Medicaid cutoff may come even earlier
President Donald Trump and House Republican leaders worked Thursday to win conservative support for legislation to repeal the Affordable Care Act, offering concessions to speed cutbacks in Medicaid and dismantle more of the President Barack Obama’s signature health law.
But in a bid to ensure passage of the Republican health care bill in the House, White House and Republican leaders risked losing support in more moderate quarters of their party — not only in the narrowly divided Senate, but in an increasingly nervous House.
A faster path to Medicaid cuts, new work requirements for Medicaid recipients and potentially smaller tax credits for the working poor could mollify conservatives who are pressing for a smaller government footprint on the health care system, but they would cut deeper into the benefits that many Trump voters have enjoyed under the Affordable Care Act.
White House officials have made clear that they are open to supporting amendments that would require a quicker end to the expansion of Medicaid under the 2010 health care law, according to an administration official involved in negotiations with Congress.
Rep. Joe L. Barton, R-Texas, and other conservatives want to freeze the expansion of Medicaid next year, two years earlier than under the legislation drafted by House Republican leaders. Referring to this change, Barton said, “The Trump administration is open to it.”
But in an interview, Rep. Leonard Lance, R-N.J., said: “I am opposed to that. New Jersey expanded Medicaid. I don’t want that to be eliminated.” The federal government pays at least 90 percent of Medicaid costs for newly eligible beneficiaries, and Lance said, “I would like that to continue for at least several years.”
House Speaker Paul Ryan said Trump was now fully engaged.
“This president is getting deeply involved,” Ryan said. “He is helping bridge gaps in
our conference. He is a constructive force to help us get to a resolution.”
The political stakes for the president and the speaker could hardly be higher. If they succeed in undoing the Affordable Care Act, it would add momentum to efforts to enact other items on their agenda, such as tax cuts and a rewrite of the tax code. If they fail, it would embolden Democrats keen to block Trump — and conservatives still seeking to imprint their hard-line policies.
But they are in a delicate dance with conservatives and moderates. Halting the expansion of Medicaid in 2018, rather than 2020, “would be a huge problem, enormously problematic,” said Rep. Charlie Dent, R-Pa., one of 31 states that have expanded eligibility for Medicaid under the Affordable Care Act.
House Republicans appeared determined to power through, despite divisions in their ranks. On Thursday, the House Budget Committee approved a motion to send the repeal bill to the full House, where Republican leaders plan to take it up later this month.
But the 19-17 vote in the Budget Committee portends possible difficulties. Three conservative Republicans — Reps. Dave Brat of Virginia, Gary Palmer of Alabama and Mark Sanford of South Carolina — voted no, joining a united Democratic opposition.
“This legislation is a conservative vision for freemarket, patient-centered health care,” said Rep. Diane Black of Tennessee, the chairwoman of the Budget Committee. “It dismantles Obamacare’s mandates and taxes. It puts health care decisions back in the hands of patients and doctors.”
The Budget Committee endorsed a Republican proposal suggesting that the bill could be improved by imposing work requirements on certain Medicaid beneficiaries — able-bodied adults without minor children. Rep. Glenn Grothman, R-Wis., said that Medicaid in its current form was “a seductive entitlement” that encourages people “not to work at all, or to work less.”
That change would have to be made later in the legislative process; the committee approved a motion directing Black to seek an amendment authorizing work requirements.
Republican leaders acknowledged that they did not yet have the votes to ensure that the full House would pass the repeal bill, but Ryan said he was “working hand in glove” with Trump to achieve that goal.
Trump “knows how to connect directly with people,” Ryan said
House passage, Trump’s aides believe, would force the Senate Republican holdouts to consider whether they would be willing to vote against repeal of a law they have been pledging to undo for seven years.
To make opposition even harder for Senate Republicans, Trump’s aides plan to deploy him to states he won where Republican senators may be uneasy about the current legislation.