Senate Republican leadership claims they’re inching closer to a deal on the party’s massive reconciliation package. But on the issue of Medicaid cuts versus spending levels, the conference seems to be pretty far apart.
There are two main factions among Senate Republicans whose entire goals are at odds with each other. There are those, like Sens. Josh Hawley, Susan Collins, Lisa Murkowski and more, who are against a number of cuts to Medicaid included in the House-passed bill,
Then there are the deficit hawks, like Sens. Ron Johnson, Rand Paul, Rick Scott and Mike Lee, who are demanding steeper cuts to spending, with Medicaid squarely on the chopping block.
“You’re not going to be able to cut your way out of this mess,” Sen. Jim Justice of West Virginia said. “And literally, when you start doing that, if you’re Republicans, if you start cutting in the bone and really hurting people, we’re not going to be in the majority.”
“And that to me, is dumb bunny stuff,” he added.
For the bill to pass the Senate, something’s got to give. And with just three weeks left until GOP leadership’s self-imposed July 4 deadline, nobody is budging.
“Everything’s still in play,” Senate GOP Whip John Barrasso said. “Everything’s still up for discussion.”
Senate Majority Leader John Thune seems optimistic that a deal isn’t too far out — maybe even just a few days away. Meetings on the bill are happening near-constantly: Republicans on the Finance Committee met with President Donald Trump Wednesday. Just before that, there was a closed-door conference meeting in the Capitol. On Tuesday, Republicans met to discuss tax provisions.
“I’d say we’re probably a week away from having an answer to what that ultimately might look like,” Thune told reporters Thursday morning. “But I feel good about how the conversations are going.”
Members leaving those meetings haven’t seemed appeased.
“It takes four people to sort of push the bill one way or the other, but those four people have to be willing to vote no,” Paul said. “So I think there’s a growing concern from the conservative wing of the party that there’s not enough spending cuts.”
Hawley, meanwhile, told NOTUS: “There’s really one camp here, and that’s going to be what the president wants.”
Though while suggesting there aren’t really two sides, Hawley still insisted Trump is on his.
“The President wants no Medicaid benefit cuts,” he continued. “So there we go. End of discussion.”
Proponents of Medicaid cuts say eligible beneficiaries will be just fine. To hear them tell it, the reconciliation package is a rare opportunity to root out “waste, fraud and abuse” in Medicaid and other social safety-net programs.
“You basically get rid of the Barack Obamacare portion of this, you know, go back to what Medicaid was supposed to be, for the vulnerable,” Johnson told reporters Tuesday. “Let’s not encourage single age people not to work. Let’s not make it easy for them not to work. Let’s get them back in the workforce.”
Johnson said he wants a commitment to pre-pandemic levels of spending in the near term and a process for getting there. The problem with Medicaid for Johnson is not a new one: Republicans have been trying to rollback the Affordable Care Act’s Medicaid expansion for over a decade.
But cuts to eligibility in the House bill as it stands are a major point of contention for Hawley and co. The center of the conflict exists around work requirements — with concerns that raising the bar for coverage would kick off beneficiaries who do actually need the program. There is also debate over the provider tax, which helps states fund their portion of Medicaid.
“The other thing you have to worry about is contracting providers, because if we don’t get it right, docs do not have to serve Medicaid patients,” Sen. Thom Tillis of North Carolina said. “And so we in rural areas, we could have doctors exit, and I don’t think our members from rural states would want that.”
So how will they solve it?
Two new areas for potential savings have been circulating in meetings this week: one is the cap on the state and local tax deduction (SALT), which was meticulously hammered out in the House until blue-state Republicans agreed to a $40,000 cap on the amount of property taxes wealthy homeowners can write off their federal taxes. Senate Republicans, who, per Sen. Kevin Cramer “don’t care” about SALT, are looking to bring that cap back down to $30,000.
The other is potentially looking at Medicare, the federal health insurance program primarily for older adult that’s long been a third rail in politics. When asked by reporters if cuts to “waste, fraud and abuse” in Medicare are on the table, Thune said “anything that’s waste, fraud and abuse” is open for discussion.
“The focus, as you know, has been on addressing waste, fraud, abuse within Medicaid,” said Thune. “But right now, we’re open to suggestions that people have about other areas where there is clearly waste, fraud, abuse, that can be rooted out in any government program.”
None of these members are hankering to be the one to tank the bill as a whole. And few are willing to get on the bad side of Trump, who’s banking on passage as a means to enact the bulk of his policy agenda.
And ultimately, Republicans said, where Trump has a will, there’s a way to unite the factions.
Sen. Kevin Cramer told NOTUS Monday that he thinks gradual tweaks on spending as negotiations continue could eventually find a version that strikes the balance.
“I think there could be a little bit of each,” Cramer told NOTUS on whether he thinks Medicaid-cut opponents or fiscal conservatives would ultimately win out. “The thing about when it comes down to a binary choice, it’s just got to be better than it would be if you didn’t have the bill,” he said.
He added: “It’s going to come down to really fine tuning things, right down to the end. But I do think that’s where Donald Trump weighs in.”
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Helen Huiskes is a NOTUS reporter and an Allbritton Journalism Institute fellow. Ursula Perano is a reporter at NOTUS.