Guthrie has long wanted to overhaul Medicaid. Now he has to sell members on a compromise

Yahoo

13-05-2025

With House Republicans warring over Medicaid, Energy and Commerce Chair Brett Guthrie is playing peacemaker — telling moderates the party isn't going to gut the safety-net program while also assuring fiscal hawks that Republicans will slash hundreds of billions of dollars.
It's a delicate balancing act for the mild-mannered Kentucky Republican, who's been largely successful in preventing an all-out, intraconference revolt. But he's about to face his biggest leadership test yet Tuesday as his panel meets to advance its contributions to President Donald Trump's 'big, beautiful bill' that go further than what some centrists would like — and not far enough to satisfy every hard-liner.
'I think he's learned a lot,' said Rep. David Valadao of California, one moderate who has more Medicaid recipients in his swing district than any other House Republican and has been working to warn his colleagues about going too far in overhauling the program. 'But he just has a very difficult task.'
The Energy and Commerce portion of the massive, party-line package needs to reduce the deficit by $880 billion. The bulk of these savings is expected to come from changes to Medicaid, which currently serves nearly 80 million Americans.
The draft legislation being marked up Tuesday would scrap the most controversial proposals that had initially been on the table, including one to cap federal spending in states that have expanded Medicaid under the Democrats' 2010 health law. At the same time, it would throw conservatives red meat, like banning federal funding for Planned Parenthood and pulling back money from states offering Medicaid to undocumented immigrants.
It also would add new mandates that will likely force states to revamp how they finance their programs or cut benefits, along with new work requirements that are expected to result in reduced enrollment. Democrats released preliminary Congressional Budget Office estimates they requested Sunday night, which found more than 8.6 million people would go uninsured if the health portions of the GOP's party-line package became law — resulting in cuts of at least $715 billion
In many ways, this bill is a compromise for Guthrie, who has talked for nearly his entire, 16-year career in Congress about wanting to make sweeping changes to Medicaid to protect it from abuse and, in turn, insolvency — in line with what hardliners are pushing.
'I'd personally love per-capita allotments for Medicaid,' said Guthrie in an interview earlier this year, referring to a controversial proposal to cap federal spending in the program. 'I'm not sure we're going to be able to get 218 votes for that.'
The conference's staunchest conservatives, however, don't see it as a compromise at all. To the extent that Guthrie's proposal seeks to strike a balance between wishlists for centrists and fiscal hawks, the latter contingent see it as falling far too short.
'I sure hope House & Senate leadership are coming up with a backup plan … because I'm not here to rack up an additional $20 trillion in debt over 10 years or to subsidize healthy, able-bodied adults, corrupt blue states, and monopoly hospital ceos,' Rep. Chip Roy (R-Texas) said in a social media post Monday.
Hard-liners are also privately livid that Guthrie and House Republican leaders were, in the later stages of negotiations, too focused on Trump's anxieties about the House appearing too aggressive on Medicaid. Fiscal hawks privately fumed that Guthrie and leadership increasingly turned to creative ways to find savings across the program. But in the end, it constituted 'shell games' that wouldn't bend long-term federal spending on the program, according to four Republicans involved in the talks.
Guthrie was a recent guest at an hours-long House Freedom Caucus meeting on the subject, where efforts to explain how Congress could inadvertently cause widespread Medicaid coverage losses largely fell flat.
'That's not our problem,' Rep. Eric Burlison (R-Mo.) shot back at one point.
Guthrie has, however, spent considerable time among moderates, often one-on-one, to walk them through various potential proposals on overhauling Medicaid and sort out any confusion.
Those conversations have involved no 'strong-arming,' said Rep. Gus Bilirakis, the Florida Republican who chairs the Energy and Commerce subcommittee on commerce, manufacturing and trade, in an interview.
'I sit down and walk through some policy options and I think I made people feel more comfortable with where we are,' Guthrie told reporters after a recent meeting with members concerned about deep Medicaid cuts. 'We're not going to do anything that's drastic.'
The conservative health policy chops Guthrie has accumulated over years of studying the issues has lent him credibility with members on opposite ends of the ideological spectrum.
'He brings up that right mixture of the human aspect — the compassionate side of being an American — along with a deep understanding of policy that exceeds most staff members,' said Rep. August Pfluger (R-Texas), an ally of Guthrie's on the committee. Rep. Morgan Griffith (R-Va.), a member of both Energy and Commerce and the House Freedom Caucus, conceded in an interview that while 'there are things we're all disappointed aren't in [the bill] … Most people who've talked with him realize that he's an honest broker who's trying to do a hard job.'
Guthrie's own willingness to compromise could also be what brings colleagues around at Tuesday's markup. That includes Rep. Nick Langworthy (R-N.Y.), who had been expressing reservations about Medicaid cuts but on Tuesday praised Guthrie's proposal as one that 'strengthens the social safety net while restoring fiscal responsibility.'
'He's probably the most transparent committee chair in the halls of Congress,' Langworthy, a member of the Energy and Commerce Committee, said of Guthrie in a recent interview. 'He and the staff of Energy and Commerce are doing yeoman's work listening to members' concerns across the conference of all ideologies to make sure that … this is a final product that will be able to get 218 votes.'
That's one Energy and Commerce Republican Guthrie can count on. He can only afford to lose about a handful of others on the panel and still advance the measure, given all Democrats are expected to oppose it. His margin of error will be even more slender when it hits the House floor as soon as next week, bundled together with the other components of the massive package of tax cuts and extensions, border security investments, energy policy and more.
Hard-liners will be sure to keep grumbling. Moderates will continue to be inundated with political attack ads from Democrats, alongside public backlash from hospitals and GOP state legislators that would feel the effects.
'The GOP is putting up smoke and mirrors but this is all very simple: Donald Trump and Republicans are abandoning working families so they can fund tax handouts to billionaires,' DNC chair Ken Martin said in a statement.
And in the leadup, Guthrie has tried to keep a low profile: A typically accessible presence on Capitol Hill, the lawmaker has recently been shielded by aides who would rather he not weigh in on the increasingly fragile, ongoing negotiations.
But Guthrie has found it hard at times to stifle his chattiness — one of the qualities that has helped him build at least modest consensus around one of the thorniest issues in the megabill.
Heading into a closed-door meeting in the basement of the Capitol two weeks ago, Guthrie almost slipped into the room undetected by the press. But ten feet from the door, a reporter asked Guthrie whether one sensitive Medicaid proposal remained under consideration.
The committee chair started to reply as a staffer quickly interjected to silence the exchange. Just before stepping into the meeting, however, Guthrie stuck his head out to confirm: 'We're still discussing.'