ADRIAN FLORIDO, HOST:
House Republicans are crafting a budget package that includes President Trump's top agenda items - boosting border security and extending his tax cuts. To pay for it, they're looking for cuts, and a large chunk is expected to come from Medicaid, the federal health care program for poor, elderly and disabled Americans. NPR congressional correspondent Deirdre Walsh joins us now to report on the split inside the Republican Party on changes to the program. Welcome, Deirdre.
DEIRDRE WALSH, BYLINE: Hey, Adrian.
FLORIDO: First, can you just explain why House Republicans are looking for savings for Medicaid?
WALSH: So the House Republican budget calls for up to $2 trillion in cuts to pay for extending Trump's tax cuts for another decade. Those are due to expire at the end of 2025. There's only so much you can cut from the discretionary side of the budget, the annual spending bills. The vast majority of the federal budget is spent on mandatory programs like Social Security, Medicare and Medicaid. So various committees are crafting details on where to get these cuts from, and the one panel that oversees health programs is tasked with coming up with over $800 billion in cuts. The expectation is most of those will come from Medicaid.
FLORIDO: But Deirdre - correct me if I'm wrong - hasn't President Trump declared that he wouldn't touch Medicaid?
WALSH: He did. Earlier this week in an interview on Fox News, the President said that, and he campaigned on not touching entitlement programs. But a day after insisting that Medicaid is off the table, he endorsed the House Republican budget proposal that includes this plan to target the program for savings to come up with the 4 1/2 trillion they're going to need to pay for these tax cuts. House Speaker Mike Johnson has insisted Medicaid benefits are not at risk and says their budget is targeting waste, fraud and abuse in Medicaid.
FLORIDO: But is there any expectation that Republicans can find hundreds of billions of dollars in waste? Yeah, how could they change Medicare?
WALSH: I mean, that's a big numbe, r and it's not expected they can get those kinds of savings, so Republicans are looking at other reforms. Ideas that conservatives have pushed for years in terms of reforming Medicaid - adding work requirements for adults who aren't caring for small children, tying their health care benefits to working or training for a job. Some conservatives are also talking about shifting Medicaid to the states more, limiting how much the federal program pays to the states for each Medicaid beneficiary. That could increase the states' share of the program.
FLORIDO: Are all Republicans on board with these proposals?
WALSH: No. I mean, in the last week, we have seen some moderate Republicans warn they have concerns and could vote no. One freshman Republican, Rob Bresnahan from Pennsylvania, issued a statement after the House budget was adopted by the Budget Committee last week. He said, if a bill, quote, "is put in front of me that guts the benefits my neighbors rely on, I will not vote for it." There's also a group of Republican lawmakers who represent districts with large number of Hispanic constituents, and they say Medicaid cuts could have serious consequences for their constituents. Remember, there's just a small, small, tiny Republican majority. The speaker can afford to lose one vote.
FLORIDO: Yeah.
WALSH: So it's going to take near unanimity next week.
FLORIDO: And are GOP lawmakers hearing anything from constituents themselves?
WALSH: You know, it's still early in the process and this is just the first step, but one of Trump's campaign pollsters, Tony Fabrizio, released a poll of swing-state House districts that shows that federal assistance to pay for health insurance is really popular with Trump voters and swing voters. There was also a town hall in a Republican district in Georgia last night where some voters did push back at the idea of cutting back some of these federal programs.
FLORIDO: That's NPR's Deirdre Walsh. Thanks, Deirdre.
WALSH: Thank you. Transcript provided by NPR, Copyright NPR.
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