House GOP moderates are telling Republican leaders they will not walk the plank and vote for Medicaid cuts in the party’s “big, beautiful bill” only to see the Senate strip them out — their latest warning shot in the effort to enact President Trump’s legislative agenda.
In the past, GOP leaders have corralled the conference around more conservative pieces of legislation to gain leverage over the upper chamber, cajoling centrists to take politically painful votes with hopes that they would help realize a more right-leaning final product. Speaker Mike Johnson (R-La.) deployed the strategy in February during negotiations over the budget resolution, and former Speaker Kevin McCarthy (R-Calif.) did the same amid the debt limit standoff in 2023.
This time around, however, moderates are putting their foot down, making clear that they will not back a more conservative Trump agenda bill that includes poison pill measures — namely drastic changes to Medicaid — as a negotiating tactic.
“That’s the vote we’re trying to avoid,” Rep. Nick LaLota (R-N.Y.) said of the intermediary step. “There is a specific appetite amongst 20-plus Republican members to vote only on something that is real and that could actually become law rather than this more conservative thing that can’t get the vote.”
“The members with whom I most frequently speak do not want to go down that path,” he added of first passing a conservative bill. “We feel like we’ve done that heavy lifting already, and members like me prefer to only vote on a bill that could actually become law.”
Rep. Jeff Van Drew (R-N.J.), a Democrat-turned-Republican, said such a situation would be the “worst” sequence of events.
“The worst scenario of all would be for the House of Representatives to vote for a bill, get it out, and then it goes to the Senate and the president, and they say we’re not doing it, it’s a bad bill,” Van Drew told The Hill. “I think we’ve emphasized that to the Speaker, and I think at this point he agrees, we have to be in communication with them to make sure that we’re all on the same page, or at least damn close.”
The cautionary signal comes as House Republicans are still haggling over spending cuts for their package full of Trump’s domestic policy priorities, with potential changes to Medicaid emerging as one of the biggest sticking points. The House Energy and Commerce Committee, which has jurisdiction over Medicaid, is directed to find at least $880 billion in cuts, a figure that the Congressional Budget Office says cannot be reached without slashes to the social safety net program.
The matter has plagued the House GOP conference: Hard-line conservatives are pushing for changes to Medicaid, sounding the alarm about the ballooning deficit, while moderates are pumping the brakes on any aggressive reforms that would hurt beneficiaries in their districts.
A majority of Republicans in the Senate, meanwhile, are apprehensive about the steep Medicaid cuts, a dynamic that helps the centrists.
The disagreement is holding up progress on the Trump agenda bill. The Energy and Commerce Committee initially planned to advance its portion of the package this week, but the vote was delayed amid the continued discord over potential Medicaid cuts.
Rep. Don Bacon (R-Neb.), a moderate lawmaker who has been opposed to significant Medicaid changes, said leadership has tried to get centrists on board with the Medicaid changes by assuring them that the Senate will remove the provisions once the package clears the House and heads to the upper chamber — the exact situation the group is trying to avoid.
“Here’s the tactic they’ve been using: ‘Don’t worry about the Senate. They’ll fix it.’ And now we’re getting ready to take our third vote on this,” he told The Wall Street Journal. “We feel like we’re being pushed up to the edge of the cliff here.”
Asked if he was concerned about supporting a package with Medicaid cuts to kick off negotiations with the Senate, only to see the upper chamber remove the provisions, Rep. Mike Lawler (R-N.Y.) responded: “No, because I’m not doing it.”
It remains unclear what Medicaid changes will make it into the final package. The party is largely united around imposing work requirements, six-month registration checks and barring those who entered the country without authorization from the social safety net program, a source told The Hill, and Johnson informed reporters Tuesday night, after a meeting with the moderates, that a controversial plan to directly reduce the enhanced federal match for states that expanded Medicaid, known as the Federal Medical Assistance Percentage, was off the table.
Other questions remain, however, including if the bill will include “per capita caps,” which would shift a massive cost to the states. Johnson told reporters Tuesday night “I think we’re ruling that out as well” when asked about the per capita caps, but House Energy and Commerce Committee Chair Brett Guthrie (R-Ky.) on Wednesday said the idea was “still kind of alive.”
Asked about the discrepancy Wednesday afternoon, Johnson demurred.
“He’s the chairman, they’re working through it,” the Speaker told reporters. “I said likely for a reason because it’s not a final decision and I’m, at the end of the day I defer to my chairs, but we’ve got to build consensus around all the ideas, so we’ll see.”
Hard-liners, meanwhile, are also concerned about what the Senate will do with the reconciliation package once it reaches the upper chamber. If steep Medicaid cuts do make it in the final bill — which looks unlikely based on comments from the moderates — the deficit hawks are worried they will get stripped out.
“That’s always a concern, that’s why early on we wanted to get a commitment from Thune and why we insisted on that before we had the vote,” Rep. Eric Burlison (R-Mo.), said referring to remarks made by Senate Majority Leader John Thune (R-S.D.) shortly before the House approved the compromise budget resolution, during which the South Dakota Republican said “we’re certainly going to do everything we can to be as aggressive as possible” when it comes to spending cuts.
“The fact that he gave us a verbal commitment and then went in front of the press was at least giving us a little bit of reassurance,” Burlison added.
Johnson, meanwhile, is aware of the concerns surrounding what the Senate will do. During the House GOP’s closed-door conference meeting on Tuesday, Rep. Cliff Bentz (R-Ore.) stood up and asked if House leaders are coordinating with their Senate counterparts, as that way those in the lower chamber would not have to support measures that the upper chamber will later remove, a source told The Hill. Johnson responded that the Senate will take the House’s bill and maybe make changes, but they will be minor, the source said.
Asked during the press conference shortly after how much of the bill he expects the Senate to change, the Speaker touted the close cooperation between the two chambers.
“We’re going to be very proud of the product we send over there. I don’t expect that it will take much modification, I hope that there’s very little at all and that we can have an agreement,” Johnson said. “But the difference now and in years past, perhaps, is that our colleagues over there know exactly what we’re doing; we’re in careful, close communication, and with the White House team as well.”
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