seen if a broader group of swing-district Republicans would be swayed by the proposal. Guthrie has made the case that the legislation would preserve Medicaid for the most vulnerable instead of “capable adults who choose not to work,” but Democrats are prepared to weaponize coverage-loss predictions and potentially major impacts on state budgets to pressure potential GOP holdouts.
“The Republicans are trying to say this is a moderate bill,” ranking member Frank Pallone (D-N.J.) told reporters Monday, referring to the proposals GOP leaders opted not to include. “Nothing could be further from the truth.”
A mounting pressure campaign from health care facilities could be especially influential; many Republicans have cited the potential for hospital and clinic closures in expressing wariness about deeper cuts. While worst-case scenarios did not come to fruition, providers are arguing the proposed policies would still have devastating impacts.
The National Association of Community Health Centers is blanketing Capitol Hill for a fly-in Tuesday, and hospital groups are issuing blistering statements. Hospitals are major employers in many members’ districts and can have significant sway over members’ votes.
“Congressional Republicans and President Trump rightly pledged to protect Medicaid benefits and coverage — this bill fails that test,” said Chip Kahn, president of the Federation for American Hospitals, in a statement. “It is imperative Republicans go back to the drawing board; too many lives depend on it.”
“Congress has a moral obligation to consider the harm that such disastrous cuts would have on America’s health safety net,” added Sister Mary Haddad, the Catholic Health Association CEO.
Some blue state governments also warned about coverage losses and crushing fiscal impacts. Sarah Adelman, commissioner of New Jersey’s Medicaid agency, said the proposal “would cut people off from coverage and take vital funding away from New Jersey” by curtailing provider taxes, a common practice states use to finance their Medicaid programs.
She also said that punishing states for using their own funding to offer coverage regardless of immigration status is “cruel and short-sighted.”
The Greater New York Hospital Association also slammed the bill, arguing in a statement that work requirements could lead to 1.6 million people to lose coverage in the state. The group also projected New York would lose $1.6 billion in federal funds from the cut to expansion funding for coverage of undocumented immigrants. New York is one of 14 states that use state funds to cover undocumented children.
Republicans, meanwhile, are accusing Democrats and their allies of fear-mongering about the impacts. They are feuding, for instance, over one CBO estimate Democrats used to claim the legislation would lead to 13.7 million more people going uninsured — an estimate that included coverage losses attributable to the potential expiration of enhanced subsidies for Affordable Care Act, something Republicans never meant to address in the party-line megabill, even if they are skeptical about extending them.
“Democrats are pedaling incorrect reports that include policies that aren’t even in the bill,” Guthrie said in a statement. “It is reckless that my colleagues on the other side of the aisle claimed an artificially high number in alleged coverage loss just so they can fear monger and score political points.”
LE SUEUR, Minnesota — The word on John Thune’s mind these days is “resources.”
In the Senate majority leader’s recollection, it was a dominant topic in his recent conversations with President Donald Trump, including at a recent visit to the White House, not to mention in his frequent conversation with Trump’s political team — and in an exclusive conversation with Blue Light News Monday during a Midwest campaign swing.
“I think the president is sincerely interested in trying to do whatever he can to help the team,” Thune said about his midterm conversations with the president and his advisers. “I also share with him, too, the importance of just the resources in some of these states. You know, some of the states have gotten very expensive.”
As Trump focuses on turning out his own voters — a message the president is taking into his own hands in a series of preelection rallies — Thune is making sure he also has money on his mind: “I … just conveyed to him the importance of ensuring that our candidates are well-resourced.”
Thune’s focus underscores the emerging question defining the 2026 midterms: Is there enough Republican money, and can it be spent fast enough, to counter surging Democratic campaigns and a lackluster national environment for the GOP?
It’s a narrative both sides largely agree on — Thune’s Democratic counterpart, Minority Leader Chuck Schumer, said as much last week — even as each leader insists his side will prevail.
Thune declined Monday to put odds on the GOP’s chances of keeping control of the Senate but said repeatedly, “I think we can keep the majority.”
“I think all of these races are margin of error, at least the ones that we have to win,” he added. “And historically, at least if you look at polls, we tend to outperform them.”
Unlike Schumer, who is keeping a low profile in October and focusing on private fundraising, Thune is barnstorming the country — visiting a mix of deep-red and battleground states.
Minnesota was not expected to be in play for Republicans when Thune took over as leader nearly two years ago. Democratic incumbent Sen. Tina Smith had a clear path to reelection in a state that has not elected a GOP senator since 2002.
But Smith chose to retire, and Democrats nominated an unabashed progressive, Peggy Flanagan, who is now facing Michele Tafoya, the well-known former sportscaster, in November. Recent public polls have shown the race in single digits, and Thune was not shy about including it alongside Michigan and New Hampshire as a GOP pickup opportunity.
Mentioning Minnesota is one thing, but investing in it is another, and national groups affiliated with Thune have not made major investments in the state so far. Standing next to Thune at a news conference Monday, Tafoya made the case for that to change.
“We have had three or four straight weeks of really solid polls,” she said. “This is one worth investing in. We are right there.”
But they both kept things vague when asked about Washington Republicans’ potential commitment to the race — including how much cash would be necessary to overcome 24 years of futility and a bad political environment.
Both Thune and Tafoya used the same words to answer that question: “We haven’t had that conversation.”
Thune put the party’s spending decisions into a larger context: “If the president is looking for places where he can make a difference … we’re in touch on a daily basis with his team and hopefully they will — as they already have — continue to help us leverage the resources that we’ve got to bring to bear to get the best possible impact and outcome in these key states.”
Thune pointed to Minnesota as one possible state where Trump could choose to deploy his $400-million-plus war chest. But the tiny national footprint in the Gopher State pales next to the hundreds of millions of dollars being spent in Texas — an expensive state Thune and Trump continue to discuss as Republicans struggle to drag Senate nominee Ken Paxton over the finish line.
Asked about the super-sized investments there, Thune declined to connect the massive spending on Paxton to tough decisions elsewhere on the map. “Dedicated donors” focused on Texas, he said, have meant GOP groups haven’t yet had to siphon funding away from other key states.
But the tough decisions are nevertheless underway. As Republican candidates play defense in a growing list of red states, the Thune-aligned Senate Leadership Fund recently pulled back spending in North Carolina — essentially surrendering a GOP-held seat to Democrats — while increasing its spending in Kansas.
Thune referred to the decision as a “pause” in financial support for nominee Michael Whatley.
The reasons for the political headwinds were on display Monday at an agriculture-focused roundtable, where Thune and Tafoya heard about the impact of Trump’s trade war with Canada, the president’s decision to import foreign beef and the high diesel prices that followed his decision to attack Iran.
Thune, a South Dakotan fluent in farm-state politics, touted Tafoya as someone who could help address some of those concerns by being a “great voice on issues like agriculture” if she makes it to the Senate.
His broader message in the interview, however, was to cast the midterm election as “choice” between the two parties rather than a referendum on the Iran war and the ensuing spike in energy prices. Democrats want “more spending,” “higher costs,” and “open borders,” he said, while Republicans had put “more money in your pockets” with their 2025 tax bill.
“Iran is temporary,” he said. “It will be behind us. Gas prices are going to come down, so who do you want to invest in for the next two years, four years?”
The midterm results carry personal stakes for Thune, who is expected to run for leader again in internal Senate GOP elections that are expected to take place just days after the midterms, regardless of the outcome.
Thune remains well-liked within the Senate GOP conference, and no other senator has raised his or her hand to run against him. But some conservatives, in and out of the Senate, have privately questioned whether Trump would publicly turn on Thune if Republicans lose their majority.
Asked about that possibility, Thune said, “I can’t control that.” He added that “the Republican conference” would ultimately make the decision.
“What the president does or doesn’t do … you just move forward and let the chips fall where they may,” he said. “All I can say is, I’m with him and his team to do the things I think are good for the future of the country.”
When Blue Light News pointed out Trump defended Thune at last month’s GOP midterm convention after some in the crowd booed the mention of his name, he laughed.
“Yeah, I know,” he said. “It’s the little things, right?”
The chair of the House Agriculture Committee said he’s not willing to “accept bad results” as a tradeoff for the benefits of advancements in artificial intelligence — a direct rebuttal to OpenAI CEO Sam Altman.
“As someone who practiced health care for 28 years, I’m never willing to accept bad results. I think we just need to do our best,” Rep. G.T. Thompson, a Pennsylvania Republican, told reporters Monday.
He was responding to Altman’s comments to Decoded by Blue Light News that people “should accept some bad things happening for the benefits of this technology and people having the agency.”
Pressed further on whether he agreed with Altman’s premise, Thompson replied, “No, I think we have to work harder to prevent any bad things from happening.”
Altman’s comments come in the wake of increased panic over the risks of catastrophic destruction from AI, with many industry leaders and experts arguing that guardrails are needed on the technology to prevent it from spinning out of human control.
Pressure is building on Congress to regulate the rapidly-advancing technology, but lawmakers are divided over whether the AI industry needs federal regulation or if it’s capable of governing itself.
The executives of major AI labs and tech companies gathered at the White House last week to discuss solutions with President Donald Trump, who believes overregulating AI will have national security repercussions. The group ended up signing a “morally binding” AI accord that critics say won’t do enough to prevent a worst-case scenario.
Thompson noted Monday he believes that AI will bring “tremendous solutions,” specifically in regards to finding cures for health issues like cancer and Alzheimer’s disease. But he also said AI has to be led with “principle” — comparing it to how he addressed digital assets in a bill to regulate the cryptocurrency industry, which he worked on as chair of the Agriculture Committee.
“The first principle is ‘do no harm.’ So we need to protect consumers, and that means, I think, building some guardrails — some guidelines — to do that,” Thompson said. He added that the second principle is to “foster innovation.”
“I think AI has a lot to do with that,” he added. “I don’t think AI works without RI: Real Intelligence.”
LE SUEUR, Minnesota — Senate Majority Leader John Thune said Monday there is no “consensus” yet on advancing a bill establishing permanent daylight saving time even as President Donald Trump ramps up pressure on Republicans to pass it.
Thune addressed the matter in a Monday interview after Trump used his Truth Social account multiple times over the weekend to rail against the legislation, known as the Sunshine Protection Act — going so far as to post the personal cell phone number of one of its GOP opponents, Sen. Tom Cotton of Arkansas.
“The president feels strongly on it like he does a lot of issues,” he said. “It’s something we’re having conversations about but there’s no clear path forward or consensus on it yet.”
While Trump singled out Cotton for scrutiny, Thune made clear the opposition to the permanent daylight saving time proposal — which would lead to very late winter sunrises in some parts of the country — ran deeper than one senator.
Cotton has publicly voiced opposition to the proposal for year, citing, among other things, the fact that children in his state would be going to school in the dark for part of the year.
Sen. Roger Wicker (R-Miss.) voiced similar objections Monday to reporters in the Capitol, saying he was mindful of “safety concerns in the more northern and rural states where children get on the school bus in very early hours.”
Thune, who spoke during a campaign swing in Minnesota with GOP Senate nominee Michele Tafoya, has himself opposed previous daylight saving bills. He said Monday that “a lot of it depends on where you are in the country” and that “your geography probably has as much to do with your position on that as anything.”
Sen. Rick Scott (R-Fla.), who has aligned himself closely with Trump, is among the lawmakers who have been pushing to get the bill through the Senate. He recently told POLITICO, “I’m going to make sure it gets passed this year.”
Riley Rogerson contributed to this report.
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