GOP FLOATS HEALTH CARE CUTS — House Republicans are circulating a menu of options amounting to more than $5 trillion in cuts they could use to bankroll President-elect Donald Trump’s top priorities this year. On the table: changes to Medicare, Medicaid and the Affordable Care Act. The list from the House Budget Committee could be used to finance a party-line reconciliation bill or other spending reduction efforts. The proposed cuts are highly ambitious, but not all are likely to become law, given the narrow margins for Republicans in the House and Senate. I caught up with POLITICO Congress reporter and former Pulse author Ben Leonard to discuss the state of play. There would be a few different ways on this “menu” to cut Medicaid. Can you walk us through them? One big target is per-capita caps, favored by House Energy and Commerce Chair Brett Guthrie (R-Ky.). They’d allocate a set amount of Medicaid funding based on population instead of being an open-ended entitlement. That’s projected to save up to $918 billion. Another major target is equalizing payments for nondisabled adults with those of traditional Medicaid enrollment — those with disabilities or low-income children, which [Republicans] say would save up to $690 billion. Adding work requirements in the program is also on the table and is pegged to save $120 billion. Which ones would get the most opposition from Dems? They’d pretty much all be nonstarters for Democrats and even some Republicans. Medicaid insures more than 70 million Americans, and any legislation that might reduce coverage in the program would be fiercely opposed by Democrats and could be a tough vote for Republicans in swing districts. The proposed ACA changes involve enhanced premium tax credits that expire at the end of the year, setting up a major policy battle. Democrats broadly support extending the enhanced subsidies, which have lowered premium costs for many Americans and led to record ACA marketplace enrollment. Many Republicans support letting them expire, arguing they’re raising health care costs, but moderate Sen. Lisa Murkowski (R-Alaska) recently said she supports extending them. Either way, Republicans will have a difficult choice: spend hundreds of billions to buoy Obamacare enrollment or raise premium costs significantly heading into an election year in 2026. Are there any proposals that could get bipartisan agreement? Site-neutral payments are a more bipartisan option under consideration. Limiting eligibility for ACA plans based on citizenship status could receive more bipartisan interest than it might have previously, given Democrats’ pivot on immigration after a tough election cycle. But most of the options are not expected to receive much, if any, Democratic support. WELCOME TO MONDAY PULSE. Even before the surgeon general’s warning about alcohol, a lot of Americans were drinking less — including your newsletter writer, who is doing Dry January. This weekend, I experimented with nonalcoholic drink options by mixing homemade syrups, including galangal and lemongrass, with ginger ale. I’d highly recommend it! Send your tips, scoops and feedback to ccirruzzo@politico.com and follow along @ChelseaCirruzzo.
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