Johnson said leadership had ruled out two Medicaid policies that could go a long way toward meeting the Energy and Commerce Committee’s $880 billion, 10-year savings target but faced strong pushback from blue-state GOP centrists.
First, Johnson said the emerging package wouldn’t touch the Federal Medical Assistance Percentage, or FMAP, rate — the portion of state Medicaid costs borne by the federal government — for the Medicaid expansion population, which is currently 90 percent.
Johnson also poured cold water over a provision that would implement per capita caps on Medicaid benefits for enrollees in expansion states, though he wasn’t quite as definitive on that front.
“I think we’re ruling that out as well, but stay tuned,” he said.
At least one provision remains in the mix: new work requirements for healthy adults in states that expanded Medicaid to receive the 90 percent federal match, a key provision of the 2010 health care law.
“That will be part of the bill, it always has been,” Johnson said on including work requirements.
The Congressional Budget Office has scored prior Medicaid work requirement proposals as saving over $100 billion — which would still leave Republicans substantially short of what they need.
Listening Session
About a dozen Republicans with qualms about making deep cuts to Medicaid participated in what was described as a “listening session” for nearly two hours.
Several Republicans, especially those in states that expanded Medicaid, had drawn a hard line against supporting a broader slate of Medicaid cuts to try to hit the $880 billion threshold required by the fiscal 2025 budget resolution.
“It’s going to take a lot more of these kinds of conversations, ultimately, to get to an understanding that 99 percent of the House Republican Conference can agree with,” New York Rep. Nick LaLota said after the meeting.
The two proposals to scale down the federal government’s financial contribution to covering the Medicaid expansion population were originally floated by Energy and Commerce Chairman Brett Guthrie.
One would have reduced the federal government’s match rate from 90 percent to something more in line with the typical match for the non-expansion population, which ranges from 50 percent to 83 percent.
An alternative proposal emerged last week to cap Medicaid benefits per expansion enrollee, with annual growth for medical inflation.
Such a change would still result in a massive cost shift to states. According to KFF, a nonpartisan health policy research organization, it could reduce the federal match over time potentially to 69 percent by 2034. States would become responsible for any costs that exceed that cap, amounting to a cost shift of about $246 billion over ten years, according to KFF.
Republican leadership is racing to find a slate of Medicaid proposals that can help pay for President Donald Trump’s “big, beautiful” reconciliation bill before a markup the Energy and Commerce Committee aims to hold next week.
That committee is charged with finding the largest share of overall savings across 11 House committees, which in total have to find at least $1.5 trillion. The money would go toward paying for a huge tax package, including extensions of Trump’s 2017 tax cuts expiring at the end of this year.
A Political Opening
The prospect of cuts to safety net programs like Medicaid in exchange for tax cuts benefiting households at the top of the income scale has given Democrats a political opening to hammer moderate Republicans whose seats are at risk next year.
House Democrats started collecting signatures on a discharge petition Tuesday to try to force a vote on a resolution they introduced earlier this year to create a point of order against any reconciliation bill that cuts Medicaid enrollment or benefits, as well as eligibility or benefits in the Supplemental Nutrition Assistance Program.
GOP Reps. Zach Nunn of Iowa, Don Bacon of Nebraska and Derrick Van Orden of Wisconsin late last week introduced their own, competing resolution that would create a similar point of order, but specifically protect from any cuts individuals under 19 or 65 and over, individuals with disabilities and those who are pregnant.
That would leave other adults who don’t fall into those categories potentially exposed. But the proposal gives vulnerable Republicans political cover to avoid signing on to the Democrats’ petition.
“Tragically, not a single Democrat wanted to join” his resolution, Nunn said Tuesday.
The three Republicans are among the party’s most vulnerable in 2026; Bacon’s and Van Orden’s races are rated Tilt Republican by Inside Elections with Nathan L. Gonzales, while Nunn’s is considered Lean Republican.
While Republicans have generally agreed on protecting the traditional Medicaid population from cuts, the GOP has stumbled over the question of how to handle Medicaid expansion.
Trump has been sensitive about cuts to Medicaid amid pressure from the “MAGA” wing of the Republican Party that is warning that cuts are deeply unpopular.
“It’s just off the table because of him [Trump], because of me, because of everybody. We just don’t like it. It’s a mistake,” said Rep. Jeff Van Drew of New Jersey, referring to the proposal to cut the federal government’s Medicaid expansion match.
Backing off on two policies to slash billions of dollars from Medicaid will likely anger conservatives who have pushed Johnson for big cuts.
“Well — I haven’t ruled it out,” Texas Rep. Chip Roy posted Tuesday evening on X, formerly Twitter. “It’s necessary to stop robbing from the vulnerable to fund the able-bodied.”
Conservatives have argued that funding for Medicaid expansion means less resources for those in the traditional Medicaid population, mainly children, people with disabilities, some low-income parents and pregnant women.
The conservative American Action Network announced a $7 million ad buy Tuesday targeting 30 congressional districts, related to reducing “waste, fraud and abuse” in health care.
The Trump administration, meanwhile, has floated savings outside of Medicaid spending, including a proposal from his first term that would peg drug prices to prices paid in other countries. So-called most favored nation policies are typically loathed by Republicans, but members said Tuesday it is under discussion.
“It’s one of the proposals that is out there,” said Rep. Earl L . “Buddy” Carter of Georgia on Tuesday.
“Everything’s still on the table. The only thing that’s in is [addressing] waste, fraud and abuse,” Carter said. Nothing’s out.”
Meanwhile, Republican Sen. Josh Hawley of Missouri, who has said he won’t support a reconciliation bill that leads to cuts to Medicaid benefits, introduced legislation that would cap retail lists prices for drugs at the average prices paid by several countries including Canada and the United Kingdom .
SNAP Cuts
Meanwhile, the House Agriculture Committee, which is tasked with finding $230 billion in savings over 10 years, is having its own problems coming up with the money.
Republicans on that panel met Tuesday morning to hash out SNAP cuts, particularly a controversial proposal to introduce a state-match requirement similar to how Medicaid operates. Van Orden has been a vocal opponent of the idea, which he says would force states like Wisconsin to subsidize other states with much higher overpayment error rates.
“I want to be explicitly clear, I will not vote to have the citizens of the state of Wisconsin pay 10 percent cost share to make up for other people’s just blatantly horrible management,” Van Orden said. “The only thing that’s acceptable to me is to tie it directly to the state error rate. Period.”
He proposed an alternative that would base the state share on SNAP overpayment error rates.
The Agriculture Department reported a nationwide overpayment rate of 10 percent in fiscal year 2023. Van Orden’s proposal would require Wisconsin to pay 4.7 percent of its SNAP costs. Alaska would see the highest rate of nearly 60 percent, according to the Agriculture Department’s 2023 figures.
“We’re not going to pay for Alaska. Not going to happen,” Van Orden said.
Still, House Agriculture Chairman Glenn “GT” Thompson of Pennsylvania said after the meeting Tuesday that his panel is on track to mark up its portion next week. “We haven’t really landed on a final proposal. I’d say we’re really close,” Thompson said.
Those two committees, plus Ways and Means, which is working on the tax package, would be the last to put their pieces of the reconciliation package together. Then the Budget Committee would vote on it before it goes to the floor.
Johnson is still eyeing the week of May 19 for a floor vote, though others are skeptical.
“We’ll have the one, big, beautiful bill ready to go,” he told reporters earlier on Tuesday. “We can pass that by Memorial Day.”
David Lerman contributed to this report.
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