With Ciscomani & other swing district Republicans opposed, GOP backs off unveiling Medicaid cuts

As advocates for healthcare programs and seniors continued to sound an alarm about GOP plans to roll back Medicaid programs this week, Republican leaders in Washington postponed a committee meeting to lay out a specific plan to cut hundreds of billions of dollars in Medicaid funding.

The House Energy and Commerce Committee, which has been tasked with finding up to $880 billion in Medicaid spending over the next decade, had announced earlier this week that lawmakers would mark up the budget bill on May 7.

But that plan was pulled back Thursday and tentatively rescheduled for the week of May 12.

Dr. Larry DeLuca, an Arizona physician who advocates for Medicaid programs, said this week that he was not surprised to see GOP lawmakers struggling to find a way to cut the Medicaid program.

“I think what’s happening is they’re also figuring out that that this seemed like a really good idea on the campaign trail, and as we start looking at the realities of trying to reform or change or eliminate Medicaid, people are starting to get nervous because they’re realizing their own care is at risk,” DeLuca said.

The decision to punt on next week’s markup comes after some Republicans in swing districts, including Southern Arizona Rep. Juan Ciscomani, warned leadership that they were opposed to significant Medicaid cuts.

Ciscomani has voted to advance the budget package that included a proposal to find up to $880 billion in Medicaid cuts and he has said that he wants to eliminate waste, fraud and abuse from the system. But at the same time, he has said he won’t support a cut to the program “that reduces Medicaid benefits for vulnerable populations the program was intended to serve, like the working poor, individuals with disabilities, single mothers, and the elderly.”

Last week, Ciscomani was among 13 GOP lawmakers who signed onto a letter to House Speaker Mike Johnson that expressed concern about the potential cuts.

“Cuts to Medicaid ‘also threaten the viability of hospitals, nursing homes, and safety-net providers nationwide,” the lawmakers wrote. “Many hospitals — particularly in rural and underserved areas — rely heavily on Medicaid funding, with some receiving over half their revenue from the program alone. Providers in these areas are especially at risk of closure, with many unable to recover. When hospitals close, it affects all constituents, regardless of healthcare coverage.”

Ciscomani’s position earned him praise from some local health care leaders.

“We applaud Congressman Juan Ciscomani for taking action in support of preserving Medicaid coverage,” said El Rio Health CEO Clint Kuntz. “Medicaid is a vital lifeline for millions of Americans and even small cuts to this program could cause catastrophic effects for both the physical and economic health of our local communities. As a Community Health Center, El Rio Health is proud to serve these patients every day and ensure they receive the care they need to live healthy, productive lives.”

The Arizona Health Care Association said in a Facebook post that its members were grateful for Ciscomani’s “leadership in protecting Medicaid and the people it serves. Cutting Medicaid hurts seniors, families, and rural communities – and mislabeling provider assessment dollars as ‘fraud only makes things worse. These dollars are vital to keeping hospitals and nursing homes open. Let’s keep pushing for reform that supports care, not cuts it.”.

But Sen. Mark Kelly said the true test would be in Ciscomani’s vote once the legislation comes together.

“Well, we’ll see what he does when he votes,” Kelly told Tucson Sentinel last week. “I encourage him to vote against the thing that will likely include some big cuts to Medicaid.”

At a March Medicaid forum in Tucson, Kelly said Republicans were seeking to cut Medicaid so they could extend President Donald Trump’s tax cuts, which he characterized as a giveaway to the richest people in America.

“What they’re trying to do is take a benefit that lower-income and disabled people rely on and they’re trying to take that money that goes to pay for that thing, and they’re trying to put it into the pockets of billionaires,” said Kelly, a Democrat first elected to the Senate in 2020. “That’s the reality of what is going on here.”

House Freedom Caucus: ‘Now is the time to act’

As lawmakers debated how to slash Medicaid spending, members of the House Freedom Caucus called for moving forward with the cuts.

In a May 1 letter, House Freedom Caucus members, including Arizona Republican Reps. Andy Biggs, Eli Crane and Paul Gosar, said that the expansion of Medicaid eligibility to 138 percent of the federal poverty level – or just under $37,000 year for a single working mom with two kids – had driven the cost of the federal program too high.

The conservative GOP lawmakers say that the expansion of Medicaid under President Barack Obama’s Affordable Care Act should be reversed. Under that expansion, many states – including Arizona – increased eligibility for Medicaid to 138 percent of the federal poverty level.

The lawmakers said that has cost the federal government too high.

“Under Obamacare’s expansion, states receive a 90% federal match for able-bodied, working-age adults — far more than the 60% average for traditional populations like low-income children and people with disabilities,” they wrote. “Medicaid has significantly moved beyond its 1965 intent, with able-bodied workers now making up the largest sub-group receiving Medicaid benefits.”

That puts the three Arizona GOP lawmakers and their colleagues at odds with Arizona business leaders, who have been warning that Medicaid cuts would lead to hundreds of thousands of low-income Arizonans losing their health insurance, which would cause major losses and job cuts for hospitals and clinics. That in turn would likely lead to higher private health insurance premiums and other fiscal ripples that would damage the state’s economy.

A coalition of more than a dozen Arizona business associations, including Arizona Chamber of Commerce and Industry, the Arizona Hispanic Chamber of Commerce and the Southern Arizona Leadership Council, urged Republican lawmakers in March not to cut the federal Medicaid funding that comes to Arizona because it would devastate the state’s healthcare system, increase private insurance costs and “result in massive job losses statewide and reduce economic productivity.”

“Proposed cuts would shift billions in costs to states and healthcare providers and would have profound negative effects on Arizonans covered by the Arizona Health Care Cost Containment System, our state’s health care providers, and the broader Arizona economy,” business leaders wrote in a March 20 letter.

SALC President Ted Maxwell called the potential Medicaid cuts “potentially catastrophic.”

GOP leaders had been floating a proposal to reduce the share of money the federal government provides for the portion of the population covered under the ACA’s Medicaid expansion, as Biggs, Gosar and Crane advocated. But some states, including Arizona, have triggers in their laws that repeal the Medicaid expansion completely if the federal share drops below 90 percent for the expansion population.

If that were to happen in Arizona, an estimated 390,000 people living on the edge of the federal poverty line would lose their health insurance, according to Kelly.

Earlier this week, Republican leaders floated a new proposal that would involve per-capita limits on how much the federal government would reimburse states rather than a reduction in percentage of the federal match, in the hope that it would not trigger the expansion repeals in red states.

But disagreements over the details resulted in a decision to put off unveiling a plan next week.

The delay was celebrated by Brad Woodhouse, president of the healthcare lobby group Protect Our Care.

“Republicans are melting down,” Woodhouse said in a prepared statement. “They’ve twisted themselves in knots to slash Medicaid to provide tax breaks to the rich, but the American people have said ‘hell no.’ They know their agenda to rip health care from millions of Americans is deeply unpopular and politically perilous.”

But Woodhouse warned that the fight against the Medicaid cuts was not over.

“This delay is not the end of the line – Trump and Republicans are hell-bent on slashing taxes for the rich no matter who they hurt or how many lose health care,” Woodhouse said. “The so-called moderate Republicans should stand their ground until these cuts are taken off the table for good.”