Medicaid decision time

It’s Medicaid decision time for these House moderates

Six Republicans said big cuts to the low-income health insurance program were unacceptable. Now they have to vote.

By Kelly Hooper and Robert King

House Republicans who said they wouldn’t accept big cuts to Medicaid are returning to Washington Wednesday facing a politically perilous decision: whether to vote for a Senate-passed megabill that cuts even more deeply than the one representatives passed in May.

The version senators passed Tuesday would reduce health care spending by about $1.1 trillion over 10 years, most of which would come from the federal-state health insurance program for low-income people, according to a Congressional Budget Office estimate, from before the bill went through some changes. That compares with nearly $800 billion in the House bill.

More than 70 million Americans rely on Medicaid, and millions will lose their coverage if either version of the bill becomes law due to new work requirements and other factors.

The House Republicans who pledged to protect Medicaid, many of whom represent large shares of enrollees, are facing intense pressure from President Donald Trump to pass it before July 4th — his self-imposed deadline.

“The American people need and deserve it,” Trump posted Tuesday on his social media site, Truth Social.

Some GOP senators who said they opposed big Medicaid cuts, most prominently Missouri’s Josh Hawley, ultimately voted for the bill. Two others voted no: Susan Collins of Maine and Thom Tillis of North Carolina.

The House’s version of the bill would freeze the states’ current provider tax rates — which they levy on hospitals to juice the federal contribution. The more money a state devotes to Medicaid, the greater amount of federal dollars it can qualify for, and the taxes ensure a state can cover its share of Medicaid costs without dipping into their own funds.

The Senate version keeps the freeze for the 10 states that haven’t taken advantage of an Obamacare provision encouraging states to expand Medicaid to cover lower-middle-income people with a generous federal match. But it cuts the amount expansion states can levy from 6 percent of a provider’s revenue to 3.5 percent. The bill starts to phase down the tax cap in 2028.

House moderates are furious with the change, alongside a clampdown on a similar tool called state-directed payments. Sixteen House Republicans wrote to Senate Majority Leader John Thune in late June, saying they won’t support the legislation if it cuts the provider taxes and state-directed payments.

The hospital industry has also bombarded House lawmakers, saying the provisions will cause facilities to close, especially in rural areas.

Democrats are already saying Republicans are shredding the social safety net to extend tax cuts for the wealthy.

As in the Senate, House Republicans can lose no more than three votes if Democrats remain united in opposition.

Here are six GOP lawmakers to watch:

Don Bacon, Nebraska’s 2nd District

Bacon privately told the White House in the spring he wouldn’t accept more than $500 billion in reductions to the program. He said he wanted to limit Medicaid changes to work requirements, excluding noncitizens from eligibility for benefits and mandating more frequent eligibility checks.

Bacon is not seeking reelection — a major pickup opportunity for Democrats. His Omaha-based district is one of only three GOP-held seats that then-Vice President Kamala Harris won in the 2024 presidential election. Bacon won his 2024 race by about 7,000 votes.

David Valadao, California’s 22nd District

Valadao represents a district in California’s Central Valley that is highly reliant on Medicaid, enrolling about 62 percent of his constituents. He led the letter to Thune last week opposing key Medicaid provisions in the Senate bill, including stricter limits on provider taxes and state-directed payments.

The lawmakers wrote that they support the Medicaid reforms in the House bill, but the Senate version “undermines” the House’s “balanced approach.”

“We are also concerned about rushed implementation timelines, penalties for expansion states, changes to the community engagement requirements for adults with dependents, and cuts to emergency Medicaid funding. These changes would place additional burdens on hospitals already stretched thin by legal and moral obligations to provide care,” the lawmakers wrote.

Valadao’s district — which is heavily Hispanic and mostly Spanish-speaking — is perennially in play. He won reelection in November by 7 percentage points. He’s in his sixth term — but lost one in the middle.

Jeff Van Drew, New Jersey’s 2nd District

Van Drew has said that Senate provisions targeting how many federal dollars states can collect for Medicaid would be “a nonstarter” for him if the bill made its way back to the House.

“I have always stood for cutting waste, and fraud, and making sure taxpayer dollars are not going to anyone who should not be getting them, especially illegal immigrants,” he said. “But the way this plan is written could unintentionally hurt the people Medicaid is meant to help.”

Van Drew, a former Democrat, switched parties at the end of 2019 to protest the first Trump impeachment in which the House found he’d abused his power by threatening Ukraine and obstructed Congress. The Senate later acquitted Trump.

Van Drew represents a south Jersey district with 22 percent of constituents enrolled in Medicaid. He won reelection in November by more than 16 percentage points.

Rob Bresnahan, Pennsylvania’s 8th District

Bresnahan has said he would not vote for a bill “that guts the benefits my neighbors rely on.”

“I will fight to protect working-class families in Northeastern Pennsylvania and stand with President Trump in opposing gutting Medicaid,” he said in a February statement. “My position on this has not and will not change.”

Trump has said he would protect Medicaid, but has also endorsed both the House and Senate versions of the megabill.

Bresnahan represents a mix of suburban and rural communities where 27 percent of residents are on Medicaid. He defeated incumbent Democrat Matt Cartwright by 1.6 percentage points in November.

Juan Ciscomani, Arizona’s 6th District

Ciscomani joined Valadao’s letter to Thune opposing the Senate Medicaid cuts, as well as another letter in April urging House leaders not to move forward with cuts that would gut Medicaid benefits.

Ciscomani won reelection by 2.5 percentage points in November. His district, in the southeast corner of the state, has a large military presence. About 24 percent of his constituents are enrolled in Medicaid.

Dan Newhouse, Washington’s 4th District

Newhouse signed Valadao’s letter opposing the Senate Medicaid cuts.

He is one of two current House Republicans who voted to impeach Trump in 2021 for inciting an insurrection at the Capitol, along with Valadao. (The Senate later acquitted Trump.)

Newhouse won reelection in November by about 6 percentage points, defeating another Republican, Jerrod Sessler, after he and Sessler advanced from the state’s multi-party primary. The district covers a large swath of central Washington state, which has long been a Republican stronghold.

About 37 percent of residents are enrolled in Medicaid, nearly 300,000 people.