Medicaid backlash

Johnson warns about a Medicaid backlash

The speaker fears the Senate’s deeper cuts to the safety-net program could cost House Republicans their majority next year.

By Benjamin Guggenheim and Lisa Kashinsky

With President Donald Trump’s July 4 deadline drawing near, Senate Majority Leader John Thune told POLITICO on Tuesday night he believes the Senate is “on a path” to start voting on the megabill Friday.

But he’s got several fires to put out first. For one, he’s under immense pressure to water down the Medicaid provisions the Senate GOP is counting on for hundreds of billions of dollars worth of savings.

Speaker Mike Johnson is warning in private that Senate Republicans could cost House Republicans their majority next year if they try to push through the deep Medicaid cuts in the current Senate version, according to three people granted anonymity to describe the matter.

That comes as Sen. Thom Tillis (R-N.C.) cautions GOP senators that those same cutbacks could become a political albatross for Republicans just as the Affordable Care Act was for Democrats.

“[Barack] Obama said … ‘if you like your health care you can keep it, if you like your doctor we can keep it,’ and yet we had several million people lose their health care,” the in-cycle senator told reporters Tuesday. “Here we’re saying [with] Medicaid, we’re going to hold people harmless, but we’re estimating” millions of people could lose coverage.

GOP leaders are trying to ease concerns by preparing to include a fund to help rural hospitals that could be harmed by the reductions, even as Thune insisted Tuesday “we like where we are.” Sen. Susan Collins (R-Maine), who’s been pushing for the fund, said while that “helps lessen the impact,” she remains “concerned about the changes in the funding for Medicaid in general.”

The other drama hanging over the bill are several imminent, critical rulings from Senate Parliamentarian Elizabeth MacDonough. Several committees that already have rulings in hand are due to release revised text as soon as this morning, according to a person familiar with the plans. And Republicans could know as soon as Wednesday whether MacDonough will clear major parts of their tax package.

As of late Tuesday, the parliamentarian had not yet ruled on provisions linked to the so-called current policy baseline, an accounting maneuver that zeroes out the costs of $3.8 trillion of expiring tax cuts, according to two people granted anonymity to disclose the private discussions.

Make no mistake: Adverse rulings could send Republicans back to the drawing board on making their tax plan permanent or otherwise force them to go nuclear and override or ignore MacDonough altogether. There’s uncertainty from all sides about how that would play out, given the gambit has never been tried before with tax legislation.

This much is already clear: With the tax package in flux and Medicaid savings under threat, GOP leaders have a major math problem on their hands. And House fiscal hawks are watching to see, regardless of the accounting method, whether the Senate sticks to the budget deal they agreed to with Johnson earlier this year.