Make no mistake: Medicaid is at the center of the GOP’s challenges as they try to assemble their “big, beautiful” bill. And the problems start at the very top.
Donald Trump is deeply skeptical of the emerging House Republican plan to make deep cuts to Medicaid to pay for the GOP’s megabill. And Speaker Mike Johnson is running out of time to convince him.
Senior House Republicans are expected in the coming days to present Trump with a menu of potential Medicaid changes, along with estimates of the savings they will generate and the impacts on beneficiaries.
Among the options the White House has agreed to consider is “per capita caps” — a controversial proposal that would limit the federal allotment to states that have expanded Medicaid under the Affordable Care Act.
The Trump administration has other ideas that have nothing to do with Medicaid: White House officials have requested proposals to instead find savings by pursuing a “most favored nation” drug-purchasing policy linking certain government payments for pharmaceuticals to the lower prices paid abroad, reviving a failed push from his first term.
Johnson has been scrambling to secure Trump’s support, shuttling up and down Pennsylvania Avenue and calling him multiple times a day to ensure they remain in lockstep and avoid a repeat of the GOP divisions that doomed the president’s 2017 push to repeal the Affordable Care Act.
But divisions abound: While moderates continue raising concerns about rolling back Medicaid expansion, fiscal hawks have been angling for even steeper cuts to the program. House Freedom Caucus members, including Reps. Chip Roy, Andrew Clyde and chair Andy Harris, met with Energy and Commerce Chair Brett Guthrie late into Wednesday night — without reaching an agreement on how to proceed.
GOP senators, meanwhile, were briefed Wednesday on polling and options for Medicaid changes, including new work requirements, during their closed-door lunch by Foundation for Government Accountability’s Tarren Bragdon. Sen. Josh Hawley issued a warning afterward, saying benefit cuts would be “catastrophically unwise.”
Elsewhere, House Republicans are being hammered on multiple other fronts as their megabill dreams come crashing into political reality. Johnson failed Wednesday to resolve his standoff with vulnerable Republicans over raising the cap on state and local tax deductions, even as he expects Ways and Means to take up its draft of the GOP tax plan next week.
Key GOP lawmakers also yanked controversial provisions around car fees and antitrust enforcement from their Wednesday markups. And GOP Rep. Mike Turner is warning that a provision cutting federal government pensions that Oversight Republicans advanced Wednesday won’t pass the full House in its current form.
What else we’re watching:
– Thune’s Ed Martin problem: Senate Majority Leader John Thune has churned through the most controversial of Trump’s nominees, but he’s facing early warning signs over another: Ed Martin, the acting U.S. attorney for D.C. Sen. Thom Tillis, whose Judiciary committee vote could be pivotal, says he plans to meet with Martin as controversy swirls over his past comments about Jan. 6.
– “Skinny budget” incoming?: White House budget director Russ Vought will meet this morning with House Appropriations Chair Tom Cole and his dozen subcommittee chairs. The appropriators are clamoring for Vought to send a “skinny budget” this week, followed quickly by a full budget request, so they can start cranking out their dozen fiscal 2026 funding bills.
– Raining on REINS: Senate Republicans are already casting doubts that the version of the REINS Act that their House counterparts advanced Wednesday as part of Judiciary’s megabill markup can pass muster with their chamber’s parliamentarian. And that’s after House Judiciary Republicans stripped a different provision, on consolidating antitrust oversight, for a similar reason. “They always think they know what the Byrd rule is, and they have no clue what the Byrd rule is,” Sen. Rand Paul said.
Rachael Bade, Adam Cancryn, Jordain Carney, Brian Faler, Meredith Lee Hill and Myah Ward contributed to this report.
