Alliance Alert: Brett Guthrie, chair of the House Energy and Commerce Committee that has been tasked with reducing healthcare spending by $880 billion over the next ten years, issued a news release tonight that indicated that the Trump/House proposal will implement work requirements and more frequent eligibility checks, without lowering the minimum share the federal government contributes to Medicaid in each state (FMAP) or cap per-person federal spending that hard liners had sought.
See news accounts and the news release below. The Alliance will provide an analysis tomorrow.
GOP Megabill Will ‘Strengthen’ Medicaid, Claw Back IRA Spending, and More, Guthrie Says
The Energy and Commerce Chair Published an Op-Ed Previewing Key Provisions Hours Before Bill Text Is Expected to Be Released.
By Ben Leonard Politico May 11, 2025
Republicans’ megabill will implement work requirements in the Medicaid program, roll back Biden-era Medicaid eligibility rules and repeal a controversial nursing home minimum staffing rule, House Energy and Commerce Committee chair Brett Guthrie (R-Ky.) wrote in a Wall Street Journal opinion piece Sunday night
Legislative text of the panel’s portion of the bill
will be released Sunday night, Guthrie said. SEE BELOW
Guthrie did not say whether the legislation, which is set for a Tuesday markup, would include a controversial proposal to cap federal spending on states that have expanded Medicaid under the Affordable Care Act.
“Democrats will use this as an opportunity to engage in fear-mongering and misrepresent our bill as an attack on Medicaid. In reality, it preserves and strengthens Medicaid for children, mothers, people with disabilities and the elderly — for whom the program was designed,” Guthrie wrote in the op-ed. “Without Republican solutions, Washington risks a complete collapse of Medicaid.”
Energy and Commerce members are set for a briefing on the bill’s finer points at 9 p.m. Sunday, according to an advisory obtained by POLITICO.
The committee has been tasked with finding $880 billion in savings in programs under its jurisdiction, which includes Medicaid, as part of the massive party-line package central to President Donald Trump’s agenda on tax, border and energy policy. The policies Guthrie detailed and gave cost-savings estimates for would save $266.5 billion, he said, leaving many more details to be filled out when the final text is released tonight. Many of the policies Guthrie touted in the piece have been expected, with thornier provisions still up in the air.
Those savings are crucial for offsetting the tax cuts Republicans are also planning for the megabill. A draft of revenue-side provisions released by the Ways and Means Committee Friday is estimated to add nearly $5 trillion to the federal deficit over the coming decade, according to nonpartisan scorekeepers. Ways and Means Chair Jason Smith (R-Mo.) is hosting a briefing on the tax title of the bill with panel members at 1 p.m. tomorrow, according to an advisory obtained by POLITICO.
Besides health care, the committee’s work will also touch on energy and telecommunications issues, clawing back Biden-era green energy spending, including climate spending under the Inflation Reduction Act, and allowing the federal government to auction off wireless spectrum. The latter provision is expected to save $88 billion, Guthrie said.
But changes to Medicaid, which are key to hitting the massive savings target, have been the most controversial parts under the committee’s jurisdiction.
Adding work requirements in the program, as Guthrie said the legislation will do, has been relatively noncontroversial among Republicans. Democrats have hammered such policies, pointing to Congressional Budget Office findings saying they do little to increase employment and would take health care away from millions of people.
“It’s a well-written op-ed that’s intended to distract from the fact that millions of people are going to lose their health care as a result of this bill,” a spokesperson for Energy and Commerce Democrats said in a statement.
It’s unclear if the work requirements will be mandatory for all states to implement or optional.
The package will allow for more frequent eligibility checks in Medicaid, reversing Biden-era rules. Doing so along with other Medicaid rules will save $172 million over a decade. It will also prevent Medicaid from funding gender-affirming surgery for children, Guthrie said. And Guthrie added the package will lower federal aid to states that offer Medicaid benefits to undocumented people.
“This policy puts undue budgetary pressure on Medicaid, thereby endangering the healthcare access of the vulnerable Americans the program was designed to help. Just as Mr. Trump is working to end sanctuary cities, congressional Republicans will reduce federal aid to states that give welfare to illegal immigrants,” Guthrie wrote.
Benjamin Guggenheim contributed to this report.
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Chairman Guthrie Op-Ed: A Common Sense Budget Reconciliation Bill
May 11, 2025 House Energy and Commerce
Press Release
WASHINGTON, D.C. – The following op-ed by Congressman Brett Guthrie (KY-02), Chairman of the House Committee on Energy and Commerce, appeared in the Wall Street Journal today.
“When President Trump took the podium for his Second Inaugural Address, he promised a ‘revolution of common sense’ that would launch a generation of growth, health and prosperity. Today, our country faces numerous threats to that goal. Medicaid waste and abuse threatens the well-being of America’s most vulnerable as the looming expiration of important 2017 tax reforms throws a shadow over U.S. industry.
“Republicans’ best chance to secure the president’s inaugural promise is this year’s reconciliation bill. On Sunday night the House Energy and Commerce Committee will release a bill that supports the rapid innovation of American industry, strengthens Medicaid, and ends spending on Green New Deal-style waste.
“This reconciliation legislation will help raise federal revenue and limit government spending to what actually helps Americans. We will raise $88 billion by reauthorizing the Federal Communications Commission’s spectrum auction authority and provide resources to modernize federal information-technology systems. Both are crucial for maintaining and expanding U.S. technological leadership.
“Savings like these allow us to use this bill to renew the Trump tax cuts and keep Republicans’ promise to hardworking middle-class families. The 2017 cuts gave Americans earning under $100,000 an average tax cut of 16%, while increasing the share of the tax burden carried by the top 1% of earners. Without this legislation, middle-class Americans will see that windfall reversed at the end of 2025.
“In addition to raising new revenue, the bill will slash waste, particularly handouts to Democrats’ climate activist cronies. The 2024 election sent a clear signal that Americans are tired of an extreme left-wing agenda that favors wokeness over sensible policy and spurs price increases. Mr. Trump has already reversed President Biden and Democrats’ electric-vehicle mandates and natural-gas export ban; now it’s Congress’s turn.
“This bill would claw back money headed for green boondoggles through ‘environmental and climate justice block grants’ and other spending mechanisms through the Environmental Protection Agency and Energy Department. The legislation would reverse the most reckless parts of the engorged climate spending in the misnamed Inflation Reduction Act, returning $6.5 billion in unspent funds. The bill would also begin refilling the dangerously low Strategic Petroleum Reserve.
“Democratic extremism is threatening Americans’ access to affordable healthcare. States are struggling to manage rising Medicaid costs, which ballooned under Mr. Biden. This is particularly true in Democrat-run states such as California that use federal Medicaid funding to subsidize health insurance for illegal aliens through state insurance programs. This policy puts undue budgetary pressure on Medicaid, thereby endangering the healthcare access of the vulnerable Americans the program was designed to help. Just as Mr. Trump is working to end sanctuary cities, congressional Republicans will reduce federal aid to states that give welfare to illegal immigrants.
“The Biden administration is responsible for this problem, too, having imposed burdensome regulations on Medicaid that jeopardize the program’s long-term health. The last president stripped away guardrails against fraud by making it more difficult for states to remove ineligible people from Medicaid enrollment and expanded coverage such that capable but unemployed adults could take resources meant for people in need. In total, these Biden rules will cost $172 billion over the next 10 years if they aren’t reversed—as our bill would do. Republicans will also reverse other nonsensical government rules that undermine access to care, such as the one-size-fits-all Nursing Home Minimum Staffing Rule that threatens to close thousands of nursing home facilities.
“Undoubtedly, Democrats will use this as an opportunity to engage in fear-mongering and misrepresent our bill as an attack on Medicaid. In reality, it preserves and strengthens Medicaid for children, mothers, people with disabilities and the elderly—for whom the program was designed.
“When so many Americans who are truly in need rely on Medicaid for life-saving services, Washington can’t afford to undermine the program further by subsidizing capable adults who choose not to work. That’s why our bill would implement sensible work requirements. Every other capable adult works to afford healthcare. Half of all Americans get insurance through work, seniors on Medicare get coverage because they paid into the trust fund, and veterans earned their care through their service to our country.
“The Republican bill also prohibits Medicaid from funding ‘gender reassignment’ surgery for children, instead recommitting the program to essential care for our most vulnerable Americans. The federal government shouldn’t be subsidizing these procedures in any form, and I am proud that we will be protecting all our children from the lasting, harmful effects of these procedures.
“Without Republican solutions, Washington risks a complete collapse of Medicaid. Even with these simple steps to eliminate waste and abuse, Medicaid spending will continue to rise every year for the foreseeable future. All who worked on this bill—from my congressional colleagues to the White House—designed it to renew the American dream for families across the country. What could be more common sense than that?”
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Proposal Cutting Medicaid Aims for GOP Middle Ground
House bill is set to include work requirements but not deeper reductions some fiscal hawks demanded
By Olivia Beavers and Liz Essley Whyte Wall Street Journal May 11, 2025
Key Points
What’s This?
- House Republicans are releasing a plan to cut Medicaid spending, including work requirements and eligibility checks.
- Party leaders want to pass the measure in the House by Memorial Day, along with the rest of Trump’s “big, beautiful” tax and spending bill.
- The proposal faces opposition from Democrats, hospitals, and groups dependent on Medicaid funding, who warn of devastating consequences.
WASHINGTON—House Republicans are releasing their plan to cut Medicaid spending, with the program’s defenders in the GOP appearing to win the intraparty clash over how aggressively to change the system that provides health insurance to more than 70 million low-income and disabled people.
A section-by-section summary of the bill text, which was viewed by The Wall Street Journal, includes some of the changes Republicans have weighed for Medicaid, including work requirements and more frequent eligibility checks. But it doesn’t lower the minimum share the federal government contributes to Medicaid in each state, cap per-person federal spending in the program or other steps some spending hawks sought.
House Energy and Commerce Committee Chair Brett Guthrie in an interview cast the changes as slowing down runaway growth in Medicaid, rather than as cuts, while warning that the program is going to cost more than $1 trillion a year in the next decade if lawmakers don’t rein in spending. The Kentucky Republican acknowledged that Republicans’ plan to trim Medicaid spending will likely be more politically palatable to moderates and centrists than to the conservative wing, which wanted a more dramatic winnowing of the program.
“I think that the people who will have the most difficult time with it would be that it doesn’t go far enough,” Guthrie said in an office boardroom lined with the committee’s policy staffers. “We’re going to go as far as we can go to get 218 votes.”
The panel was set to release the bill text as soon as Sunday night, ahead of a committee hearing on Tuesday. Guthrie’s panel has been charged with finding $880 billion in cuts over a decade, but the tally of the planned reductions crafted by the committee wasn’t available.
Party leaders want to pass the measure in the House by Memorial Day, along with the rest of President Trump’s “big, beautiful” tax and spending bill.
While members of the Energy and Commerce committee say Guthrie has given everyone on the panel a chance to have input in the bill, the chairman is still predicting a series of negotiations with various factions of the party ahead of final passage.
Aside from healthcare, the committee focused heavily on clawing back funding that was directed to clean-energy projects as part of President Joe Biden’s Inflation Reduction Act as well as unrelated energy projects, including nixing unspent funds from certain grants and loan programs. The committee is also looking to auction off wireless spectrum, which Guthrie predicted would bring in $88 billion in revenue.
The proposal includes efforts to clamp down on states’ use of special tax arrangements to pay their share of Medicaid costs. The Republican plan would freeze at current rates the arrangements known as “provider taxes” and ban states from establishing new ones. The legislation also seeks to ensure only those who are eligible remain on Medicaid rolls, delaying Biden-era rules on looser eligibility checks and blocking federal funds for Medicaid recipients whose citizenship or immigration status is unverified.
The bill includes work requirements—a policy broadly popular across the GOP—though not as strict as some fiscal hawks had hoped. It also aims to stop federal dollars from going to facilities and organizations that provide abortion services such as Planned Parenthood, a provision some centrist Republicans have tried to block.
The bill is set to face unified opposition from congressional Democrats, hospitals and other groups that depend on Medicaid funding. They say cuts to Medicaid would devastate state budgets, force rural hospitals to close and leave vulnerable people without coverage.
Rep. Frank Pallone Jr. of New Jersey, the top Democrat on the Energy and Commerce committee, said the GOP proposal is “designed to take healthcare away from millions of people,” with the money instead being used for tax breaks for the wealthy.
Medicaid is one of the largest targets in the broader bill House Republicans are looking to pass by the end of this month, which will fund Trump’s top priorities. The GOP is using a process called budget reconciliation that allows lawmakers to bypass the Senate’s 60-vote filibuster threshold.
While GOP budget hawks are trying to find at least $1.5 trillion in spending cuts over the next decade, with the goal of reaching at least $2 trillion, a bloc of Republicans have vocally warned that deep reductions in Medicaid coverage will hurt GOP voters who depend on the program and hamper their efforts to keep the House majority in 2026.
Trump has promised not to cut Medicaid benefits, but his position on many details has been unclear. Guthrie says his efforts to run through his plan with the president at the White House earlier this month were cut short, given the meeting was running behind schedule. Guthrie did, however, leave the White House meeting with a red “Gulf of America” hat and the president’s challenge coin.
The bill would require Medicaid recipients to work, volunteer or attend school for 80 hours a month. The requirement would apply to most able-bodied adults through age 64 without dependents and includes exceptions for pregnant women, people with substance-use disorders and others.
Not included in the bill: Major changes to the minimum share the federal government shoulders for Medicaid, which is also funded by states. Some conservatives had wanted to see the federal government lower the percentage it pays for Medicaid in wealthier states such as California or for able-bodied Medicaid recipients who joined under the ACA expansion.
Per-person federal spending limits for the Medicaid expansion population, considered by the committee as recently as last week, also aren’t included.
Additionally, a drug-pricing policy the White House embraced as a way to help pay for Trump’s tax cuts isn’t making it into the bill. Trump said in a post on Truth Social Sunday night that he would be signing an executive order related to the policy.
The White House’s proposal, known as “Most Favored Nation,” would have tied the price Medicaid pays for drugs to those paid by other countries, many of which pay lower prices because their single-payer healthcare systems negotiate for deals. The White House’s position startled the drug industry, people familiar with the matter said, triggering a last-minute dash by pharmaceutical lobbyists to get Congress to kill the plan.