Senate Majority Leader John Thune is making the case for reforming Medicaid in President Donald Trump’s “big, beautiful bill” — arguing that eliminating alleged waste, fraud and abuse in the entitlement program is the “right thing to do.”
Thune told the Daily Caller News Foundation in an exclusive interview Wednesday that the Senate is likely to keep House-passed provisions reforming Medicaid while leaving open the possibility that the upper chamber will tweak the language. Though key text outlining reforms to Medicaid in the Senate bill have not been released thus far, Thune lauded some of the House lawmakers’ reforms to the entitlement program and cited the need to rein in Medicaid spending’s explosive growth as justification for preserving some of the House provisions, which is expected to yield significant savings.
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“Medicaid was designed to serve a particular population, and what’s happened is [that] it’s evolved and morphed into this thing now that covers a lot of people that weren’t supposed to be covered in the first place, including illegals and the Medicaid expansion population,” Thune told the DCNF. “It’s really just making these programs, strengthening them, improving them, and targeting them to the people who you know Medicaid was designed to serve in the first place.”
Thune has largely refrained from commenting on how the Senate would address the House-passed Medicaid reforms as well as other issues threatening to stall momentum on passing the president’s package by the July 4 deadline. He can afford to spare just three Republican votes to pass the spending bill and said unequivocally that he is willing to keep the Senate in during the July 4 recess until the bill clears the upper chamber.
Still, Thune voiced optimism that enough Senate Republicans will get in alignment on reforms to Medicaid and other major provisions of the House-passed bill, still being debated, to pass the tax and spending legislation with the Senate’s changes over the coming weeks.
“There’s a lot of work ahead of us, but I think we’re starting to hone in on the right range of solutions, and both on spending and on tax [parts of the bill],” Thune told the DCNF. “We certainly are prepared to do what’s necessary to get this done.”
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Medicaid reforms are likely to be a part of the emerging Senate bill, including work requirements for able-bodied, childless adults enrolled in the program, according to Thune.
“The House really honed in on the waste, fraud and abuse in the program, and the people who are benefiting from the program in a way that in for whom it wasn’t designed,” Thune said. “That’s where your work requirements come in. And we think that’s a natural assumption that you would make.”
Thune cited polling showing Medicaid work requirements for adults is broadly supported by voters.
A poll shown to Senate Republicans by White House officials Tuesday showed that a majority of voters support Medicaid work requirements (63%) and terminating taxpayer-funded Medicaid benefits for 1.4 million illegal immigrants (52%), according to a source familiar.
The polling, shown during a conference-wide lunch, also indicated that roughly 70-80% of Americans favor other provisions in the tax and spending bill, including eliminating taxes on tips and overtime pay for eligible Americans and raising the child tax credit to $2,500.
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Thune’s case for reforming Medicaid comes as Senate Democrats are characterizing the House-passed reforms to the entitlement program as “the largest cut to healthcare in American history” and repeatedly suggested that Americans will die if the president’s bill becomes law.
Thune disputed his colleagues’ characterizations as flat-out lies that are intended to mislead voters about Republican intentions for the program, which he said are slowing the rate of Medicaid spending while strengthening benefits for the most
“The idea that you’re actually cutting spending [on Medicaid] — no, you’re not,” Thune said, referring to projections that show federal Medicaid spending will continue to grow over the next decade when taking into account House Republicans’ reforms. “You’re just not increasing it at the rate that it was going under the current assumptions. The argument they’re making is just a false one to start with.”
The federal government spends 51% more on Medicaid today than it did in 2019, according to the Competitive Enterprise Institute.
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“I think the American people believe that you ought to be helping the elderly, the disabled, low income seniors, pregnant moms,” Thune added. “The Medicaid population that the program is designed to serve isn’t affected by this [Republicans’ reforms to the entitlement program].”
Speaker Mike Johnson has also defended House Republicans’ proposed Medicaid reforms as “an important and frankly heroic thing, to preserve the program so that it doesn’t become insolvent.”
Thune also signaled that Senate Republicans will preserve House language limiting provider taxes in the Senate reconciliation bill. The majority leader argued that certain blue states have exploited provider taxes — a tax maneuver states use to help pay for their share of Medicaid costs — to receive additional federal Medicaid dollars, which they can, in turn, use for unrelated programs.
“As the House was working through this, and as we work through it now, we’re paying a lot of attention to ensuring and protecting folks who have made decisions,” Thune said. “States have made decisions predicated upon existing law.”
“But we also think there ought to be some lid or some cap or some freeze going forward to not allow states like the New Yorks and the Californias to bleed the program by taking advantage of it and essentially creating a windfall,” Thune added. “I think that when our members see that, they’re like, ‘We’ve got to do something about this.’”
Several GOP senators, including Republican Sens. Josh Hawley of Missouri and Jim Justice of West Virginia, have previously expressed unease with maintaining a freeze on provider taxes, citing their potential impact on hospital’s finances, especially those in rural areas.
The majority leader also suggested that the Senate will maintain the roughly $1.6 trillion in spending cuts over a decade proposed by the House-drafted bill, and may identify additional savings to include in the Senate product. A cohort of deficit hawks, including Republican Sens. Ron Johnson of Wisconsin, is pushing Thune to take a more aggressive approach on slashing spending in the budget bill.
“We’re going to eliminate waste, fraud and abuse in some of these spending areas,” Thune said. “You get some pushback on that, but I think it’s the right thing to do, and I’m hoping that we will be able to find above and beyond what the House did, some additional savings, but we at least want to, least want to maintain what the House did.”
Thune also signaled that the current reconciliation bill is not the last opportunity that GOP senators will have to rein in discretionary or mandatory spending during Trump’s first two years in office.
“I think it’s a cumulative thing,” Thune said, referring to efforts the GOP will take to rein in discretionary spending through the upcoming appropriations process as well as forthcoming rescissions packages sent by the White House to codify Department of Government Efficiency cuts. “There could be a second reconciliation bill if some of our folks who are really drilling down in some of these programs on the mandatory side of the budget can find areas where we can achieve savings.”
“I think there would be a big appetite for doing another bill,” Thune continued while expressing optimism that the current bill under consideration will boost economic growth and, in turn, bring in additional tax revenue to shrink budget deficits. “If the consensus is among our members and House leadership and the White House that there are things that we can do that will achieve even greater savings, greater efficiency, and get a better return for the American taxpayer then, absolutely I’m open to that.”
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First published by the Daily Caller News Foundation.
