Speaker Mike Johnson has ruled out some of the biggest potential cuts to Medicaid for Republicans’ party-line package to enact President Donald Trump’s agenda.
The House has targeted at least $880 billion in savings from the Energy and Commerce Committee, a task that is expected to require significant reductions to Medicaid spending. That has spurred significant concern among centrist Republicans, many of whom have a lot of Medicaid recipients in their districts.
In an interview with CNN’s Kaitlin Collins Wednesday night, Johnson ruled out putting per-capita caps on Medicaid in the eventual budget reconciliation bill. Those caps would mean the federal government would pay a share of states’ Medicaid costs based on their population, instead of the program being an open-ended entitlement. He also said that changes to the Federal Medical Assistance Percentage are off the table — a move that would cut into the share of federal payments for Medicaid, a joint state-federal program.
Both of those are options that could produce some of the most significant potential savings from the Medicaid program — but they also would have shifted significant costs to states and led to benefit cuts.
“We’re not going to cut into those programs that way,” Johnson said when asked if he would cap federal funding or reduce match rates. “We’re talking about finding efficiencies in every program, not cutting benefits for people who rightly deserve them.”
Energy and Commerce Chair Brett Guthrie (R-Ky.) has told POLITICO that he wasn’t sure if per capita caps would get enough votes to become law, and GOP lawmakers have gotten assurances behind closed doors about protecting certain services. But Johnson’s red line Wednesday was the most definitive Republican leaders have been publicly so far about not entertaining specific major Medicaid changes. They’ve mainly said any reductions would go after fraud, waste and abuse.
GOP leaders this month told senior Republicans that Trump wasn’t yet on board with significant Medicaid cuts. Republicans have been increasingly eyeing other potential options to fund the president’s agenda, including extending Trump-era tax cuts.
The speaker also said in the interview that he does not expect the Senate to make changes to the House’s budget resolution, which was barely adopted by the House’s slim Republican majority Tuesday night. But senators have already noted there will be issues on components like the debt ceiling, the current proposed spending reductions and tax cuts.
“I don’t think they will,” Johnson said when asked if he thinks the Senate would change the budget resolution. “I think they understand the necessity of letting the House lead on this. We’ve got a smaller margin than they do for the first time in the modern era.”
Ahead of the March 14 government funding deadline, Johnson noted that Congress will likely have to pass a stopgap funding bill, known as a continuing resolution or a CR, in place of individual appropriations bills. Spending negotiations have stalled, and Johnson called Democrats’ requests to rein in Trump and Elon Musk’s power over federal funding in exchange for support on appropriations bills “crazy.”
Johnson added that he expects it to be a clean continuing resolution “but with some of those changes to adapt to the new realities here,” including some of the federal funding changes from the Department of Government Efficiency.
“It may be an entire year-long CR, with some anomalies on it,” Johnson said. “It’s not what we prefer, we would like to do individual appropriations bills.”
