Key Republican moderates said Tuesday they had grown more comfortable with a revised House GOP effort to overhaul Medicaid following an evening meeting with Speaker Mike Johnson and other leaders.
Johnson needs to find near-unanimity among House Republicans as he finalizes the GOP megabill central to President Donald Trump’s agenda, and several of the centrists emerged from the closed-door huddle sounding closer to yes. The plan is centered around work requirements for beneficiaries, more frequent eligibility checks in the program and cracking down on coverage for noncitizens, they said.
Meanwhile, some controversial changes the moderates had blanched at appear to be omitted from the latest plan: cutting the federal share of funding for states that expanded Medicaid under the Affordable Care Act and capping federal payments to those expansion states.
Asked if Republicans were pursuing changes to the federal cost share, known as FMAPs, Johnson replied: “No.”
Asked about “per capita caps” on Medicaid funding, he added, “I think we’re ruling that out as well, but stay tuned.”
Republicans discussed the caps proposal at length in the room, according to members in attendance. There was “lots of opposition” to applying the caps for expansion states, according to one attendee granted anonymity to describe the private meeting.
The retreat from the most ambitious cost-cutting proposals risks inciting House GOP hard-liners. One leader of that group, Rep. Chip Roy of Texas, said on X that caps were “necessary to stop robbing from the vulnerable to fund the able-bodied.”
Republicans have debated for months how to handle states that have expanded Medicaid to people with higher incomes, though still near the poverty line, under the Affordable Care Act. Several states have so-called trigger laws that would end or pull back on the expansion program if the federal government reduces their role, and many lawmakers are leery invoking those provisions.
Even beyond the moderates, conservative Republicans across Virginia and other expansion states have warned GOP leaders not to pursue deeper spending cuts that would throw hundreds of thousands of Americans off Medicaid rolls. Republicans are now parsing what the fallout would be in their individual states over some per capita cap changes.
“I have to see in Arizona if the per capita cap impacts the trigger laws. I don’t think I’m 100 percent clear on that,” Rep. Juan Ciscomani (R-Ariz.) told reporters. “That would be a deal-breaker for me if it does trigger it, obviously.”
Rep. Mike Lawler (R-N.Y.) said he remains opposed to both controversial proposals: “I don’t support any change to FMAP. I don’t support per capita caps.”
“We’re coming up with options, we’re discussing them, hashing through them, debating them,” said Rep. Nicole Malliotakis (R-N.Y.). “They’ll come back with a revision.” Malliotakis left the door open to capping the federal government’s payments for certain beneficiaries in states that have expanded Medicaid.
“States need to have some skin in the game,” she said.
Members said a policy the Trump administration has pushed as an alternative to the steep Medicaid cuts — linking what the program pays for drugs to the lower prices paid abroad — wasn’t a focus.
Several other Republicans said the meeting was more productive than previous conversations around Medicaid changes.
“I feel better about it,” said one vulnerable House Republican who was in the room.
“I think he’s got something that’s workable,” Rep. Dan Newhouse (R-Wash.) said, adding, “there’s a few wrinkles that need to be worked out, but I think he’s on … a good path.”
Some members said they want to know more about what Trump thinks.
“We have to make sure that we know where the president is on this and also where the Senate is,” Ciscomani said. “We can’t be just unilaterally moving this without knowing where they’re going to be and then have some surprises there at the end.”
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