Starting on May 13, 2025, the House Energy & Commerce Committee held a markup of the Committee’s budget reconciliation committee print, which will be added to work of other committees to produce a larger budget reconciliation bill for consideration by the full House at a later date. While health policy has received much of the attention, the instructions to the Committee under the budget resolution are not confined only to health policy, and the Committee print included 4 subtitles covering energy, environment, communications, and health. Following debate on the separate titles and the consideration of amendments, the Committee approved the subtitles in party line votes, sending the committee print to the House Committee on the Budget to be incorporated with legislation from other House committees into a larger legislative package.
OPENING STATEMENTS
Before moving to the formal debate of the legislation before the Committee, several members offered opening statements. Chairman Brett Guthrie (R-KY) and Ranking Member Frank Pallone (D-NJ) began the May 13 markup with opening statements. Health Subcommittee Ranking Member Diana DeGette (D-CO) and numerous members of the Committee also made opening statements, with members on both sides of the aisle sharing personal stories of Medicaid enrollees. Committee Democrats highlighted individuals in their home states concerned about losing Medicaid coverage should the budget reconciliation legislation move forward and be signed into law. Republican statements focused on stressing that Medicaid is unsustainable as a program and that the legislation will help preserve Medicaid by addressing waste, fraud, and abuse in the program, implementing a work requirement for able-bodied Medicaid enrollees, ending Medicaid coverage for immigrants without legal status, and forbidding Medicaid coverage of transgender surgeries for minors. Democratic statements focused on estimates from Congressional Budget Office (CBO) communications that more 13 million individuals could potentially lose coverage and connected the reductions in Medicaid to Republican efforts to extend tax cuts for wealthier Americans. Not surprisingly, Republicans and Democrats disagreed about the veracity of the numbers of individuals who could lose coverage. Regarding the work requirement, Chairman Guthrie outlined specific exceptions to the work requirement to address many concerns that have been raised, while Democrats raised the objection that the work requirement would cause eligible individuals to lose coverage.
HEALTH SUBTITLE AND AMENDMENTS
For consideration of the health subtitle, Chairman Guthrie offered an amendment of the nature of a substitute to serve as the base text for consideration. During their comments, Committee Democrats continued to highlight the stories of Medicaid enrollees and the more than 13 million estimated to lose coverage in CBO communications. Following comments from multiple members regarding the health subtitle, the Committee moved to consideration of amendments.
During the debate, the Committee considered 20 separate amendments on a range of provisions and issues.
Each amendment offered was defeated on a party-line vote. Among the amendments of note and interest include the following:
- Health Subcommittee Ranking Member Rep. Diana DeGette (D-CO) offered the first amendment, which would prevent the provisions of the health subtitle from taking effect until the Secretary of Health & Human Services certifies that the legislation would not reduce benefits under state plans.
- Rep. Marc Veasey (D-TX) offered an amendment to strike the provisions setting limits on new provider taxes. Often criticized as a gimmick or loophole for states to access additional federal dollars, arguments for the amendment centered on the value to states in utilizing provider taxes to generate funding for their Medicaid programs and provide additional funds back to states.
- Rep. Kathy Castor (D-FL) offered an amendment to remove the legislation’s limits on state directed payments, which would allow existing state directed payment systems in place to continue but would cap the level of future state directed payments at Medicare levels.
- Rep. Raul Ruiz, MD (D-CA) offered an amendment requiring states to submit a report assessing the effects of the bill on rates of uncompensated care and on emergency department wait times.
- Rep. Scott Peters (D-CA) offered an amendment to strike the work and community engagement requirement for the Medicaid expansion population. Supporters of the amendment cited concerns about the administrative burden that would be imposed under the requirement, and supporters also cited past experiences in Arkansas and Georgia to demonstrate that the requirement could lead to eligible individuals losing coverage. Chairman Guthrie responded noting that the provisions were created with exceptions and provisions to help address and prevent situations like those that occurred under Arkansas and Georgia’s work requirements.
- Rep. Robin Kelly (D-IL) introduced an amendment requiring state audits of individuals who lost coverage under the legislation’s community engagement or work requirement but would otherwise have qualified for coverage under the requirement’s exceptions.
- Rep. Greg Landsman (D-OH) offered an amendment to strike the provision allowing states to assess cost-sharing of up to $35 per service on Medicaid expansion adults with incomes over 100 percent of the federal poverty level (FPL). Supporters of the amendment argued that this will lead to large numbers of enrollees forgoing care, further driving up costs of uncompensated care. Chairman Guthrie and other Republican committee members pointed out requiring enrollee “skin the game” is important and required in other health plans and that states have flexibility to impose much lower cost-sharing much lower than $35.
- Rep. Nanette Diaz Barragan (D-CA) offered an amendment to strike the provision limiting retroactive coverage under Medicaid and CHIP to one month prior to an individual’s application date, which would be a reduction from current law which allows for 3 months of retroactive coverage. Committee Democrats argued that this will reduce healthcare coverage for children and families that earn too much to qualify for Medicaid but not enough to afford coverage under the health insurance exchange under the Affordable Care Act (ACA).
- Rep. Debbie Dingell (D-MI) offered an amendment stating a sense of Congress supporting most favored nation pricing for prescription drugs. Supporters noted President Trump’s recent executive order to lower U.S. drug costs by linking prices to those paid in other developed countries. Chairman Guthrie expressed agreement with the President on the need to address American drug pricing but pointed out that Americans also benefit from pharmaceutical innovation.
- Rep. Alexandria Ocasio-Cortez (D-NY) introduced an amendment which would include the provisions to address risk adjustment in Medicare Advantage along with modifying the update to Medicare physician payments to be consistent with the Medicare economic index (MEI) ,which is an annual measure of the inflationary rise in medical practice costs. Health Subcommittee Chair Buddy Carter (R-GA) offered supportive comments regarding the amendment but stated the reconciliation legislation was not the appropriate avenue for these provisions.
- Rep. Ocasio-Cortez (D-NY) offered an amendment that would effectively undo the legislation’s provisions rescinding the nursing home staffing rule that was finalized under the Biden administration.
- Rep. Dingell (D-MI) offered an amendment prohibiting states from imposing new limitations or payment reductions for home and community-based services (HCBS).
Following the consideration and dispensing of amendments, the Committee approved the health subtitle, as amended by Chairman Guthrie’s amendment in the nature of a substitute, on a party line vote.
COMPLETION OF CONSIDERATION AND NEXT STEPS
Following approval of the health subtitle, the full Energy & Commerce Committee voted 30-24 along party lines to report and transmit the legislation and its four subtitles, consistent with the instructions received under the budget resolution, to the House Committee on the Budget.
The House Budget Committee has announced plans to meet in a markup on Friday, May 16 to consider the legislative package that incorporates the E&C Committee’s work and the work of other House committees to be considered under the budget reconciliation process.
Assuming passage by the House Budget Committee, Speaker of the House Mike Johnson (RLA) and House Republican leadership continues to assert their plans to bring up the legislative package before the full House of Representatives for consideration and passage before Memorial Day.
The Senate has not announced plans for consideration, but it is speculated that the Senate will not meet in its respective committees to consider the legislative package. Rather, there is speculation that the full Senate will take up, amend, and pass the House-passed legislation in June.
Following Senate consideration and passage, the House and Senate will need to work to reconcile their respective differences in the weeks that follow in June and July.