GOP lines up behind Medicaid overhaul

Politico

14-05-2025

Presented by HCA Healthcare
With Robert King and Ben Leonard
Driving The Day
LONG DAY'S JOURNEY — The Energy and Commerce Committee pulled an all-nighter debating the potential impacts of Republican proposals to change Medicaid, part of the GOP's domestic policy megabill, Ben and Robert report.
Republicans defended their efforts as needed reforms to eliminate waste, fraud and abuse in a bloated program.
Democrats said the proposals, which include work requirements, new limits on provider taxes and penalties for states that use the program to insure undocumented immigrants, would throw millions of vulnerable Americans off the rolls.
The $625 billion in savings from most of the Medicaid provisions helps pay for the $4 trillion spending package that will extend President Donald Trump's tax cuts and fund other domestic policy priorities.
But the bill's passage remains an open question as several conservative hardliners have complained it doesn't go far enough to cut government spending.
Protests erupt: The day got off to a raucous start.
As E&C Chair Brett Guthrie (R-Ky.) finished his opening statement, protests erupted throughout the room, with Capitol Police arresting 25 people and escorting out more as protesters chanted, 'No cuts to Medicaid.'
Here's some of the committee debate:
— Democrats cited a preliminary estimate they requested from the Congressional Budget Office that found more than 8.6 million people could lose insurance if the bill becomes law.
'Let me be clear — this is not a moderate bill, and it is not focused on cutting 'waste, fraud, and abuse.'' said ranking member Frank Pallone (D-N.J.). 'Instead, Republicans are intentionally taking health care away from millions of Americans so they can give giant tax breaks to the ultrarich who don't need them.'
— Republicans countered that the changes are necessary to preserve Medicaid for those who need it, which includes people who are elderly or disabled. 'Medicaid was created to protect health care for Americans who otherwise could not support themselves, but Democrats expanded the program far beyond this core mission,' Guthrie said. 'That's why we are establishing common-sense work requirements for capable, but not working, adults in the expansion population.'
— The bill is generating fierce pushback from hospital groups worried about losing Medicaid funding. However, more moderate Republicans are happy that Guthrie didn't include more drastic reforms, such as a cap on federal funding for Medicaid's expansion.
WELCOME TO WEDNESDAY PULSE. I'm FDA reporter Lauren Gardner, filling in for your regular Pulse authors today. Have thoughts on the secretary's performance today on the Hill? Pass along your tips, scoops and feedback to [e-mail], [e-mail] and [e-mail] and follow along @Gardner_LM, @Kelhoops and @ChelseaCirruzzo.
AROUND THE AGENCIES
RIF REVERSAL — The Trump administration on Tuesday notified some of the thousands of recently fired public health workers that their reduction-in-force notices are 'hereby revoked,' which follows a weekslong outcry from lawmakers, unions and health experts, POLITICO's Alice Miranda Ollstein and Sophie Gardner report.
The move, detailed in emails shared with POLITICO, reinstates employees at the National Institute for Occupational Safety and Health, a CDC office that lost more than 90 percent of its workforce as part of HHS's broader staff purge last month. It also comes a day before HHS Secretary Robert F. Kennedy Jr. is scheduled to testify before Congress.
Employees who received the emails work for NIOSH teams that include the Respiratory Health Division, the Division of Safety Research, the Division of Compensation and Analysis Support, the National Personal Protective Technology Laboratory and part of the Division of Field Studies and Surveillance. The offices perform research and provide services to workers in high-risk fields like firefighting and coal mining.
Most are based at NIOSH's Morgantown, West Virginia, facility, though some are headquartered at outposts in Cincinnati, Ohio.
The Trump take: An HHS spokesperson declined to specify how many employees received similar notices, saying in a statement that the workers were rehired because the administration 'remains committed to supporting coal miners, who play a vital role in America's energy sector' and recognizes 'the courage and selflessness of firefighters, who embody the principle that public service is the highest calling.'
The administration has defended the cuts as lawful 'streamlining,' but a judge deemed them likely unconstitutional on Friday and temporarily blocked them. The Department of Justice is appealing the decision.
In Congress
KENNEDY'S DOUBLEHEADER — HHS Secretary Robert F. Kennedy Jr. returns to the Capitol today for two hearings before House appropriators and the Senate's health panel. While ostensibly focused on the president's fiscal 2026 budget request for the department, expect lawmakers to press Kennedy on the myriad headlines his political and policy moves have generated since his swearing-in.
In his statement for the House Appropriations hearing at 9:30 a.m., Kennedy will rehash already-released details of the department's restructuring and promise to work with members to realize those plans and improve how HHS delivers services.
'HHS will be prepared to share additional information with Congress in the coming weeks,' he'll say.
HELPing hand: Meanwhile, public health experts hoping for the top Senate Republican on health policy to challenge Kennedy at the Health, Education, Labor and Pensions Committee's 1:30 p.m. hearing will likely be disappointed.
Excerpts of Louisiana Republican Bill Cassidy's prepared remarks shared with Pulse emphasize the gastroenterologist's agreement with Kennedy on the need to overhaul programs and 'bloat' at HHS — and urge him to better explain how his proposed changes will help Americans.
'Much of the conversation around HHS's agenda has been set by anonymous sources in the media and individuals with a bias against the president,' Cassidy is expected to say. 'Americans need direct reassurance from the administration — from you, Mr. Secretary — that its reforms will make their lives easier, not harder.
No 'fireworks' show? Indeed, people familiar with Cassidy and Kennedy's relationship told POLITICO's Carmen Paun and Adam Cancryn not to expect a public dressing-down of the secretary's vaccine rhetoric to date, such as his lukewarm endorsement of the MMR vaccine amid a nationwide outbreak.
'It's probably going to be really disappointing for people who want fireworks,' said one of those people, who noted the pair often talk several times a week.
IN THE STATES
CALIFORNIA TO TARGET PBMs — California Gov. Gavin Newsom will release a revised budget blueprint today outlining a sweeping regulatory proposal targeting pharmacy middlemen to help rein in the state's ballooning health care costs, POLITICO's Rachel Bluth writes.
The proposal would impose new reporting and regulatory requirements on pharmacy benefit managers, the entities that negotiate drug prices among manufacturers, pharmacies and health plans. It would also expand California's ability to acquire name-brand drugs under CalRx, the state's prescription drug program.
PBMs have become popular bipartisan bogeymen for federal and state lawmakers. In California, Newsom's plan isn't entirely new.
His ideas mirror some that state Sen. Scott Wiener advanced last year in a bill that Newsom ultimately vetoed over its suggested licensing process.
'The Governor's announcement is a solid step toward ending the PBM abuses that are driving up drug costs,' Wiener said in a statement.
Names in the News
Conner Coles has joined AHIP as director of public affairs. Coles is a Biden HHS and State Department alum and previously worked in the press office of former Rep. Carolyn Maloney (D-N.Y.).
WHAT WE'RE READING
U.S. Capitol Police arrested 25 protesters who objected to proposed Medicaid cuts and disrupted Energy and Commerce's reconciliation markup on Tuesday, POLITICO's Ben Leonard and Hailey Fuchs report.
NPR's Rob Stein examines the unknowns surrounding the Trump administration's recent announcement of a universal flu vaccine project.