During the campaign, Trump was largely silent on Medicaid while also pledging he would protect Medicare and Social Security. But last week when asked about spending cuts, Trump included Medicaid in the list of programs he vowed not to touch — with a catch.
"We're not going to do anything with that, unless we can find some abuse or waste," Trump said. "The people won't be affected. It will only be more effective and better."
House Republicans are debating how deep they need to cut to pay for an extension of Trump's tax cuts and border enforcement funding. They are also eyeing hundreds of billions of dollars in savings from Medicaid changes. Those changes include instituting work requirements and capping how much federal money is spent per person.
House Energy and Commerce Committee Chairman Brett Guthrie (R-Ky.) said he's reached out to the White House for more clarification on what Trump wants.
But Guthrie said Trump's point about making Medicaid "more effective" means the president supports ways to make the program more efficient.
"More efficiency ... a lot of that is, you know, work requirements," Guthrie told reporters, noting that he thinks limiting the Medicaid program to only the neediest by enforcing work requirements should be a federal requirement.
"I think it should be, if you're going to take federal money and expand the population for people that are able bodied to work, it should be mandated," Guthrie said.
Work requirements could save around $120 billion, per recent GOP estimates. But hardline conservatives are pushing for a bottom-line figure between $2 trillion and $5 trillion, which could necessitate even more cuts.
"I think is more efficient to limit the growth of Medicaid, too," Guthrie added. "So we're gonna see where we can go" and what qualifies under the strict rules of reconciliation.
Separately, House Budget Committee Chairman Jodey Arrington (R-Texas) said he understands there will be backlash to any cuts, though he noted the 2017 ObamaCare repeal bill passed the House despite the unpopularity of Medicaid cuts.
"There is a constituency for every dime and dollar we spend, whether it's necessary and good and consistent with our constitutional mission, whether it's wasteful and fraudulent ... some constituency feels it's a threat to them," Arrington told reporters recently.
"So there's nothing easy about reducing spending. But ... we either do it on our own volition ... or the bond markets and our creditors are going to tell us exactly how we're going to have to do it."
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