By Bob Bryan

Getty Images/Pool

Senate Republican leadership is trying to thread the needle in their bill to bridge one of the biggest healthcare divides in the party.

Axios’ Caitlin Owens and The Hill’s Peter Sullivan reported Monday that party leadership is attempting to placate both conservatives and more moderate members on the key issue of Medicaid spending. But the top brass seems to favor deeper cuts in the long run.

Rank-and-file GOP senators have been divided on Medicaid funding since the beginning of the debate over the new healthcare overhaul.

Some members, especially in states that expanded Medicaid under the Affordable Care Act, want to preserve higher federal funding levels to help maintain access to healthcare for the low-income people Medicaid is designed to help.

More conservative members have decried the expansion as a new entitlement and believe its funding should be stripped immediately.

Here are the three big changes being discussed, according to the reports:

  • Phase Medicaid expansion out over three years starting in 2020. That is different than the House bill, which would drop the increase in federal funds for the Medicaid expansion immediately after 2019. It would likely please moderates and members in Medicaid expansion states.
  • Change the formula for growth in Medicaid spending after 2025. Instead of using the consumer price index for medical costs to formulate the increase, the consumer price index for all goods would be used, which would make spending growth increase at a much slower rate. That would likely appease conservatives who have demanded lower Medicaid spending.
  • States could select the baseline from which to start their Medicaid spending growth, which would help smooth the transition for states that took the expansion.

The Congressional Budget Office estimated that the House proposed changes would result in 14 million more people going without insurance by 2026 compared to the current baseline. It will be unclear how the Senate’s changes would impact that number until a CBO score is released for its version of the legislation.