MICHEL MARTIN, HOST:
The tool that Republicans are going to try to use to try and pass the president's agenda is budget reconciliation. That lets Republicans pass major policy changes with just 51 votes in the Senate. To talk through the Republican plan and the challenges ahead, we're joined by political strategist Rina Shah. She's also a former Republican congressional aide. Good morning, Rina. Thanks for joining us once again.
RINA SHAH: Good morning.
MARTIN: So House Republicans released their plan yesterday. Medicaid is obviously a pain point. Now, we reported last week, you know, there was this open letter that a group of moderates released saying that they won't support a bill that leaves vulnerable people without care. OK, so according to an early estimate from the Congressional Budget Office, most of the spending cuts, about 715 billion, would come from changes to Medicaid and the Affordable Care Act.
And this bill includes work requirements. People on Medicaid would have to show they work 80 hours every month. The estimate says that the whole plan would cause more than 8 million people to become uninsured. So the question I have for you is, putting that together, does this strike the kind of balance that would keep the Republicans together?
SHAH: Well, this week, we're seeing House Republicans move forward with that budget reconciliation plan that could reshape Medicaid. And that's the biggest thing here. The reshaping of Medicaid is not something we've heard in this way for quite some time. And so when you look at the House eyeing these $880 billion in savings from the Energy and Commerce Committee, which oversees Medicaid, that signals deep cuts to the program that are on the table, right? And they've been very open about this, and it's been contentious in public.
But the potential mechanisms for cuts is what's most important here. The work requirements, cost sharing for beneficiaries above the poverty line and restrictions on state provider taxes are all under consideration, but all of which could reduce enrollment or access to care. And that is what the moderates are feeling really could endanger their reelections, and it's particularly the New York Republicans. These blue state Republicans do have leverage here to negotiate with Speaker Johnson today because what they're saying here is that we already know, Speaker Johnson, what the Senate plans to do.
The Senate's been very clear about their - sorry, been less clear about their approach. But the reconciliation process itself requires only 50 votes in the Senate, and it makes significant changes possible here. So again, you have this chorus of a few but mighty House Republicans - again, the New York contingent largely - that says, don't do this to us. It's not necessary to force us to take such a tough vote when we know the Senate might not even pass it. And one particular name here that sticks out to me is Congresswoman Elise Stefanik, who did not go into the Trump administration, as was expected. And she was somebody that didn't vote for Trump's 2017 tax cuts because of her issues with SALT caps.
MARTIN: So you're saying they are not there yet? You're saying that this...
SHAH: They are not there.
MARTIN: They're not there yet. Well, you know, we heard Elena Moore mention that Republicans are pointing to cutting waste as a way to make this plan work. I mean, you know, one person's waste is another person's essential, right?
SHAH: Oh, yes.
MARTIN: So is that really enough or is that a fig leaf?
SHAH: Well, like I said, the specifics of how these cuts might happen are still emerging. And we're going to hear all in just the next few days because of the three key committees in the House that are charged with marking it up before the end of the week. This is a very aggressive plan, I want to remind folks. But what we're hearing about the proposals - again, like lowering the federal match for Medicaid expansion, capping funding per enrollee or adding work requirements - again, which is the one thing that gets talked about the most.
MARTIN: Yeah.
SHAH: These could save federal dollars but shift billions in costs to states. And what that does is potentially forces them to cut coverage or benefits. And certain states are going to come out looking good, and some are going to look pretty bad.
MARTIN: Yeah.
SHAH: So the moderates who are pushing back on some of these ideas have put the final plan, which is still in flux but could get ironed out later today, actually - Speaker Johnson has said, hey, I'll meet with you all because we understand...
MARTIN: Yeah.
SHAH: ...These cuts could disproportionately harm these vulnerable populations, I want to say, again, including the 12 million Medicare beneficiaries who - Medicare beneficiaries, excuse me, who rely on Medicaid for long-term care and cost sharing. That's important.
MARTIN: So before we let you go - we only have 30 seconds left - President Trump has floated raising taxes on the wealthy. That's something Republicans usually resist. What kind of reaction is that getting?
SHAH: Oh, goodness. Politically, that's a high-stakes issue. You know, there are House Republicans who are caught between moderates who fear voter backlash in swing districts and conservatives, you know, who want more to help in places like offsetting tax breaks. When we talk about spending and tax breaks, it gets very murky. But the one thing to know is a new tax bracket is not going to be created for the ultrarich. Even though that is what Trump wants, I'm hearing from House Republicans, that's a nonstarter.
MARTIN: That is Republican strategist Rina Shah. Rina, thank you.
SHAH: Thank you. Transcript provided by NPR, Copyright NPR.
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