President Donald Trump’s endorsement of the House budget resolution as his preferred path to pass an extension of his 2017 tax cuts, border security funding and other parts of his agenda would likely require deep cuts to Medicaid, even though he has vowed not to “touch” the program, magnifying a divide among Republicans on overhauling the program.
Even after Trump made his preference for “one big, beautiful bill” known Wednesday, Senate Republican leaders indicated that they plan to stick to a two-bill approach and avoid, for now, politically contentious debates about Medicaid, the health program that covers more than 70 million low-income Americans, including children and people with disabilities.
Senate Republican leaders have said that in the resolution currently being debated, they intend to find cost savings by repealing a Biden administration nursing home staffing rule to help pay for Trump’s immigration priorities.
They’d pursue a separate reconciliation measure later in the year to extend the expiring tax policies. That second package could potentially deal with Medicaid, but Republicans have acknowledged that overhauling the politically popular program would be an uphill battle.
“Entitlements are difficult to deal with, and I say that from experience, because we worked a long, long time on Medicaid,” Sen. Charles E. Grassley, R-Iowa, said Wednesday.
The House version of the budget resolution also would require the authorizing committees to find spending cuts; it would call on the Energy and Commerce Committee, which has jurisdiction over Medicaid, to find $880 billion in savings, or nearly half of the overall spending cuts over a decade. House Republicans have suggested finding the cuts at least in part through changes to Medicaid.
“It’s going to be strengthened — but won’t be touched. Medicare, Medicaid, none of that stuff is going to be touched,” Trump said in an interview with Sean Hannity of Fox News Tuesday. “Now, if there are illegal migrants in the system, we’re going to get them out of the system, and all of that fraud. But it’s not going to be touched.”
Reaching the House benchmarks to offset the expiring tax cuts without touching Medicaid, Medicare or Social Security, as Trump has called for, would be nearly impossible through the reconciliation process, analysts say.
“Cuts of that magnitude go well beyond eliminating fraud and abuse,” Larry Levitt, executive vice president for health policy at the health think tank KFF posted on the social media platform X on Wednesday.
House Republicans, however, argue that some of their policies including work requirements and per capita caps on spending should not be considered cuts.
Many of those policies would not directly “cut” benefits, but instead would shift costs to states, which would then be likely to scale back benefits, reduce payment rates or even end their Medicaid expansion programs.
“It doesn’t go back a single penny. It actually grows with medical inflation,” House Energy and Commerce Chairman Brett Guthrie, R-Ky., told reporters last week, referring to his idea of capping what the federal government spends on Medicaid per beneficiary.
But states would need to find other ways to cover costs that exceed that cap.
Senate path
Despite Trump’s comments Wednesday, Senate Republicans said they were still moving ahead with their own proposal following a meeting with Vice President JD Vance Wednesday afternoon.
“I have some issues with it, but I like the fact that they’re moving forward,” said Senate Finance Chair Michael D. Crapo, R-Idaho, on the House budget resolution. “That’s what always happens in Congress. There’s a Senate position and a House position.”
“I’m not going to advise the House on what they should do. I’ll just get ready,” said Crapo, whose committee holds jurisdiction over Medicaid.
Sen. Rand Paul of Kentucky, the sole Republican who voted against advancing the Senate proposal during a procedural vote Tuesday, welcomed the opportunity to revise the federal match rate created to incentivize states to expand Medicaid coverage.
“The problem with that is that, you know, we’re short of money up here,” he said. “We spend about $2 trillion more than what comes in because of that. In order to try to have more fiscal responsibility, we need the states to pay more.”
“Most of the proposals that are up here are for the states to share the burden equally, the same way they’ve done traditionally, with all of Medicaid,” he added.
Grassley seemed skeptical of opening the door to scaling back entitlement programs like Medicaid.
He pointed to the strained negotiations in 1996 and 1997 that led to the Balanced Budget Act that led to billions in Medicaid savings.
“We got some changes made, but when you look at the problems today, what we accomplished back then was kind of a spit in the ocean,” he said.
Meanwhile, Democrats in both chambers organized a series of events Wednesday highlighting how cuts to Medicaid could impact their districts.
“They cannot fund Trump’s tax scam by just cracking down on fraud, waste and abuse in Medicaid,” said Sen. Catherine Cortez Masto, D-Nev. “To cut nearly a trillion dollars, which their budget plan calls for, they have to gut Medicaid.”
Senate Budget Committee ranking member Jeff Merkley, D-Ore., said at a separate Democratic leadership press conference that there was “nothing beautiful about cutting Medicaid for millions of American families.”
“In the Budget Committee, we put forward provision after provision that said, if you don’t want to hurt families by cutting Medicaid, then vote for our amendment that says Medicaid will be protected,” Merkley said. “Democrats said yes, Republicans said no.”
David Lerman contributed to this report.
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