| | | |  | | By Chelsea Cirruzzo and Kelly Hooper | Presented by the Coalition for Medicare Choices | | | | 
House Speaker Mike Johnson has rejected extreme Medicaid cuts as Republicans seek $880 billion in savings. | Francis Chung/POLITICO | THE MEDICAID QUESTION — Republicans in Congress are looking to Medicaid to help finance their sweeping party-line bill driving President Donald Trump’s agenda — a perpetually thorny endeavor. Previous attempts to cut from the program have driven backlash from moderate Republicans and GOP governors, including during Republicans’ failed attempts to repeal Obamacare. The House Energy and Commerce Committee has been tasked with slashing $880 billion, meaning they’ll likely have to turn to the program for savings. In a CNN interview Wednesday, House Speaker Mike Johnson drew a red line on some of the steepest potential cuts to Medicaid. Those are per-capita caps — which would turn the joint federal-state program from an open-ended entitlement to one capping federal payments based on population — and changes to the Federal Medical Assistance Percentage, or FMAP — a move that would cut into the share of federal payment. I caught up with former Pulse author Ben Leonard to discuss Republicans’ path forward. Republicans’ planned cuts to Medicaid have shifted in recent days. What’s the significance of Johnson’s comments? I had heard from key Republicans on the Hill that per capita caps might not be able to get the votes to become law, but Johnson’s comments on those were by far the clearest red line on specific policy details we’ve seen so far. It eliminates one of the biggest potential buckets for savings — and also a proposal that would draw intense political backlash. What’s left on the table? Johnson made an affirmative case for work requirements in the interview. That’s long been considered one of the most politically viable options. One proposal that has also been floated by Energy and Commerce Chair Brett Guthrie (R-Ky.) would examine the taxes states levy on doctors and hospitals to help pay for their share of Medicaid expenditures rather than tap their general funds. Democrats have been open to changes there in the past. There’s been some debate in conservative health policy circles about what Johnson meant on FMAP. Some argued his comments about not wanting “able-bodied workers” on a program intended to help the most vulnerable left room for lowering federal payments gradually for the Medicaid expansion population. What are the barriers and next steps to getting these proposals passed? Any changes to Medicaid are likely to face intense backlash from Democrats, hospitals and others in the industry and will draw a critical eye from moderate Republicans. House Republicans also have to reconcile their plan with Senate Republicans, who have been more hesitant to enact sweeping cuts to the program. WELCOME TO FRIDAY PULSE. Efforts to clean Washington’s Anacostia’s River are all about figuring out who pooped in it, KFF Health News reports. Yep, bird, dog, deer or human feces must be identified to help the advocacy group, the Anacostia Riverkeepers, figure out the best clean-up strategies. Fun fact: HHS Secretary Robert F. Kennedy Jr. helped establish the Anacostia Riverkeepers in 2008. Send your tips, scoops and feedback to ccirruzzo@politico.com and khooper@politico.com and follow along @ChelseaCirruzzo and @Kelhoops.
| | | | A message from the Coalition for Medicare Choices: Protect Medicare Advantage: 34 million seniors are counting on it. Over half of America's seniors choose Medicare Advantage because it provides them better care at lower costs than fee-for-service Medicare. With their coverage and care on the line, seniors are watching closely to see whether policymakers keep the bipartisan promise to protect Medicare Advantage by ensuring this vital part of Medicare is adequately funded. Learn more at https://medicarechoices.org/ | | | | | | 
Congressional Republicans looking to cut Medicaid could turn to state programs by targeting provider taxes instead of direct program cuts. | Justin Sullivan/Getty Images | STATE MEDICAID TAXES AT RISK — Major cuts to Medicaid may be off the table as Republicans scramble to help pay to extend President Donald Trump’s tax cuts — and s tates might not like their next target, POLITICO’s Robert King reports. GOP lawmakers want to stop states from taxing insurers and providers to raise money for Medicaid, which could generate $612 billion in savings over a decade, according to the Congressional Research Service. But some states are already balking at touching the tax revenue, which they say is a key source to supplement their Medicaid programs. A state must kick in its own funds to qualify for federal dollars for Medicaid. The more money a state contributes, the larger the federal share. All but one state, Alaska, taxes providers or insurance plans to help finance their share of Medicaid. But Republican leaders have argued that states have been inflating their Medicaid costs since they can kick back the taxes to providers via higher payments. “States and providers scheme so that the provider gets an enormous flow of federal dollars with no state cost exposure,” said Brian Blase, who served in Trump’s first administration and has pitched restrictions on the state taxes at his think tank, the Paragon Health Institute. But hospitals that pay the taxes balked that losing the revenue could force states to cut the program. “States would have to make difficult decisions about how to fill the gaps, including raising taxes on residents, reducing eligibility for some Medicaid populations such as children, elderly, or disabled individuals, or reducing Medicaid benefits,” said the American Hospital Association in a statement. It remains unclear whether the House Energy and Commerce Committee, which must find the $880 billion in savings, will reduce or eliminate the taxes.
| | | | Donald Trump's unprecedented effort to reshape the federal government is consuming Washington. To track this seismic shift, we're relaunching one of our signature newsletters. Sign up to get West Wing Playbook: Remaking Government in your inbox. | | | | | | | MASS CUTS TO FOREIGN AID — Sweeping cuts in foreign aid announced Wednesday will slash HIV treatment, prevention and research; health services to treat malaria; and care for new mothers and their babies, among other lifesaving programs, say global health and humanitarian groups whose contracts were cut, POLITICO’s Carmen Paun and Daniel Lippman report. It will also halt basic health services for people displaced by conflict, such as those in Sudan or Gaza. Background: President Donald Trump froze foreign aid shortly after taking office, saying his administration would review the funding to ensure it aligned with Trump’s “America First” policy. Soon thereafter, Secretary of State Marco Rubio said lifesaving aid would continue under a waiver. But the administration said Wednesday the review was over. The list of programs cut included many aimed at saving lives. Among them were funds provided by the President’s Emergency Plan for AIDS Relief, better known as PEPFAR, a program credited with saving 25 million lives globally since former President George W. Bush started it in 2003. Supreme Court Chief Justice John Roberts granted the administration a respite Wednesday from a decision by a lower-court judge who had ordered the administration to release frozen funds since it had not conducted “a good-faith, individualized assessment” of the grants and contracts it had halted. Global health researchers and providers worry that cutting access to prevention and treatment services for HIV and malaria will lead to resistance to the drugs that treat them, rendering those drugs mostly ineffective in the future. “With HIV prevention programs halting immediately, we are headed for disaster,” said Ivette Raphael, the executive director at Advocacy for Prevention of HIV and AIDS in South Africa. A State Department spokesperson said USAID “retained critical awards, including food assistance; life-saving medical treatments for HIV, tuberculosis, and malaria; and critical support for nations like Lebanon, Haiti, Venezuela, Cuba, and others.” The spokesperson and the State Department did not immediately respond to questions about why programs covered by Rubio’s waiver were terminated.
| | | | A message from the Coalition for Medicare Choices:  
| | | | | MEASLES STRATEGIES — Republican Sen. Ted Cruz said Thursday that HHS Secretary Robert F. Kennedy Jr. is “very focused” on a measles outbreak in Cruz’s state of Texas. “I actually spoke with Secretary Kennedy this morning,” Cruz told reporters. “[H]e’s very focused on it and on helping provide federal resources to assist Texas in dealing with the outbreak. .... We had a discussion. I’ll let HHS make those announcements, but yes, we discussed in detail the assistance he’s working to provide.” Also on Thursday, congressional Democrats representing New Mexico, where nine cases have been reported, wrote to Kennedy, urging him to “maintain weekly disease tracking data updates, rehire federal health workers, launch a vaccination promotion campaign against measles and other life-threatening infectious diseases, and trust the recommendations of public health experts, physicians, and scientists.” Context: The multistate outbreak started in late January with 93 cases across several states, with most in Texas. Texas officials confirmed the death of an unvaccinated child on Wednesday, the first measles death in the U.S. in a decade. Speaking on Tuesday, Kennedy said he was monitoring the outbreak. “It’s not unusual; we have measles outbreaks every year,” he said. Measles was considered eradicated in the U.S. in 2000 thanks to high vaccination rates. However,285 measles cases were reported in 2024 amid falling vaccination rates among kindergartners. HHS did not comment on the kind of federal assistance being provided to Texas. Lara Anton, a press officer for the Texas Department of State Health Services, told POLITICO that the department has been keeping the CDC informed of the outbreak, and the CDC has been “providing guidance and vaccines.”
| | Melisa Byrd, senior deputy director and Medicaid director for Washington, D.C., Department of Health Care Finance, will be the next president of the National Association of Medicaid Directors.
| | STAT News reports that federal health officials have dropped out of a key health tech industry conference. NPR reports on disputes about Elon Musk’s claim that Ebola prevention efforts have been fully restored. The Associated Press reports on a CDC study strengthening evidence that HPV vaccines prevent cervical cancer.
| | | | A message from the Coalition for Medicare Choices: Medicare Advantage helps seniors prevent and manage chronic disease. Medicare Advantage outperforms fee-for-service Medicare in preventive care and supporting seniors living with chronic disease. Seniors in Medicare Advantage experience fewer readmissions, fewer preventable hospitalizations, lower rates of high-risk medications and better outcomes. Learn more at https://medicarechoices.org/ | | | | | | | Follow us on Twitter | | | | Follow us | | | |
