- Fiscal conservatives are upset over what they see as weak Medicaid reforms in President Trump’s legislative package, threatening GOP unity ahead of a planned vote.
- Criticism focuses on the House Energy and Commerce Committee’s section, which strengthens Medicaid work requirements and adds eligibility checks but avoids major funding cuts to states.
- Rep. Eric Burlison (R-Mo.) and other House Freedom Caucus members argue the reforms don’t go far enough, despite a CBO estimate showing over \$880 billion in deficit reduction.
- Burlison doubts the CBO’s math and says deeper cuts are needed to address the \$2 trillion deficit, comparing current measures to “shuffling chairs on the Titanic.”
- Rep. Ralph Norman (R-S.C.) voiced concerns during a closed-door GOP meeting, calling for more substantial changes and claiming the current approach fails to fix fiscal problems.
- A key issue is the delay in implementing Medicaid work requirements until 2029, which hard-liners say is too lenient and ineffective.
- Rep. Andy Harris (R-Md.) likened the delay to a parent giving a grown child four years to find a job, calling it unrealistic.
- Rep. Warren Davidson (R-Ohio) said the delay makes the reforms feel like “hollow promises.”
- Conservatives also want changes to the federal matching rate for Medicaid (FMAP) and a cap on Medicaid expansion spending—ideas that moderates have blocked.
- Rep. Keith Self (R-Texas) criticized the 90% federal match for able-bodied adults, calling it a “money laundering scheme” by states.
- The Energy and Commerce Committee is conducting a lengthy markup session expected to last 27 hours, amid continued debate.
- The GOP package includes \$1.5 trillion in cuts, with \$880 billion from Energy and Commerce. The CBO estimates \$912 billion in federal savings, \$715 billion from health, and 8.6 million people losing insurance.
- Speaker Mike Johnson (R-La.) is trying to balance hard-liner demands for deeper cuts with moderate concerns about coverage losses.
- Rep. Mike Lawler (R-N.Y.) noted that many of the more drastic cuts were prevented, but said he’s still reviewing the bill.
- Rep. Andrew Garbarino (R-N.Y.) said there’s widespread dissatisfaction with different bill provisions.
- Johnson said conservative concerns are part of the legislative process, not an attempt to move the goalposts.
- The Medicaid dispute adds to tensions over the SALT deduction cap. Moderates want the cap raised to \$30,000 for filers under \$400,000, but hard-liners oppose it due to the cost.
- SALT Caucus members demand relief for their constituents and won’t support the bill without it.
- Deficit hawks say they won’t support a higher SALT cap unless it’s fully offset elsewhere in the budget.
- Rep. Burlison criticized SALT advocates, saying they can’t demand tax cuts while rejecting spending reductions.
- He argued that increasing the SALT deduction without offsets will raise national debt and inflation: “You can’t have your cake and eat it too.”
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