BURSTFiscal hawks are lashing out over what they say are the lack of Medicaid reforms in President Trump’s legislative package, which could thwart the House GOP’s goal of passing the legislation next week.
The gripes from conservatives are centered on the House Energy and Commerce Committee’s portion of the sprawling package, which beefs up work requirements for Medicaid and imposes more frequent eligibility checks but stops short of more substantial changes — such as siphoning federal funding away from states.
“In my opinion they don’t go far enough,” said Rep. Eric Burlison (R-Mo.), a member of the House Freedom Caucus who does not support the package.
The Congressional Budget Office (CBO) found the panel’s work would reduce deficits by more than $880 billion by 2034, exceeding the instructions laid out in the budget resolution.
But hard-liners such as Burlison are unconvinced by the CBO’s “funny math.”
“I really don’t trust the CBO score,” said Burlison, who told reporters he was shocked the cuts weren’t larger.
“At the end of the day, we have a $2 trillion deficit and the fact that we’re — we’re shuffling the chairs on the top of the Titanic here,” he added. “So we’ve got to do more.”
Rep. Ralph Norman (R-S.C.), another deficit hawk in the Freedom Caucus, said he spoke out against the bill during the conference’s closed-door meeting Wednesday morning, along with several others. He wants “substantial” changes.
“I’m not flexing this as a, because I’m trying to get something for South Carolina,” he told reporters after the meeting. “I’m trying to get the math in order to get this country back on track financially, and it just hasn’t happened.”
One of the biggest complaints from conservatives revolves around the work requirements, which demand Medicaid enrollees take part in at least 80 hours of “community engagement,” including work, community service or a work program. That provision, however, would not take effect until the beginning of 2029 — which hard-liners say is far too late.
“Literally, that's like a parent telling their 25-year-old living in the basement, ‘You've got to get a job and move out, but you know what? I'm giving you four years to do it.’ It's ridiculous. Nobody works that way,” said Rep. Andy Harris (R-Md.), the chair of the House Freedom Caucus.
Rep. Warren Davidson (R-Ohio) echoed that sentiment, saying he was “a little disappointed.”
“Delaying a lot of these things are like hollow promises,” he added. “They’ll cut that in four years, or they’ll phase it in over a longer period of time. And I’d rather see actually aggressive cuts.”
Deficit hawks are also miffed that GOP leadership did not go further and lower the federal matching rate for Medicaid, known as the federal medical assistance percentage (FMAP).
Hard-liners pushed for changes to the FMAP and placing a per-capita cap on people who get coverage from Medicaid expansion, two proposals that moderates dubbed red lines. In the end, centrists won that fight.
“We’re still letting the states launder money through Medicaid by paying 90 percent of the cost for an able-bodied adult, when we pay for 57 percent of pregnant women, children, seniors and disabled,” Rep. Keith Self (R-Texas) said. “It’s a money laundering scheme by the states.”
The airing of grievances came as Energy and Commerce debates its portion of the bill at a meeting poised to break the record for its longest markup — 27 hours.
Hard-liners had pushed for significant spending cuts in the entire package, leading leadership to call for at least $1.5 trillion in slashes — $880 billion of which would come from Energy and Commerce. The panel achieved that goal: According to a draft CBO analysis circulated by Democrats, the bill would reduce federal spending by roughly $912 billion over the decade, with $715 billion coming from the health provision. The scorekeeper also said 8.6 million people would lose insurance.
Those results are now drawing scrutiny and caution from both sides of the GOP’s ideological spectrum, posing a difficult balancing act for Speaker Mike Johnson (R-La.).
While conservatives complain the cuts are too small, moderates are more guarded and appear nervous to back provisions that were not as significant as they could have been but will still leave millions of more Americans uninsured.
“I’m still reading through it but obviously a lot of the draconian cuts that people were pushing for, I and others were able to prevent, so we’re reading through the bill as it’s written,” said Rep. Mike Lawler (R-N.Y.), who represents a swing district.
“There could be some changes there, too,” Rep. Andrew Garbarino (R-N.Y.) said. “There are a lot of people that are unhappy with a lot of provisions.”
That hesitation means Johnson may have a difficult time ratcheting up Medicaid cuts to appease hard-liners, as it would almost certainly be met with opposition from moderates.
Johnson is remaining even-keeled. Asked by The Hill on Wednesday if he believes the deficit hawks are changing the rules midgame by complaining about the lack of spending cuts after the CBO said the committee reached the minimum $880 billion, Johnson said their gripes are part of the process.
“No, I don’t think the goalposts are being moved,” he said. “I think everybody's just expressing their preferences for the final product, and again, that’s part of the process.”
The debate over Medicaid cuts is just one disagreement over the GOP’s blueprint. The Speaker is also grappling with a heated debate over the state and local tax (SALT) deduction cap, which has also pitted moderates against conservatives.
Republican centrists from high-tax blue states — including New York, New Jersey and California — have pushed for an increase to the SALT deduction cap, which currently sits at $10,000. The House Ways and Means Committee’s portion of the bill proposes a $30,000 cap for individuals making $400,000 or less, a number that SALT Caucus members have vocally rejected. Johnson is now working with those lawmakers to find consensus, with moderates saying they will not support the final package without reasonable SALT relief for their constituents.
On the other end of the conference, hard-line conservatives are speaking out against a SALT deduction cap increase because of its costly price tag.
Deficit hawks are warning they will not get on board with a higher deduction cap unless it is paid for.
“My view on the SALT Caucus is that, look, I get it. I get you’re in that situation, but it costs money. And you can’t be the same group of people that are b‑‑‑‑ing or complaining about spending cuts in other areas,” Burlison said. “If you want your SALT tax deductions, it’s got to be paid for, otherwise the American people are going to pay it in debt and deficit and interest rates and inflation.”
“You can’t have your cake and eat it too,” he continued. “If you want your SALT tax deduction to go up, you need to find the savings. So don’t complain.”
Emily Brooks and Mike Lillis contributed.