The White House and Republicans in Congress have not decided on their top priority after passing their tax bill, leaving a big and unusual void at the top of the legislative agenda, according to Politico. (A conference of the House and Senate is expected to hammer out the discrepancies between the two chambers’ tax bills before Christmas.)
In his public statements, President Trump has suggested Republicans should overhaul anti-poverty programs, such as food stamps and direct cash assistance for the poor, and return to trying to repeal the Affordable Care Act. And Sen. Ted Cruz (R-Tex.), who is up for reelection next year, dismissed the possibility of targeting Medicare out of hand. “I’m not aware of anyone who is talking about cutting Medicare, other than in Democratic talking points,” Cruz said on Thursday.
Last week, House Speaker Paul D. Ryan (R-Wis.) said that Congress should try passing a reconciliation package in 2018 to target Medicare, Medicaid and the Affordable Care Act. But in the Senate, many Republicans sounded at best wary of the prospect of taking on the popular health-care program that primarily insures the elderly, according to interviews with more than a dozen Republican senators on Thursday. Though none of the Republican senators disagreed with the need to cut spending on the social programs, even those most eager to do so recognized they faced steep political obstacles.
As Sen. Pat Roberts (R-Kan.) put it: “We’re talking about Medicare, and that’s a pretty big bite in the middle of an election year. I’m not saying no, but there are other things that could happen.”
Several Republican senators said they knew Trump had called on Congress to move next to tackle “welfare reform,” which conservatives in the House, including Ryan, have also expressed interest in pursuing. A number of them — including Sens. Rob Portman (R-Ohio), John Boozman (R-Ark.) and Richard C. Shelby (R-Ala.) — also suggested that the party may want to first try passing an infrastructure and transportation bill, rather than return to the divisive issue of health care. The White House is also expected to announce an infrastructure package next month.
The senators most eager to push the GOP toward entitlement cuts come from the conservative wing of the caucus. Sen. Jeff Flake (R-Ariz.), who voted for the tax bill that's projected to increase the deficit by at least $1 trillion, said that he was “big time” in favor of tackling entitlements, including Medicare, in 2018. Sens. Roy Blunt (R-Mo.), Bob Corker (R-Tenn.) and Ron Johnson (R-Wis.) all agreed, and Sens. Orrin G. Hatch (R-Utah) and Marco Rubio (R-Fla.) have also talked in recent weeks about constraining America's spending on social welfare programs.
“We all know the contours of it — it’s means-tested, it’s chained CPI,” Flake said, referring to policies that would require higher-income Americans to pay more for entitlements. “We all know what we have to do. We just have to do it.”
During his presidential campaign, Trump promised not to touch Social Security, Medicare or Medicaid. Last week, Ryan said he thought he was making progress in private conversations trying to convince Trump to overhaul Medicare. Johnson and Flake both said they hoped that report was true.
“All we do is slightly slow the rate of increased spending, but if you do that — and block-grant it — I think it will be supported by the American people,” Johnson said Thursday about overhauling Medicare. “It depends on how you do it, but I think there’d be a fair amount of support to send those dollars [for Medicare and Medicaid] back to the states.”
Blunt added: “I’m always in favor of looking at entitlement reform. … We ought to look at everything and see if it meets the demographic needs of the projected future.”
But other Senate Republicans cautioned that attempting to repeal the Affordable Care Act had already exposed serious divisions in the GOP ranks, and that it would be difficult to take on a more popular federal program in an election year. Only five percent of Democratic voters and 15 percent of Republican voters support cuts to Medicare, according to a May survey by the Pew Research Center. “I don’t know if there’s any appetite for true entitlement reform,” Sen. Tim Scott (R-S.C.) said. “I haven’t heard of any.”
Portman and Boozman both expressed a desire to reduce long-term Medicare spending but said that the party shouldn't tackle the program unless their plans for doing so also had support from congressional Democrats. Since that's almost certainly not going to happen, both senators were effectively ruling out the possibility of Medicare cuts.
“I see a lot of other things coming first,” Portman said. “It has to be bipartisan.”
They're unlikely to find any votes from across the aisle, and Democrats have vowed to block any GOP-led attempts to cut Medicare. “I would support a fierce, unyielding resistance to what the speaker is trying to do,” Sen. Robert P. Casey Jr. (D-Pa.) said. “If they want a fight, we're ready to fight.”
Republicans aiming to cut spending on social programs next year will also face criticism after passing a tax bill that has as its biggest winners corporations and the wealthy. “After providing a trillion dollars in tax breaks to the top 1 percent and large corporations, they will now attempt to cut Social Security, Medicare, Medicaid, nutrition programs and help for the poorest and most vulnerable Americans,” Sen. Bernie Sanders (I-Vt.) said.
Some Republican senators said they are interested in reviving the Cassidy-Graham bill, a measure intended to repeal the Affordable Care Act that came close to passing in September. That bill would have block-granted Medicaid funding back to the states, cut Medicaid spending overall and slashed federal subsidies for patients in the individual markets under the ACA's exchanges. Even if they don't touch Medicare next year, Republicans could revive Cassidy-Graham and other bills they introduced in 2017 to cut Medicaid, which provides insurance to almost 70 million Americans.
“My focus for 2018 is to replace Obamacare,” said Sen. Lindsey O. Graham (R-S.C.), co-sponsor of one of the failed GOP bills that tried to dismantle the ACA. “I don't think there's a whole lot of appetite to do anything in the Senate through reconciliation but replacing Obamacare.”
Other congressional Republicans, including House Ways and Means Committee Chair Kevin Brady (R — Tex.), are already taking up Trump's call to target anti-poverty programs. Their plans could include new work requirements on the $73 billion federal food stamp program that feeds 42 million Americans, and cuts to housing assistance for the poor.
Sen. Lamar Alexander (R-Tenn.), chair of the Health, Education, Labor and Pensions Committee, also said he didn't necessarily oppose Ryan's vision of tackling Medicare, Medicaid and the Affordable Care Act, but that he doubted Congress would muster the ambition to do so.
“That’s a big package — we’ll have to see,” Alexander said. “I like to think: Let’s take it one step at a time.”