GOP centrists revolt against steep cuts to Medicaid in Trump's tax breaks bill

WASHINGTON -- When it comes to Medicaid, Rep. Juan Ciscomani is telling fellow Republicans he won't support steep cuts that could hit thousands of residents in his Arizona district — “my neighbors, people my kids go to school with” — who depend on it.

Republican Rep. Don Bacon, who represents the liberal-leaning “blue dot” of Omaha, Nebraska, is trying to protect several Biden-era green energy tax breaks. He's warning colleagues that “you can’t pull the rug out from under” businesses that have already sunk millions of dollars into renewable developments in Nebraska and beyond.

And for Republican Rep. Nick LaLota of New York, it’s simple: “No Salt. No Deal. For Real.” He wants to revive — and bump up — what’s known as the SALT deduction, which allows taxpayers to write off a portion of their state and local taxes. Capping the deduction at $10,000 hurt many of his Long Island constituents.

“Governing is a negotiation, right?” said Rep. Nicole Malliotakis of New York, another Republican who is also involved in the talks. “I think everybody is going to have to give a little.”

As GOP leaders draft President Donald Trump’s "big, beautiful bill” of some $4.5 trillion in tax breaks and $1.5 trillion in spending cuts by Memorial Day, dozens of Republicans from contested congressional districts have positioned themselves at the center of the negotiating table.

While it’s often the most conservative members of the House Freedom Caucus driving the legislative agenda — and they are demanding as much as $2 trillion in cuts — it’s the more centrist-leaning conservatives who could sink the bill. They have been hauled into meetings with Trump at the White House, some have journeyed to his Mar-a-Lago estate in Florida, and many are huddling almost daily with House Speaker Mike Johnson.

And they are not satisfied, yet.

“To get everybody politically and policy-wise on the same page is going to require more conversations,” said LaLota, who is among five Republicans pledging to withhold their support unless changes to the SALT deduction are included.

Diving into the gritty details of the massive package, the GOP leaders are running into the stubborn reality that not all the ideas from their menu of potential tax breaks and spending cuts are popular with voters back home.

Moreover, their work of compiling the big package is not happening in a vacuum. It comes amid growing economic unease rippling across the country as Trump has fired thousands of federal workers, including some of their own constituents, and as his trade war sparks concerns of empty store shelves and higher prices.

Brendan Buck, a former adviser to an earlier House speaker, Paul Ryan, warned in an op-ed Wednesday that all the party's energy is being poured into one bill, with questionable returns.

"Many Republicans are hoping that the tax bill can blunt the economic damage caused by the Trump tariffs," Buck wrote in The New York Times, “but that is highly unlikely.”

Democrats are ready for the fight, warning that Trump and his fellow Republicans are ripping away health care and driving the economy into the ditch — all to retain tax breaks approved during Trump's first term that are expiring at year's end.

“What we see from Donald Trump and the Republicans is they are actually crashing the economy in real time,” said House Democratic Leader Hakeem Jeffries of New York.

“Why,” the Democratic leader asked, “are Republicans jumping through hoops” to try to reduce Medicaid and food stamps used by millions of Americans?

“It's all in service of enacting massive tax breaks for their millionaire donors like Elon Musk,” he said.

Johnson has projected a calm confidence, insisting that House Republicans are on track to deliver on Trump's agenda.

The speaker's office has become a waystation with a revolving door of Republicans privately laboring to piece together the massive package.

So far, GOP leaders have signaled they are walking away from some, but not all, of the steep Medicaid cuts. The nonpartisan Congressional Budget Office has said the proposals could result in millions of people losing their coverage.

Instead, what appears to still be on the table are tougher work requirements for those receiving Medicaid and food stamp assistance and more frequent eligibility tests for beneficiaries.

That's not enough for the conservatives, who also number in the dozens and are insisting on deeper reductions.

Ciscomani, in his second term, signed onto a letter with Bacon and others warning House Republican leadership he cannot support a bill that includes “any reduction in Medicaid coverage for vulnerable populations.”

“Our point is that we understand the need for reform,” Ciscomani said. “But anything that goes beyond that and starts jeopardizing rural hospitals in my district and their existence overall, then we’re running into an area where it will be very difficult to move forward. I think it’s very important they know that.”

Bacon, Ciscomani and others joined on a separate letter raising concerns about eliminating clean-energy tax credits, including those passed under President Joe Biden, a Democrat.

“Go with a scalpel. Go pick out some things,” Bacon told The Associated Press. He and the others warned that companies are already investing millions of dollars from the Inflation Reduction Act's incentives to green energy.

"You just can’t do a wholesale throw it out," Bacon said.

Democrats are also applying political pressure in Ciscomani’s district and beyond.

As Republicans decline to hold town halls on the advice of their leaders, Democrats are stepping in to warn constituents about what could happen to programs they rely on for health coverage and to put food on the table.

Democratic Sens. Mark Kelly of Arizona and Cory Booker of New Jersey visited Ciscomani's Tucson-based district last month to offer harsh condemnations.

Kelly asked how many in the room were represented by Ciscomani, and then he warned about how scores of residents in the district could lose their health care coverage.

“And for what? It is so Donald Trump could give a big, giant tax cut to the wealthiest Americans. It is not fair,” Kelly said.

Booker, fresh off his 25-hour speech on the Senate floor, was even more pointed, saying just three House Republicans have to change their mind to upend the GOP’s effort in the House, with its narrow majority.

“I believe one of them has to be in this district right here,” Booker said. “Either he changes his mind or this district changes congresspeople. It’s as simple as that.”

___

Associated Press writer Leah Askarinam contributed to this report.