House Panel Advances Spending Bill With Medicaid Cuts

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By Nathaniel Weixel

March 15 — A bill (H.R. 4725) that would save $25 billion through targeted cuts and changes to the Medicaid program and the Affordable Care Act cleared a House committee March 15 on a 28-19 party-line vote.

Republicans on the Energy and Commerce Committee hope the measure will attract conservative support for a budget blueprint, and said the legislation is needed to contain entitlement spending. Democrats said the bill amounts to an attack on Medicaid, and questioned why Republicans would want to shift costs to states and take away care from low-income children and the elderly.

About $15 billion in savings would come from cuts to Medicaid and the Children's Health Insurance Program, and $10 billion would come from repealing the ACA's Prevention and Public Health Fund.

Committee Republicans rejected all eight Democratic amendments, including one from Rep. Gene Green (D-Texas) that would have prevented the repeal of the Prevention and Public Health Fund until the Centers for Disease Control and Prevention certifies that all state and local health officials have the epidemiology and laboratory capacity to track and respond to the Zika virus outbreak.

Republicans also rejected an amendment that would have required the Department of Health and Human Services to certify the legislation wouldn't negatively affect children's health coverage.

No Republicans offered amendments. The bill next moves to the full House.

Cost Shift

Under the Common Sense Savings Act sponsored by Rep. Joe Pitts (R-Pa.), “multimillion dollar jackpot” lottery winners wouldn't be eligible for Medicaid, states would be able to lower the maximum provider tax and the federal government would pay a lower share of Medicaid expenses for prisoners, among other provisions.

“Commonsense reforms like moving million dollar jackpot winners off the taxpayer’s dime deserve our support,” committee Chairman Fred Upton (R-Mich.) said in his prepared testimony. “Reforms that also strengthen Medicaid and the State Children’s Health Insurance Program, so they can better serve the most vulnerable who rely on their critical services.”

The bill was opposed by state Medicaid agencies, which objected to the federal government forcing states to pay more for their share of Medicaid. Nursing homes also strongly objected to the provision that would allow the government to lower provider taxes. States can set the maximum threshold for provider taxes at 6 percent, but the bill would lower that maximum to 5.5 percent.

“It puts a tremendous amount of fiscal pressure on our 13,000 provider communities to care for millions of elderly Americans, Clif Porter II, the American Health Care Association's senior vice president of government relations, said in a March 15 statement. “We cannot allow frustration with existing policy to drive blunt decisions that affect millions of lives. Cuts of this magnitude will lead to less access to care and poorer health outcomes. Policy moving forward must be measured and thoughtful to the needs of America’s most vulnerable.”

Budget Fight

House Republicans March 15 released their budget blueprint, a document that would set the spending levels for Congress in fiscal year 2017. Members of the conservative House Freedom Caucus said they will reject the budget proposal, and H.R. 4725 was seen as an attempt from the rest of the Republican caucus to garner the support of the Freedom Caucus ahead of a March 16 budget markup.

Rep. Frank Pallone Jr. (N.J.), the ranking Democrat on the Energy and Commerce Committee, said the bill was “thrown together at the last minute to once again appease the extreme right of the House Republican Conference.”

It's unclear if H.R. 4725 is enough to persuade the Freedom Caucus to support the budget measure, but the legislation is expected to advance to the House floor regardless of whether a budget is agreed to.

To contact the reporter on this story: Nathaniel Weixel in Washington at

To contact the editor responsible for this story: Nancy Simmons at