Key Medicaid issue yet to be resolved ahead of markup, GOP leaders say

One of the thorniest issues around Medicaid is yet to be resolved ahead of a crucial House Energy and Commerce Committee meeting next week to mark up its portion of President Donald Trump's "big, beautiful bill."

Speaker Mike Johnson told reporters Thursday Republicans are still considering a controversial proposal to cap federal spending in states that have expanded Medicaid under the Affordable Care Act, which could help Energy and Commerce hit its $880 billion savings target to finance the party-line package.

“There's still ongoing discussion about per capita caps, but it's a sensitive thing,” Johnson said, nodding to tensions between moderates wary of the proposal and hard-liners pushing for it to be included. He said Wednesday that Republicans were actively discussing a smaller version of a per capita caps plan.

Energy and Commerce Chair Brett Guthrie (R-Ky.) echoed Johnson, saying, “we’re still working” on the policy as Republican leaders work to nail down final details of its contribution to the GOP megabill of taxes, energy and border security investments.

But one thing appears to have been decided, said Guthrie: A drug pricing policy the administration has been pushing is likely not to be included.

The likely exclusion of the so-called most favored nation policy in the panel's portion of the bill — which would cut prescription drug costs through Medicaid by linking certain government payments for medications to the lower prices paid overseas — would be a blow to the White House, which had been advocating for it as an alternative to steep cuts to Medicaid to offset the party-line package.

Many Republicans, including Johnson, opposed the proposal, saying it was tantamount to price fixing and would stifle research and development efforts.

“President Trump is right that Americans are taken advantage of in terms of we pay for the world’s research. I absolutely agree with what the administration wants to fix,” said Guthrie Thursday morning. “We want to find a different way to do it … 'most favored nation' is probably not going to be in Tuesday’s markup, but we agree with what the president is trying to do.”

Trump is now expected to separately sign an executive order directing aides to pursue the initiative for a selection of drugs within the Medicare program.

Jennifer Scholtes contributed to this report.