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.
The Senate is aiming to leave Washington for a five-week recess early Saturday after Republicans cut a deal with President Donald Trump to punt some of their priorities, including a framework for a party-line spending plan.
The Senate is trying to lock in an agreement that would set up votes on a college sports bill, a stopgap government funding bill, Todd Blanche’s attorney general nomination and GOP voter ID legislation, according to a copy of an internal notice reviewed by Blue Light News.
The Senate would then leave Washington until mid-September.
Any one senator could object to the tentative deal, forcing it to be altered or dragging the Senate deeper into the weekend. Senators believe there are still objections to advancing the college sports bill. Democrats are also waiting to see if one of their own will prevent speeding up Blanche’s confirmation.
The breakthrough is a U-turn from earlier Friday evening, when Republican senators emerged from a closed-door meeting predicting they would have to spend Saturday trying to break a stalemate within the party about how to wrap final votes before recess.
Shortly after that meeting, Trump spoke by phone with Senate Republicans including Ron Johnson of Wisconsin, Rick Scott of Florida and Mike Lee of Utah about the path forward for the GOP’s lengthy to-do list.
During the call, according to Johnson, Trump agreed to punt a vote on a budget blueprint for a third party-line spending bill until later in the year. Lee, who has been pushing for action on the separate SAVE America Act, also agreed to drop his demand for a formal, roll call vote on adjourning given the understanding with the president.
“I think the conclusion of the conference – and we had a discussion with the president and he agrees – [is] don’t take the vote tonight,” Johnson said after the meeting in Thune’s office.
Republicans were in talks with the White House throughout Friday. A White House official granted anonymity said Friday evening that “we’re continuing to have productive conversations with senators to advance several legislative priorities.”
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.
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