Updated: May 19 at 12:56 p.m. ET
A key House panel has signed off on the GOP's massive reconciliation package, after overcoming some intra-party pushback on the provisions.
The House Budget Committee advanced the proposal late Sunday after several Republicans joined Democrats in rejecting the proposal in a 16-21 vote on Friday. Four GOP representatives sided against the bill, arguing that the included spending cuts are back-loaded.
For example, Medicaid work requirements would not kick in until 2029, and for the hardline conservatives on the committee, that was too late. However, over the weekend, those concerns were overcome, and the bill advanced along party lines with a 17-16 vote.
Committee Chairman Jodey Arrington, R-Texas, urged the Senate in a statement Sunday to act quickly on the reconciliation process, should the legislation pass the House.
“Tonight, the House Budget Committee took a critical step to passing the One Big Beautiful Bill Act and making President Trump’s America First vision a reality for the American people," Arrington said. "I look forward to finishing the work on this bill and passing this historic legislation through the House."
"I encourage my Senate colleagues not to delay and quickly take up our bill so we can expedite it to the President’s desk and make America safe and prosperous again," he said.
House Republican leaders are aiming to pass the bill before Memorial Day. Analysts suggest that it will likely face a challenging path in the Senate, given the magnitude of the cuts.
Updated: May 14 at 5:38 p.m. ET
Republicans managed to will a bill through the House Energy and Commerce Committee by a party-line vote, which would see a federal mandate for Medicaid work requirements for able-bodied adults.
The bill also allows recipients to be charged a $35 copay (PDF) starting in October 2028.
Moderates and Freedom Caucus members disagreed on how much of Medicaid to cut, but chose to advance the legislation despite the rallying cries of Democratic lawmakers, advocacy groups, the hospital lobby and on-the-ground protestors. The markup hearing lasted nearly 27 hours, with Democrats introducing amendment after amendment to no avail.
The next step for the bill is to see a vote on the House floor. There is also skepticism the reconciliation bill will survive in its current form once the Senate begins debate. Some senators, like Josh Hawley of Missouri, are opposed to Medicaid cuts. Hawley penned an op-ed opposing Medicaid cuts in the Wall Street Journal Monday.
Still, Congressional leaders have managed so far to thread the needle between keeping President Donald Trump, committee chairs, conservatives and moderates happy enough to keep advancing the bill. It will need a simple majority and no Democratic support in both chambers to pass.
Updated: May 13 at 4:35 p.m. ET
Protests disrupt hearing
From the onset of the Energy and Commerce markup hearing, protestors opted to make their voices heard.
Following Chair Brett Guthrie's opening remarks, protestors yelled "No cuts to Medicaid!" and were seen escorted off the floor. Some protestors were in wheelchairs. Guthrie warned disruptions could lead to arrests.
About 25 people were arrested for illegally obstructing the Rayburn House Office Building, Capitol police told The Hill. More protestors disrupted the proceedings throughout opening remarks.
Republicans in the committee blamed the media and Democrats for fear-mongering, accusing them of not reading the bill and exaggerating its impacts.
"Let me be clear—these work requirements would only apply to able-bodied adults without dependents who don’t have a disqualifying condition, encouraging them to re-enter the workforce and regain their independence," said Guthrie, a Republican who represents Kentucky, during his opening remarks.
On the other side of the aisle, House members repeatedly highlighted personal stories within their districts to highlight the ramifications of members losing their health coverage. They held up signs reading "Medicaid matters."
"This bill bans the people that they kick off of Medicaid from even buying their own insurance from the Affordable Care Act exchange," said Rep. Alexandria Ocasio-Cortez, D-New York. "It increases costs for people who they deem eligible, and who are low-income, and forces them to pay even more. And if you have a private insurer, don't worry, you're getting screwed over too because your healthcare premiums are going to skyrocket from the disaster that is happening from this bill."
She then held up three signs from districts in New York, California and Colorado, where a sizable percentage of the population relies on Medicaid insurance. Hospitals in those district are at risk of closure, she warned.
Meanwhile, the American Hospital Association (AHA) submitted a list of policy positions on key elements of the reconciliation bill. Of note, the AHA said the group is concerned about a provision to freeze current provider tax rates and ban new provider taxes.
"The committee’s proposal, based on our reading of the text, does not simply freeze provider percentage tax rates — it also appears to lock in the amount of dollars raised as of enactment of the law into perpetuity," the AHA said (PDF). "We also are concerned that the Committee does not include any alternate funding mechanisms to replace the loss of federal support in the states due to the proposed restrictions placed on provider taxes."
The AHA said there is also concern new work requirements would lead to additional uncompensated care for hospitals. The group does support rescinding the nursing home staffing regulation from the Biden administration, a delay of the Medicaid disproportionate share hospital reductions at $8 billion per year and applying a new conversion factor for the physician fee schedule services under the Medicare program starting in 2026.
Democratic lawmakers are now introducing amendments to the bill, which are expected to be flatly denied by the Republican majority.
Updated: May 13 at 12:54 p.m. ET
Health plans, advocacy groups descend on DC ahead of Medicaid markup hearing
It’s markup week in the House.
Starting today, the House Energy and Commerce Committee and the Ways and Means Committee will scrutinize text of the proposed reconciliation bill. The legislation will need a simple majority in the House and Senate to pass, but contradictory wishes from the moderate and more conservative wings of the Republican party will make passage difficult. Debate is expected to last hours.
In the E&C Committee, most eyes will be on reductions to Medicaid spending.
The proposal calls for the inclusion of work requirements starting in 2029, an elimination of a 5% federal funding match, the restriction of services to immigrants without proof of citizenship, a halt on Biden-era regulations on nursing homes and program enrollment, reform for pharmacy benefit manager, modifications to the drugs eligible for the drug price negotiation program, a ban on states enforcing AI laws or regulations for 10 years, a prohibition on nonprofits that administer abortions from receiving federal funds, a ban of a federal share for gender transition procedures under the age of 18, a mandate of no new provider taxes and a curtailing of state-directed payments, among the changes.
“We’ve been approached at [the Centers for Medicare and Medicaid Services (CMS)] by governors, both Republicans and Democrats, who are aligned to one fundamental reality—that Medicaid growth is crowding out other services that they feel obliged to provide,” said CMS Administrator Mehmet Oz, M.D., in an event Tuesday hosted by the Duke-Margolis Institute for Health Policy.
He estimated $1 billion is lost a month because beneficiaries are registered in more than one state for Medicaid, or they’re enrolled in Medicaid and Affordable Care Act (ACA) plans in the same state.
Advocacy and trade groups are sounding the alarm, considering this week to be a major flashpoint for the bill. Congressional leaders hope to get a bill in front of President Donald Trump over the summer.
“Instead of making it easier or more efficient to enroll in health coverage these policies will lead to significant coverage losses by creating new bureaucratic hurdles and financial restrictions for beneficiaries, and restricting funding streams to states as well as payments to safety net providers,” a coalition including the Association for Community Affiliated Plans, Families USA and the National Alliance on Mental Illness said in a statement May 13.
The National Association of Community Health Centers is flying in advocates to Capitol Hill today to warn of the impact Medicaid cuts will have on its patients. The group said more than 20,000 emails have been sent to members of Congress.
“Cuts in Medicaid can trigger a cascade of health center site closures and service reductions that ultimately cost taxpayers more through increased emergency department visits, preventable hospitalizations, and more costly specialty care,” said the association's president and CEO, Kyu Rhee, M.D.
All told, the Congressional Budget Office estimates more than 13 million Americans would lose their health insurance under the currently released text and assuming the ACA enhanced subsidies expire at the end of the year. Dental advocates also worry optional dental benefits will be the first services axed if state budgets are severely impacted, the CareQuest Institute for Oral Health told Fierce Healthcare.
Health priorities (PDF) will be discussed during the Ways and Means Committee as well.
Currently, the bill would make permanent and expand a paid family and medical leave tax credit, codify individual coverage health reimbursement arrangements and rename them Custom Health Option and Individual Care Expense arrangements, and allow employees enrolled in ICHRAs to use a salary reduction to payment for premiums purchased through the individual market.
It would also provide a two-year tax credit for small businesses with less than 50 employees to experiment with CHOICE arrangements for the first time.
Further, the bill allow seniors in a high-deductive health plan (HDHP) to contribute to a health savings account (HSA), lets people in HDHPs also enroll in direct primary care (DPC) arrangements and mandates HSA distributions for DPC services not exceed $150 per month for individuals. Fitness facility and gym memberships will be HSA-eligible. For people who make less than $75,000 annually, they would be granted permission to contribute $8,600 annually, double the current allowance.
Darbin Wofford, deputy director of healthcare for Third Way, a think tank that says it "champions moderate policy and political ideas," said the provisions in Ways and Means constitutes a “massive giveaway to the wealthy.”
“While tightening eligibility for ACA subsidies and putting up new barriers to coverage, the bill expands HSAs—a tax shelter that overwhelmingly benefits higher-income households,” he said in an email. “Most working families can’t afford to set aside thousands in pre-tax dollars for future medical bills, making HSAs irrelevant to those who need help the most.”
Ways and Means also tackles health benefits for immigrants. The text says it strikes loopholes allowing illegal immigrants to access ACA premium tax credits or enroll in Medicare. The bill also requires individuals to annual verify income and enrollment in the individual market to earn premium tax credits and stops people from receiving tax credits when signing up during a special enrollment period.
The Department of Health and Human Services would be given a $25 million piggy bank for AI contractors and data scientists to “examine Medicare improper payments and recoup overpayments,” a section-by-section summary of the bill highlights.
“We have an opportunity and a responsibility to secure a brighter future for America’s workers, families, farmers and small businesses,” said Ways and Means Chairman Jason Smith.
This is a developing story and will be updated as the E&C hearing unfolds.