The ideological differences among the Senate’s Republican majority have produced an unexpected alignment on the Medicaid provisions of the House-passed domestic policy megabill, with a group of senators seeking to curb the bill’s impact on the program. This coalition, termed ‘Medicaid moderates’, spans a spectrum from conservative figures like Josh Hawley to more moderate representatives such as Susan Collins. Their shared concern over the implications of the House bill on Medicaid has resulted in a rare display of unity among typically polarized Republicans.
The potential for widespread coverage loss—projected at 10.3 million Medicaid beneficiaries—has prompted significant concern, particularly in the red states, which may affect the support base of Senate Majority Leader John Thune. The Medicaid moderates’ influence is amplified by the backing of former President Donald Trump, who has publicly urged congressional Republicans to minimize any impact on the program, a stance he has maintained in recent statements.
However, the Senate’s fiscal constraints present a challenge for the Medicaid moderates, as the House bill’s provisions are designed to offset hundreds of billion of dollars in tax cuts. Any revision or rollback of these provisions is likely to result in political difficulties for the majority, as they must balance the demands of fiscal hawks and the Medicaid moderates. Speaker of the House Mike Johnson has emphasized the need for minimal changes to the bill, which complicates the negotiations.
Leaders such as Thune and Finance Committee Chair Mike Crapo are cognizant that Medicaid, serving nearly 80 million low-income Americans, will be a formidable point of contention. They are in discussions with key senators to navigate these negotiations carefully, without drawing public red lines. Thune has expressed a desire to reform and strengthen programs without impacting beneficiaries, aligning with the sentiments of some of the concerned senators.
Despite the efforts of the Medicaid moderates, resistance remains within the Senate, particularly from factions pushing to increase spending cuts. While some senators, like Kevin Cramer, have expressed support for reforms, others advocate for more extensive changes, which could complicate the final outcome of the negotiation. Senator Ron Johnson and others continue to push for changes to the cost-sharing between the federal government and Medicaid beneficiaries, an adjustment that could face significant opposition within the GOP conference.