Congress
House GOP’s Medicaid revisions aim to please hard-liners
House Republicans made substantial changes to the Medicaid portion of the GOP megabill in amendments unveiled Wednesday night, including accelerating work requirements and paying states not to expand the program under the Affordable Care Act.
The proposal will move up the start date of Medicaid work requirements from Jan. 1, 2029, to Dec. 31, 2026, in a concession to conservative hard-liners who have been pushing for deeper cuts to the program.
The work requirements included in the previous bill would yield nearly $280 billion in savings, according to congressional scorekeepers — the most of any policy under the House Energy and Commerce Committee’s jurisdiction. The new accelerated timeline could lead to additional savings of tens of billions of dollars but also result in even more people losing coverage. GOP moderates have not raised significant concerns about implementing them more quickly.
The new bill does not include controversial changes hard-liners had pushed for that would alter the federal share of spending in the joint federal-state Medicaid program. Moderates had balked, arguing they would cut too deep into benefits, and House Speaker Mike Johnson had ruled out those changes.
But in other sops for conservatives, the revisions would expand the criteria for states that could lose a portion of their federal payments if they offer coverage to undocumented people. It also moves to bar coverage of gender-affirming care for adults under the program, not just minors as previously proposed.
The Congressional Budget Office estimated that a previous iteration of the bill could lead to 7.6 million people who had Medicaid going uninsured, and millions more from the the Affordable Care Act marketplace also losing coverage. Those coverage losses are expected to be higher with this new version. The Energy and Commerce portion of the bill has been estimated to save nearly a trillion dollars over a decade.
The new amendments would make another notable change to Medicaid -— one that hard-liners hope would incentivize states to not to expand their programs under the ACA after the legislation goes into effect. The wonky measures would give states a financial incentive not to expand coverage to people with higher incomes than traditional enrollees, though still near the poverty line. The policy would make higher payments to providers like hospitals for uncompensated care.
Hard-liners, particularly Rep. Chip Roy of Texas, pushed for the provision to be in the bill during a White House meeting with President Donald Trump Wednesday afternoon, according to three people with direct knowledge of the meeting. One senior GOP aide described the provision as “a small Medicaid tweak” that would give the hard-liners a reason to support the bill, along with several other minor changes.
Notably, they did not secure any further changes to the Medicaid state provider tax, which moderates had held firm against.
Rep. Ralph Norman of South Carolina said in a brief interview Wednesday night he was happy with the meeting and that “there were some good things from the White House.”
Another Republican lawmaker said hard-liners would chiefly tout the accelerated Medicaid work requirements, the expansion change and a newly accelerated phase-out of clean-energy tax credits.
In a major departure, the bill would fund cost-sharing reduction payments to insurers on Obamacare’s insurance exchanges.
The policy would offer subsidies to insurers that would, in turn, help reduce premiums and co-pays for patients. Trump ended this practice in his first administration, saying it constituted a bailout to the insurance industry. But the nonpartisan Congressional Budget Office estimated at that time that ending the payments would cost hundreds of billions of dollars over a decade. Bringing the policy back could provide savings.
Rachael Bade contributed reporting.
Senate Republicans confirmed dozens of President Donald Trump’s nominees Friday, just before they leave for a five-week congressional recess.
Senators voted 51-47 to approve officials at the Departments of Defense, Energy, State and other agencies.
They included David Cummins to head the Transportation Security Administration, Cameron Hamilton to lead the Federal Emergency Management Agency, Hal Duncan to be OMB deputy director and Francis Brooke to be Treasury deputy secretary. Among the group were several ambassadors, including former Rep. David Brat to be ambassador to Australia.
Senate Republicans changed the chamber’s rules last year to be able to confirm lower-level nominees as a package instead of having to hold a vote on each.
After finishing the expedited procedure Friday, Senate Republicans estimate they will only have a small number of civilian nominees awaiting confirmation.
President Donald Trump said voters may seek to punish Republicans — but not him — in the November midterm elections, as GOP lawmakers sweat that affordability concerns and the war in Iran could mean Democrats flip the House and perhaps even the Senate.
“They’re angry at Republicans,” Trump said in an interview with Punchbowl News that aired Friday. “But they’re not angry at me. They’re not angry at me, but they are angry at Republicans.”
The GOP faces the prospect of heavy losses this November, as gas and grocery prices remain stubbornly high due in part to the White House’s five-month-long war in Iran. The administration’s guidance on campaign trail messaging has been “tone deaf,” House Republicans fear.
Meanwhile, the president’s approval rating has tumbled since he returned to the Oval Office last year, and even his biggest supporters have grown frustrated over his Middle East war.
And with a messy, jam-packed slate of primaries now all but in the rearview mirror, Democrats are determined to go on offense. The Democratic Congressional Campaign Committee has 58 seats on its midterm target map that stretches into redder territory — while still facing an uphill climb to take the Senate.
Trump has a massive war chest at his disposal. His MAGA Inc. super PAC reached $400 million in June. The president told Punchbowl he plans to use it to “help Republicans,” but he stressed that he faces no pressure in this campaign cycle.
“I said to somebody, ‘Wait a minute, you don’t understand, I won,’” Trump said, referencing his 2024 presidential election victory. “I’m not campaigning.”
The biggest issue for Republicans this year? That Trump himself is not on the ballot, he said.
“If I don’t run, will those people go out and vote? And that’s the one thing I can’t tell, I’m going to ask them to,” he said.
The Senate’s plan to get out of town is coming together.
Majority Leader John Thune teed up a final vote on the Russia sanctions legislation for this morning, as well as a confirmation vote for dozens of nominees and a procedural step on a stopgap funding bill.
But there’s still a number of questions that need to be answered if Thune wants to adjourn for recess by the end of the day:
— BLANCHE’S FATE: President Donald Trump’s pick for attorney general needs to secure at least one more vote to be confirmed before the break.
It looks like it’s all up to Sen. Bill Cassidy after Sen. Lisa Murkowski announced Friday morning she is opposed. Thune indicated Thursday night Blanche’s fate was uncertain and that leaders were “still working to get the final vote.”
— SAVE AMERICA ACT: Thune said to expect a vote related to the SAVE America Act as well as an initial vote on a budget blueprint for a third party-line spending bill — which includes elements of Trump’s election security legislation.
The decision to hold the budget vote comes after two Republican senators, granted anonymity to speak candidly, told Blue Light News Thursday they believed Sen. Mike Lee or another member of the GOP’s right flank would have otherwise forced a vote on the framework.
But as we’ve previously reported, Republicans don’t believe the budget resolution has the votes within the conference to be adopted — meaning the expected initial vote today will fail to clear a simple majority threshold.
And it’s not clear Lee or like-minded senators will be satisfied and allow for lawmakers to adjourn for recess without more action on the elections measure. The senator has made similar threats over the past year but has never followed through.
— TIME AGREEMENT: GOP leaders need to strike an agreement to finish other business, including passing the stopgap government funding bill and advancing a college sports bill.
At this point, any single senator could still object to expediting the chamber’s agenda, which would derail Thune’s goal of getting members out of town by the end of the day.
“We’ve been having these conversations with Democrats trying to figure out what’s the path,” Thune said.
“We’ll see how it goes,” he added.
What else we’re watching:
— GOP EXPECTS CRYPTO BILL DELAY: The Senate will leave for the chamber’s August recess without holding a vote on a landmark cryptocurrency bill, according to three people with knowledge of the matter. Thune may still file cloture on the bill, but it likely won’t come to the floor until lawmakers return to Washington next month, two of the people said.
— COLLEGE SPORTS BILL STUMBLES: Sens. Ted Cruz and Maria Cantwell’s legislation to impose new guardrails on college sports is looking increasingly unlikely to hit the floor this week. Eleven senators objected to expedited consideration of the Protect College Sports Act after Thune filed cloture earlier this week, two people familiar with discussions told Blue Light News.
— OGLES OUSTED: GOP House leaders lost an incumbent — and a perennial headache — with Rep. Andy Ogles’ primary defeat in Tennessee Thursday night. His loss to former Tennessee Agriculture Commissioner Charlie Hatcher represents the second Trump-endorsed candidate to lose a primary this week.
Jordain Carney, Mia McCarthy, Andrew Howard and Jacob Wendler contributed to this report.
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