Representative Jeff Van Drew, a Republican who has resisted his party’s efforts to cut Medicaid to pay for President Trump’s domestic agenda, says he has a powerful ally on his side: Mr. Trump himself.
“He does not want to hurt Medicaid,” said Mr. Van Drew, a congressman from New Jersey. “He hasn’t said it once, twice, three times — it’s been about half a dozen times. And I’ve had those conversations with him one on one.”
Mr. Trump has traditionally acted as House Republicans’ most effective whip when they are facing tough votes, leaning on holdouts in person and on social media and threatening to run an opponent against them if they fail to fall in line with the party. But when it comes to unifying G.O.P. lawmakers around the most politically perilous piece of their budget plan — cutting Medicaid to pay for the tax cuts they want to enact — the president has made clear that he is not going to do any arm-twisting.
“We’re not cutting Medicaid, we’re not cutting Medicare, and we’re not cutting Social Security,” Mr. Trump repeated in an interview with NBC last weekend. He said he would veto the megabill carrying his agenda through Congress “if they were cutting” Medicaid. “But they’re not cutting it,” he added. “They’re looking at fraud, waste and abuse. And nobody minds that.”
His unequivocal stance on the matter — he has said he does not want to “touch” Medicaid in any way — is one reason that Republicans have failed so far to coalesce around a cost-cutting plan for the program. That, in turn, has left them toiling to produce key details of the “one big, beautiful bill” they are trying to push through Congress over the solid opposition of Democrats.
Complicating the situation, Mr. Trump is well known for abruptly changing his mind on major issues once his party has staked out a position, leaving Republican leaders and their rank-and-file members uncertain of where he might end up and whether they could find themselves locked into an untenable political position. They are keenly aware of the potential political blowback that could come from slashing the government program that provides health coverage to tens of millions of Americans.
The president is considering at least one Medicaid cost-saving measures: adding a work requirement for some recipients, which he sees as a way to reduce spending on the program without cutting benefits, according to people briefed on the process. But he does not want to take any action that could be characterized as a cut to the program, they said.
A person familiar said the White House has suggested other measures to cover the budget’s overall cost that have so far been met with obstacles, and that Mr. Trump rejects the idea that there need to be significant Medicaid reductions to make room for his desired tax cuts.
That flies in the face of the budget plan House Republicans have written and passed, which calls for $880 billion in cuts from the committee that oversees Medicaid, a target that would be difficult to achieve without substantial cuts to the program.
“The president has been very clear he does not want to cut benefits for individuals on Medicaid and Medicare,” said Representative Jason Smith, Republican of Missouri and the chairman of the Ways and Means Committee. “He wants to create efficiencies and reforms. He shows an openness to work requirements.”
At its core, the dynamic reflects an ideological gap between Mr. Trump and many in his party. The president’s populist approach and reluctance to cut social programs, especially entitlements, is fundamentally at odds with the core principles of many Republicans in Congress. Those lawmakers came to Washington during the rise of the Tea Party with one goal: slashing federal spending, especially entitlements, to rein in the national debt.
“If the House budget reconciliation package does not include structural Medicaid reform that achieves desired Republican outcomes, we will be setting up massive tax increases and benefit cuts in the future,” a group of 20 fiscal hard-liners wrote in a letter to Speaker Mike Johnson. “For once, Congress should stop procrastinating, using excuses and finally fulfill the Republican agenda.”
Mr. Trump has instead shown more interest in a handful of options that would raise federal revenue, floating trial balloons for ideas that Republicans on Capitol Hill have long viewed as counter to the party’s goal of cutting, not raising taxes.
In a phone call with Mr. Johnson on Wednesday, the president urged him to consider raising taxes on the wealthiest earners and scrapping a tax break for some private equity executives, according to a person briefed on the call who was not authorized to discuss it publicly.
On Friday morning, Mr. Trump appeared to equivocate on social media, arguing that “even a ‘TINY’ tax increase for the RICH” would allow Democrats to accuse Republicans of violating their oft-stated pledge not to raise taxes.
“In any event, Republicans should probably not do it, but I’m OK if they do!!!” he concluded.
Mr. Trump’s entreaties not to cut Medicaid benefits have improbably aligned him with more moderate Republicans who are facing tough re-election campaigns in swing districts and have balked at the most aggressive options to reshape the program. That, in turn, has infuriated the hard-liners in the House Republican conference, many of whom are normally in lock step with Mr. Trump.
Mr. Johnson announced this week that House leaders had dropped one of the most aggressive options Republicans were considering to cut Medicaid costs. That plan — to lower the amount the federal government pays states to care for working-age adults who became eligible for the program through the Affordable Care Act’s Medicaid expansion — would have saved an estimated $710 billion over a decade.
The speaker also suggested he was leaning against another way of reducing spending on Medicaid, by changing the way the federal government pays states — currently by providing a percentage of beneficiaries’ medical bills — to a flat fee per person.
His explanation for why House Republicans were taking off the table two of the biggest policy pathways for coming up with Medicaid savings echoed Mr. Trump.
“It’s a sensitive thing,” Mr. Johnson told reporters on Thursday at the Capitol. “Look, our true and honest intention is to ensure that every Medicaid beneficiary who is in that traditional community of folks — you’re talking about young pregnant mothers and young single mothers and the elderly and disabled — those folks are covered, and no one loses their coverage.”
Maggie Haberman and Andrew Duehren contributed reporting.
