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Senate Republicans are setting up a surprise vote within the next 24 hours that could effectively end Obamacare’s expansion of Medicaid for future recipients, with Majority Leader John Thune backing it.
Thune’s endorsement aligns with key Senate conservatives who want even more aggressive Medicaid cuts in President Donald Trump’s party-line tax and spending cuts bill.
The vote can pass with only three GOP defections — and if it succeeds, it could prompt a rebellion against the bill among House Republican moderates.
Several sources closely following the debate believe the amendment, which is expected to eliminate a 90% federal share of funding for states that expanded Medicaid under Obamacare for future recipients, will not get 50 GOP senators on board.
But it could be close, and Thune’s backing raises the stakes significantly.
The amendment written by Sen. Rick Scott, R-Fla., is now the top demand of conservatives who withheld their votes on Saturday evening to advance the bill, so there’s an open question about how many Republicans will oppose the final product if it fails. In the meantime, Thune said he’ll put his muscle behind it, though he couldn’t guarantee it will pass.
“We think it’s a really good policy, and I think a lot of us are going to be supporting it,” Thune told reporters on Sunday. “It’s great policy and something that’s there’s a high level of interest in our conference of making it part of the final bill.”
Scott’s amendment would kick in in 2031, according to a copy shared with Semafor, and save $313 billion, according to a person familiar with the plan.
A vote to make the bill’s cuts to Medicaid even harsher distills the current challenge for Republican leaders, who are caught between hardline conservatives and more centrist members in the debate over deeper cuts to health care benefits.
Ultimately, Saturday’s vote to advance the bill was successful only because of Scott and GOP Sens. Mike Lee, Cynthia Lummis and Ron Johnson, all of whom withheld their votes until turning to yes late in the evening.
Sen. Bernie Moreno, R-Ohio, told Semafor that he’s not sure how he would vote until he sees the language: “I’ve heard rumors about it. But the devil is in the details of this legislation.”
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Moreno is among the Republicans who have previously resisted the addition of Medicaid benefit cuts to the bill, a group that includes GOP Sens. Susan Collins of Maine, Josh Hawley of Missouri, Lisa Murkowski of Alaska and Thom Tillis of North Carolina.
The latter senator announced his retirement on Sunday amid opposition to the Senate bill’s Medicaid cuts.
“This has been an unhappy episode here in Congress, this effort to cut Medicaid. And I think, frankly, my party needs to do some soul-searching,” Hawley said Saturday as he said he would vote for the bill — but fight to keep some of its other Medicaid cuts from taking effect.
North Carolina’s Medicaid expansion could be particularly vulnerable to Scott’s amendment. States would get the same federal match for Medicaid expansion recipients as they do for other Medicaid beneficiaries under Scott’s plan.
“My proposal is real simple. No one gets kicked off … people who are on it, they stay on it,” Scott said recently. If his proposal takes effect, he added, “anybody new goes” on the traditional Medicaid state rate, which is much lower than 90 percent.
The exact details of the amendment are still being drafted, according to aides.
Thune said he’s spoken to Speaker Mike Johnson, R-La., about the effort: “The way that Sen. Scott has written it, it should be something I don’t know how Republicans couldn’t be in favor of what he’s trying to get done here.”
Notable
- North Carolina’s Medicaid expansion would fall apart if the state’s costs increased, according to NC Health News.