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Chicago Tribune
7 days ago
- Health
- Chicago Tribune
The GOP's big bill would bring changes to Medicaid for millions
WASHINGTON — Republican Sen. Josh Hawley has been clear about his red line as the Senate takes up the GOP's One Big Beautiful Bill Act: no Medicaid cuts. But what, exactly, would be a cut? Hawley and other Republicans acknowledge that the main cost-saving provision in the bill – new work requirements on able-bodied adults who receive health care through the Medicaid program — would cause millions of people to lose their coverage. All told, estimates are 10.9 million fewer people would have health coverage under the bill's proposed changes to Medicaid and the Affordable Care Act. That includes some 8 million fewer in the Medicaid program, including 5.2 million dropping off because of the new eligibility requirements. 'I know that will reduce the number of people on Medicaid,' Hawley told a small scrum of reporters in the hallways at the Capitol. 'But I'm for that because I want people who are able bodied but not working to work.' Hawley and other Republicans are walking a politically fine line on how to reduce federal spending on Medicaid while also promising to protect a program that serves some 80 million Americans and is popular with the public. As the party pushes ahead on President Donald Trump' s priority package, Republicans insist they are not cutting the vital safety net program but simply rooting out what they call waste, fraud and abuse. Whether that argument lands with voters could go a long way toward determining whether Trump's bill ultimately ends up boosting — or dragging down — Republicans as they campaign for reelection next year. Republicans say that it's wrong to call the reductions in health care coverage 'cuts.' Instead, they've characterized the changes as rules that would purge people who are taking advantage of the system and protect it for the most vulnerable who need it most. House Republicans wrote the bill with instructions to find $880 billion in cuts from programs under the purview of the Energy and Commerce Committee, which has a sprawling jurisdiction that includes Medicaid. In the version of the bill that the House passed on a party-line vote last month, the overall cuts ended up exceeding that number. The Kaiser Family Foundation projects that the bill will result in a $793 billion reduction in spending on Medicaid. Additionally, the House Ways & Means Committee, which handles federal tax policy, imposed a freeze on a health care provider tax that many states impose. Critics say the tax improperly boosts federal Medicaid payments to the states, but supporters like Hawley say it's important funding for rural hospitals. 'What we're doing here is an important and, frankly, heroic thing to preserve the program so that it doesn't become insolvent,' Speaker Mike Johnson said on NBC's 'Meet the Press.' House Democratic leader Hakeem Jeffries, meanwhile, has denounced the bill as an 'assault on the healthcare of the American people' and warned years of progress in reducing the number of uninsured people is at risk. The nonpartisan Congressional Budget Office estimates that the GOP's proposed changes to federal health programs would result in 10.9 million fewer people having health care coverage. Nearly 8 million fewer people would be enrolled in Medicaid by 2034 under the legislation, the CBO found, including 5.2 million people who would lose coverage due to the proposed work requirements. It said 1.4 million immigrants without legal status would lose coverage in state programs. The new Medicaid requirements would apply to nondisabled adults under age 65 who are not caretakers or parents, with some exceptions. The bill passed by the U.S. House stipulates that those eligible would need to work, take classes, or record community service for 80 hours per month. The Kaiser Family Foundation notes that more than 90% of people enrolled in Medicaid already meet those criteria. The legislation also penalizes states that fund health insurance for immigrants who have not confirmed their immigration status, and the CBO expects that those states will stop funding Medicaid for those immigrants altogether. Republicans have cited what they call the out-of-control spending in federal programs to explain their rationale for the changes proposed in the legislation. 'What we are trying to do in the One Big Beautiful Bill is ensuring that limited resources are protected for pregnant women, for children, for seniors, for individuals with disabilities,' said Rep. Erin Houchin, R-Ind., in a speech on the House floor. Senate Majority Whip John Barrasso argued that Medicaid recipients who are not working spend their time watching television and playing video games rather than looking for employment. Republicans also criticize the CBO itself, the congressional scorekeeper, questioning whether its projections are accurate. The CBO score for decades has been providing non-partisan analysis of legislation and budgetary matters. Its staff is prohibited from making political contributions and is currently led by a former economic adviser for the George W. Bush administration. While Republicans argue that their signature legislation delivers on Trump's 2024 campaign promises, health care isn't one of the president's strongest issues with Americans. Most U.S. adults, 56%, disapproved of how Trump was handling health care policy in CNN polling from March. And according to AP VoteCast, about 6 in 10 voters in the November election said they wanted the government 'more involved' in ensuring that Americans have health care coverage. Only about 2 in 10 wanted the government less involved in this, and about 2 in 10 said its involvement was about right. Half of American adults said they expected the Trump administration's policies to increase their family's health care costs, according to a May poll from KFF, and about 6 in 10 believed those policies would weaken Medicaid. If the federal government significantly reduced Medicaid spending, about 7 in 10 adults said they worried it would negatively impact nursing homes, hospitals, and other health care providers in their community. For Hawley, the 'bottom lines' are omitting provisions that could cause rural hospitals to close and hardworking citizens to lose their benefits. He and other Republicans are especially concerned about the freeze on the providers' tax in the House's legislation that they warn could hurt rural hospitals. 'Medicaid benefits for people who are working or who are otherwise qualified,' Hawley said. 'I do not want to see them cut.'
San Francisco Chronicle
7 days ago
- Health
- San Francisco Chronicle
The GOP's big bill would bring changes to Medicaid for millions
Republican Sen. Josh Hawley has been clear about his red line as the Senate takes up the GOP's One Big Beautiful Bill Act: no Medicaid cuts. But what, exactly, would be a cut? Hawley and other Republicans acknowledge that the main cost-saving provision in the bill – new work requirements on able-bodied adults who receive health care through the Medicaid program -- would cause millions of people to lose their coverage. All told, estimates are 10.9 million fewer people would have health coverage under the bill's proposed changes to Medicaid and the Affordable Care Act. That includes some 8 million fewer in the Medicaid program, including 5.2 million dropping off because of the new eligibility requirements. 'I know that will reduce the number of people on Medicaid,' Hawley told a small scrum of reporters in the hallways at the Capitol. 'But I'm for that because I want people who are able bodied but not working to work.' Hawley and other Republicans are walking a politically fine line on how to reduce federal spending on Medicaid while also promising to protect a program that serves some 80 million Americans and is popular with the public. As the party pushes ahead on President Donald Trump' s priority package, Republicans insist they are not cutting the vital safety net program but simply rooting out what they call waste, fraud and abuse. Whether that argument lands with voters could go a long way toward determining whether Trump's bill ultimately ends up boosting — or dragging down — Republicans as they campaign for reelection next year. Republicans say that it's wrong to call the reductions in health care coverage 'cuts.' Instead, they've characterized the changes as rules that would purge people who are taking advantage of the system and protect it for the most vulnerable who need it most. What's in the bill House Republicans wrote the bill with instructions to find $880 billion in cuts from programs under the purview of the Energy and Commerce Committee, which has a sprawling jurisdiction that includes Medicaid. In the version of the bill that the House passed on a party-line vote last month, the overall cuts ended up exceeding that number. The Kaiser Family Foundation projects that the bill will result in a $793 billion reduction in spending on Medicaid. Additionally, the House Ways & Means Committee, which handles federal tax policy, imposed a freeze on a health care provider tax that many states impose. Critics say the tax improperly boosts federal Medicaid payments to the states, but supporters like Hawley say it's important funding for rural hospitals. 'What we're doing here is an important and, frankly, heroic thing to preserve the program so that it doesn't become insolvent,' Speaker Mike Johnson said on NBC's 'Meet the Press.' House Democratic leader Hakeem Jeffries, meanwhile, has denounced the bill as an 'assault on the healthcare of the American people' and warned years of progress in reducing the number of uninsured people is at risk. Who would lose health coverage The nonpartisan Congressional Budget Office estimates that the GOP's proposed changes to federal health programs would result in 10.9 million fewer people having health care coverage. Nearly 8 million fewer people would be enrolled in Medicaid by 2034 under the legislation, the CBO found, including 5.2 million people who would lose coverage due to the proposed work requirements. It said 1.4 million immigrants without legal status would lose coverage in state programs. The new Medicaid requirements would apply to nondisabled adults under age 65 who are not caretakers or parents, with some exceptions. The bill passed by the U.S. House stipulates that those eligible would need to work, take classes, or record community service for 80 hours per month. The Kaiser Family Foundation notes that more than 90% of people enrolled in Medicaid already meet those criteria. The legislation also penalizes states that fund health insurance for immigrants who have not confirmed their immigration status, and the CBO expects that those states will stop funding Medicaid for those immigrants altogether. Why Republicans want Medicaid changes 'What we are trying to do in the One Big Beautiful Bill is ensuring that limited resources are protected for pregnant women, for children, for seniors, for individuals with disabilities,' said Rep. Erin Houchin, R-Ind., in a speech on the House floor. Senate Majority Whip John Barrasso argued that Medicaid recipients who are not working spend their time watching television and playing video games rather than looking for employment. Republicans also criticize the CBO itself, the congressional scorekeeper, questioning whether its projections are accurate. The CBO score for decades has been providing non-partisan analysis of legislation and budgetary matters. Its staff is prohibited from making political contributions and is currently led by a former economic adviser for the George W. Bush administration. What polling shows While Republicans argue that their signature legislation delivers on Trump's 2024 campaign promises, health care isn't one of the president's strongest issues with Americans. Most U.S. adults, 56%, disapproved of how Trump was handling health care policy in CNN polling from March. And according to AP VoteCast, about 6 in 10 voters in the November election said they wanted the government 'more involved' in ensuring that Americans have health care coverage. Only about 2 in 10 wanted the government less involved in this, and about 2 in 10 said its involvement was about right. Half of American adults said they expected the Trump administration's policies to increase their family's health care costs, according to a May poll from KFF, and about 6 in 10 believed those policies would weaken Medicaid. If the federal government significantly reduced Medicaid spending, about 7 in 10 adults said they worried it would negatively impact nursing homes, hospitals, and other health care providers in their community. For Hawley, the 'bottom lines' are omitting provisions that could cause rural hospitals to close and hardworking citizens to lose their benefits. He and other Republicans are especially concerned about the freeze on the providers' tax in the House's legislation that they warn could hurt rural hospitals. 'Medicaid benefits for people who are working or who are otherwise qualified,' Hawley said. 'I do not want to see them cut.'
Yahoo
22-05-2025
- Business
- Yahoo
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 to this report.
Politico
22-05-2025
- Business
- Politico
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.
Yahoo
19-05-2025
- Business
- Yahoo
Major sticking points unresolved as Johnson races to push Trump's massive policy bill through House by Thursday
House Republican leaders are still trying to resolve major internal battles over President Donald Trump's massive domestic policy bill even as Speaker Mike Johnson is engaged in last-ditch negotiations to win over GOP members' conflicting demands before an expected floor vote later this week. Among the major issues that are still unresolved: The timeframe over when new Medicaid work requirements would kick in, whether to change the federal-state cost sharing program for Medicaid, when green energy tax credits would be phased out and how much Americans can deduct from the state and local taxes they pay. There are also big questions: How much the sweeping bill will add to the deficit and how many Americans would lose access to benefits like Medicaid and food stamps — since the non-partisan Congressional Budget Office has yet to release an official estimate on the bill's impact to the debt and the economy. House GOP leadership aides said Monday morning that key decisions have not been finalized even though Johnson wants the bill passed out of his chamber by Thursday. 'Everything is in plan all the way until the end,' said one leadership aide, noting the talks are 'extremely difficult' given the narrowness of the majority and the diversity of the demands. But aides contended that '95%' of the bill had been agreed to among House Republicans. The bill calls for first-time work requirements for Medicaid beneficiaries to be implemented by 2029, but GOP hardliners are demanding that timeframe be moved up — something that is causing angst among more moderate members. Moreover, some of the hardliners want to pare back the amount of money the federal government pays into state-run Medicaid programs, a change that moderates have long resisted. Moving up the start date of Medicaid's work requirements would boost the amount of savings in the bill, but it would also strip coverage from more people, experts say. Currently, the Energy and Commerce Committee's Medicaid provisions are expected to reduce spending by $625 billion but leave 7.6 million more people uninsured by 2034, according to preliminary estimates from the Congressional Budget Office released by the GOP. The work requirement proposal accounts for nearly half the savings, at $300 billion. Some of the more moderate GOP members are also demanding an increase of the proposed $30,000 cap on the amount taxpayers can deduct on state and local taxes they pay — a push that would increase the price tag but also cause a revolt on the right. A source involved in the so-called SALT negotiations told CNN Monday morning that the issue had not been resolved, and they had not heard much on where leadership was going on it. Asked for an update on where leadership had left things over the last 24 hours, the source responded with a cricket emoji. Johnson is expected to continue talks Monday with his members as they negotiate final changes to the bill before the House Rules Committee meets at 1 a.m. on Wednesday for a key vote to advance the package to the full House. At that meeting, an amendment would be added to the bill to make the changes to win over holdouts in his conference. CNN's Tami Luhby contributed to this report.
