Republican leaders are taking heat from two GOP factions in the House over the Senate’s changes to Medicaid provisions in the One Big Beautiful Bill Act.
But while both groups oppose the upper chamber’s revisions, they do so for the exact opposite reasons.
The OBBBA, a multitrillion-dollar budget resolution implementing the president’s policy agenda, barely passed the House after Speaker Mike Johnson, R-La., made multiple compromises with Republican holdouts, including over Medicaid.
The House’s Medicaid reforms included changing eligibility requirements back to pre-COVID-19 standards; imposing weekly work or volunteering requirements on most able-bodied adult recipients without dependents; and closing financing loopholes exploited by states.
According to the Congressional Budget Office, the plan would save $301 billion and reduce the federal deficit by at least $625 billion over the next decade.
The lack of direct cuts to the program reassured lawmakers from vulnerable districts, while the savings-producing work requirements placated most fiscal hawks.
Senate committees, however, upended the Medicaid provisions. Under their plan, the amount states can tax Medicaid providers would cap at 3.5% by 2031, down from the House plan to freeze the current cap at 6%.
More than a dozen House Republicans oppose this plan — which is currently under review by the Senate parliamentarian — because they fear it will harm rural hospitals and treat Medicaid expansion and non-expansion states unfairly.
In a letter sent Tuesday to Johnson and Senate Majority Leader John Thune, R-S.D., 16 lawmakers led by Rep. David Valadao, R-Calif., urged the leaders to stick with the House’s framework.
“Throughout the budget process, we have consistently affirmed our commitment to ensuring that reductions in federal spending do not come at the expense of our most vulnerable constituents,” the lawmakers wrote. “The House’s approach reflects a more pragmatic and compassionate standard, and we urge that it be retained in the final bill.”
Medicaid worriers are not the only faction opposed to the Medicaid changes, however. Fiscal hardliners are up in arms over the Senate softening the House’s work requirements by exempting able-bodied enrollees if they have dependents under the age of 14. That could potentially slash billions of savings from the OBBBA.
Rep. Eric Burlison, R-Mo., called the Senate’s “watered-down” version of the OBBBA “a joke” on social media Tuesday, adding it contains “no real Medicaid reform.” His objections echo Reps. Chip Roy, R-Texas; Andy Harris, R-Md.; and Thomas Massie, R-Ky., who have also pledged to vote no on the bill if it returns to the House in its current form.
In a press conference the same day, Johnson told reporters that the House’s Medicaid plan strengthens the program by focusing it on “the most vulnerable populations.”
“If you’re going to be on the public wagon and you’re able [bodied], you should try to help pull it,” Johnson said. “For heaven’s sake, do something constructive.”
He expressed optimism over the OBBBA negotiations in general, but implored the senators in charge of Medicaid revisions to “not do anything that couldn’t pass” in the House.
President Donald Trump also exerted pressure on the Senate to quickly produce a result palatable to both chambers.
“To my friends in the Senate, lock yourself in a room if you must, don’t go home, and GET THE DEAL DONE THIS WEEK,” Trump posted on X Tuesday. “Work with the House so they can pick it up, and pass it, IMMEDIATELY. NO ONE GOES ON VACATION UNTIL IT’S DONE.”
