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Medicaid-cut pushback coming from inside the House

Presented by the Coalition for Medicare Choices With David Lim Driving The Day GOP'S MEDICAID PROBLEM — Republican leaders want to cut billions from Medicaid, but some of their colleagues are pushing back because they represent larger-than-average Medicaid populations, Kelly reports. A POLITICO review of enrollment in Medicaid by congressional district found that 11 Republicans in competitive seats represent larger-than-average Medicaid populations — collectively, nearly 2.7 million recipients. A vote to cut the program presents a politically sensitive decision that may come back to haunt them in 2026. Why it matters: That dissension could grow considering that President Donald Trump has made the GOP more appealing to the working class. With a 218-215 House split — the tightest in modern history — Republicans must fight for every seat during the midterms to keep control of the chamber. And they can lose only one vote in the House and still pass their budget bill. House Republican leaders plan to use Medicaid cuts to pay for tax relief, border security and energy production in the coming weeks. The Democratically aligned group Protect Our Care is targeting several Republicans in the most competitive districts with ads urging them to stop the cuts, including California's David Valadao and Ken Calvert, New York's Mike Lawler, Pennsylvania's Robert Bresnahan and Washington's Dan Newhouse. It may be having an effect. More than 3 in 5 of Valadao's constituents — more than 470,000 people — rely on Medicaid, according to an NYU Langone Health estimate. He was among six Republican representatives and two territorial delegates who recently signed a letter to Speaker Mike Johnson warning that 'slashing Medicaid would have serious consequences, particularly in rural and predominantly Hispanic communities.' Also among the signers were Bresnahan and Rep. Juan Ciscomani, a second-term Republican from Arizona who represents Tucson suburbs and rural areas to the east. He won reelection by less than 3 percentage points. Nearly a quarter of his constituents rely on Medicaid. Some Senate Republicans have begun pushing back against major cuts to Medicaid. Sen. Josh Hawley of Missouri, where more than 21 percent of the population is enrolled in Medicaid, told HuffPost he doesn't support massive cuts to the program that House Republican leaders are weighing. Hawley joined Sen. Susan Collins (R-Maine) in the early hours of Friday morning in backing a Democratic amendment to the Senate budget resolution that would prevent tax cuts for the wealthy if any Medicaid funding is cut. The rest of the Republican caucus voted it down. WELCOME TO MONDAY PULSE. Our colleague Michael Schaffer looks into how Washington's Kennedy Center might change under chair Donald Trump. Send your tips, scoops and feedback to ccirruzzo@ and khooper@ and follow along @ChelseaCirruzzo and @Kelhoops. AROUND THE AGENCIES RFK'S FIRST WEEK — HHS Secretary Robert F. Kennedy Jr. wants to start at square one with his new employees, but his first week is testing that sentiment, I report with POLITICO's Adam Cancryn and Ruth Reader. An anti-vaccine activist widely dismissed as a fringe political figure just six months ago, Kennedy in his first week began steering the 80,000-person department in a radically new direction — preparing to dismiss key vaccine advisers, vowing to alter longstanding public health priorities and standing by as the Department of Government Efficiency gutted elements of the workforce at health agencies that he's openly accused of 'corruption.' The upheaval triggered by Kennedy's confirmation as the nation's top health official has shaken much of the HHS workforce, which endured days of mass layoffs that hollowed out whole offices and decimated morale. Within Kennedy's orbit, advisers cast his disruptive first week as necessary for an HHS they believe has failed in its mission to advance the nation's health — saying he'll need to move even more aggressively in the coming weeks to achieve his wide-ranging agenda, according to three people familiar with the internal dynamics who were granted anonymity to speak candidly. Kennedy has begun exploring a shakeup of key outside committees that influence vaccine recommendations and other major public health decisions, with plans to remove experts he believes are too close to the pharmaceutical establishment in favor of replacements likely to take a far more skeptical view. The moves come weeks after Kennedy promised Senate Republicans he wouldn't do anything to diminish the nation's trust in vaccines. What's next? The HHS secretary is expected to revamp the government's public health research priorities, shifting resources away from work on infectious disease and toward chronic conditions that Kennedy and his allies see as a greater collective threat to Americans' health. Kennedy's team has also discussed imposing sweeping new restrictions on so-called conflicts of interest — a policy that advisers maintain is critical to rooting out undue industry influence, yet one that many in the public health community worry will be used to justify more firings and quash initiatives that don't align with Kennedy's personal views. 'There will be a clearing out — there's too many conflicts of interest right now in that organization,' one Kennedy adviser said of the health department. 'There is something disruptive that needs to happen for it to change.' FDA WORKERS ASKED BACK — Some probationary employees of the Food and Drug Administration who were dismissed this month were asked to return to their roles this weekend, according to four people familiar with the situation, I report with David. That includes employees responsible for reviewing medical device products, one FDA employee granted anonymity to speak candidly told Pulse. Context: A Trump administration effort to cut spending in the federal government saw hundreds of probationary health agency employees dismissed, raising fears that some firings would slow the FDA's ability to evaluate and approve new devices. According to the three people close to the situation, granted anonymity to speak candidly, some of those employees were contacted via phone over the weekend by FDA officials offering their jobs back. It's unclear how many were contacted. Spokespeople for the FDA and the White House did not respond to requests for comment. DON'T ANSWER — HHS is telling its staff to not respond to an email sent Saturday ordering them to explain their jobs. The email to workers, asking them what they did in the past week, came after Elon Musk posted on X that all federal government employees must share what they've been working on in the last week or face dismissal if they don't. However, according to emails viewed by Pulse, both HHS leadership and the NIH Acting Director Matthew J. Memoli have asked workers to hold off responding. HHS officials say they plan to provide additional guidance on Monday. That is in keeping with other agencies that are now also asking employees to hold off. Kash Patel, recently confirmed to lead the FBI, told workers in an email Saturday not to respond and that the FBI would review its own employees. Global Health USAID REDUCTION — Most U.S. Agency for International Development employees, about 1,600, have been placed on administrative leave — aside from 'mission critical' employees — as the Trump administration continues to dismantle the agency in charge of disbursing billions in foreign aid, POLITICO's Carmen Paun reports. All USAID direct-hire personnel not considered 'mission critical' will be placed on leave globally as of Sunday at 11.59 p.m. EST, said an email from the office of the USAID administrator sent to staff Sunday afternoon, seen by POLITICO. The email said that about 2,000 employees would be impacted. However, a version posted on USAID's website placed that number at 1,600. Why it matters: This is the latest move in the Trump administration's effort to realign foreign aid with the ''America First' policy and to quickly shut down an agency that for more than 60 years distributed everything from HIV drugs to food for malnourished children. President Donald Trump, his billionaire adviser Elon Musk and congressional Republicans have accused the agency of funding progressive causes abroad, including LGBTQ+ and diversity, equity and inclusion projects, which they view as a waste of taxpayer money. The USAID staff on administrative leave will have access to the agency's IT systems and should monitor email for further guidance, the email said. However, they can't conduct agency business nor download or access official USAID files without the permission of agency leaders. The email didn't state the length of time people will be on administrative leave nor how many employees will be affected in total. The State Department didn't immediately respond to a request for more information. WHAT WE'RE READING POLITICO's Mari Eccles reports on how the pharmaceutical industry is bracing for tariffs. The Washington Post reports on the economic impact of weight-loss drugs. PBS reports on the measles outbreak in Texas as cases rise to 90.