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

Trump says voters are mad at other Republicans, not him, as midterms approach

Published

2 hours ago

August 7, 2026

Blue Light Newsroom

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.

Congress

Capitol agenda: Senators find their exit strategy

Published

4 hours ago

August 7, 2026

Blue Light Newsroom

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.

Congress

Lisa Murkowski says she will oppose Blanche, endangering his confirmation

Published

6 hours ago

August 7, 2026

Blue Light Newsroom

Todd Blanche’s attorney general nomination is on the brink after Sen. Lisa Murkowski announced Friday that she would oppose confirming him.

The Alaska Republican said in a statement that she did not believe Blanche, who has been serving as acting attorney general since April, would act to rein in President Donald Trump and reverse the “politicization—even weaponization” of the Justice Department that has “accelerated” under Trump.

“The country needs an Attorney General who will check the worst impulses of this administration,” she said. “I hope Mr. Blanche is able to achieve that, if confirmed, but I simply do not have confidence that will be the case.”

Blanche’s fate is now thought to come down to Sen. Bill Cassidy of Louisiana, who has been increasingly critical of the president since losing his renomination campaign to a Trump-backed Republican earlier this year.

Cassidy met with Blanche alongside Murkowski Wednesday afternoon but hasn’t yet said how he will vote. Blanche has to win his support in order to be confirmed, given unified opposition from Democrats and opposition from Murkowski and Sen. Susan Collins (R-Maine).

The extended absence of Sen. Mitch McConnell of Kentucky for health reasons has also left Republicans short of a vote.

Murkowski cited Blanche’s handling of the Jeffrey Epstein files and the settlement agreement reached between Trump and the IRS under his watch as well as DOJ’s “repeated targeting” of Trump’s political enemies.

Senate Republicans rejecting Blanche would be a significant blow to Trump, who has pressured GOP senators to support Blanche over the past week as his nomination has been in limbo. And it would come as he’s already fuming at the conference, and Senate Majority Leader John Thune, over their inability to end the legislative filibuster and pass the elections bill known as the SAVE America Act.