Lawmakers on the House Energy and Commerce Committee are scheduled to mark up their portion of the budget reconciliation package Tuesday, combing over proposed work requirements for some Medicaid recipients and claw backs of unspent climate grants, among other things.
The $5.8 trillion Republican budget reconciliation framework calls for Energy and Commerce to find savings of at least $880 billion over the next 10 years in programs under its jurisdiction, helping finance the planned extension of President Donald Trump’s 2017 Tax Cuts and Jobs Act.
The Congressional Budget Office estimated that $581 billion of those savings must come from Medicaid, but Republicans haven’t included some of the most controversial reforms suggested, such as per-capita caps on states.
Instead, the proposed changes include closing Medicaid financing loopholes often exploited by states; changing Medicaid eligibility requirements back to pre-COVID-19 standards; and imposing work requirements on most able-bodied adult recipients without dependents.
These changes would result in an estimated 8.6 million people losing Medicaid coverage by 2034, according to the Congressional Budget Office. The reforms would also reduce the deficit by an estimated $912 billion over the next decade.
The Biden administration boosted Medicaid spending by 20% and expanded program eligibility beyond low-income seniors; families with children; and pregnant mothers with their infants to able-bodied, childless adults. As a result, work requirements for able-bodied, childless adult Medicaid recipients have gained popularity among Republican lawmakers.
Democrats immediately condemned the bill draft which was released over the weekend, with Energy and Commerce Committee Ranking Member Frank Pallone, D-N.J., accusing Republicans of “lying” about the impact of their Medicaid changes.
“This is not trimming fat from around the edges, it’s cutting to the bone,” Pallone said in a statement. “No where in the bill are they cutting ‘waste, fraud, and abuse’—they’re cutting people’s health care and using that money to give tax breaks to billionaires.”
Medicaid costs more than $890 billion taxpayer dollars per year, with the federal government shouldering roughly two-thirds of that spending and state governments paying for the rest.
But states will often employ financing gimmicks to take advantage of federal support for Medicaid. As an example, Illinois will overtax Medicaid-participating hospitals and nursing homes but then provide reimbursement, allowing the state to collect matching federal payments for a nonexistent expense.
The health portion of the bill would prevent this practice by limiting how much states can tax hospitals and providers, saving the federal government money in the process. It would also axe federal funding to Planned Parenthood and other reproductive clinics, as well as prevent Medicaid and CHIP funding from going to gender transition procedures on children.
The energy portion of the bill, also lambasted by Democrats, would generate tens of billions of savings by rescinding unobligated funding set aside for climate-related programs under the Inflation Reduction Act.
That includes slashing funding to the Department of Energy’s loan office to target green-energy infrastructure loans, clawing back tens of billions in the Greenhouse Gas Reduction Fund, repealing grants related to air and methane pollution reduction, and dozens of other proposals that would support natural gas and fossil fuel-based energy.
