U.S. Rep. Rob Bresnahan’s vote for a federal spending bill expected to end the Medicaid benefits of millions has drawn criticism centered mostly on whether he broke a promise.
Protesting citizens and many groups aligned with Democrats say the first-term Republican congressman promised he would not vote to cut the federal health insurance program meant mainly for low-income people, but did it anyway.
During Bresnahan’s June 10 telephone town hall, a caller praised his other work in Congress but expressed dissatisfaction with his spending bill vote. The House passed the One Big Beautiful Bill Act by a 215-214 vote on May 22 with all but one Republican voting yes.
The caller said he found Bresnahan's yes vote "offensive, insulting to my intelligence."
"Is it really beneficial for us, or is it a ... cut on Medicaid, which you promised you wouldn't do?" the caller asked.
Bresnahan contends he did exactly as he promised and no one who deserves Medicaid will lose it, despite numerous independent analyses that say millions will lose coverage because of work requirements and other measures.
“We worked significantly throughout this process to protect Medicaid benefits for the people of Northeastern Pennsylvania. And the bill that ended up being voted on, 48 hours before that vote, (it) looked drastically different,” Bresnahan said in a May 30 interview with WVIA News.
'Cutting' vs. 'gutting'
Strictly speaking, Bresnahan never promised zero cuts to Medicaid. His office issued issued two carefully worded news releases that referred to his opposition to gutting Medicaid, not cutting it.
“If a bill is put in front of me that guts the benefits my neighbors rely on, I will not vote for it,” he said in a Feb. 13 news release. “These benefits are promises that were made to the people of NEPA, and where I come from, people keep their word.”
The news release said more than 200,000 Medicaid recipients live in the 8th Congressional District, more than a quarter of its population.
“I will fight to protect working-class families in Northeastern Pennsylvania and stand with President Trump in opposing gutting Medicaid. My position on this has not and will not change,” Bresnahan said in a Feb. 26 news release after an initial budget vote.
In an April 17 letter to House Republican leaders, Bresnahan and 11 fellow Republicans said they favor reforming Medicaid so “it is a strong and long-lasting program for years to come.”
Instead of opposing “gutting Medicaid,” the letter uses different language.
“However, we cannot and will not support a final reconciliation bill that includes any reduction in Medicaid coverage for vulnerable populations,” the House members wrote.
On May 22, Bresnahan and all of Pennsylvania’s Republican House members voted for President Trump’s One Big Beautiful Bill Act.
“Medicaid will be protected while ensuring taxpayer dollars are spent prudently,” Bresnahan said in a statement after the vote. “During this process, I fought to protect social safety net programs from the waste, fraud, and abuse that have threatened their long-term solvency. By ensuring states are not using Medicaid dollars on illegal aliens, conducting more frequent eligibility checks, and requiring work for able-bodied recipients, we are securing Medicaid for those who truly need it.”
Defending the work requirement
Bresnahan defended the work requirement in response to the town hall caller.
“It was something that we were vocally supportive of from the get-go,” he said.
In the WVIA interview, Bresnahan contended instituting a “work requirement” doesn’t equate to cutting Medicaid.
“If that is what they are going to label a cut, I'm not sure I can, you know, persuade them differently,” he said. “But the work requirement for Medicaid, it's only 20 hours per week, and the requirement can be fulfilled through work, but also through job training, caregiving, school and volunteering.”
He pointed out the bill carries plenty of exceptions to the work requirements. The bill says work isn’t required if someone is:
- Younger than 18 or 65 or older.
- Medically certified as physically or mentally unfit for employment.
- A parent or other member of a household with responsibility for a dependent child younger than 7.
- Pregnant.
- Homeless.
- A veteran.
- 24 or younger and in foster care under the responsibility of a state on the day they turned 18.
- Responsible for a dependent child 7 or older and is married to someone who complies with work requirements.
Bresnahan said he and other Republicans blocked proposals aimed at lowering two key sources of revenue for state Medicaid spending.
One is provider taxes. Under Medicaid, states can impose fees on healthcare providers and use that money to match federal Medicaid money. Many Republicans think that’s a gimmick that allows states to unfairly draw down more Medicaid. Some Senate Republicans want to amend the bill to cap or forbid new provider taxes.
The other is the federal Medicaid assistance percentage. When states expand Medicaid eligibility, they can receive 90% reimbursement from the federal government. The Senate is considering a lower threshold.
The House One Big Beautiful Bill Act freezes state provider taxes and the Medicaid assistance percentage at existing levels.
“And I negotiated with my colleagues, with leadership, with the White House, to block any proposals attempting to lower the provider tax or (the) percentage,” Bresnahan said.
The act will undoubtedly cut spending on Medicaid.
Under the work requirement — known in the bill as a “community engagement requirement” — an able-bodied adult who wants Medicaid must work at a job, perform community service or undergo job training for at least 80 hours a month or be enrolled in “an educational program.”
The act would also forbid Medicaid spending on non-citizens or undocumented immigrants altogether. Some states now use their own Medicaid money to avoid an existing federal ban.
Coverage, cost-reduction estimates
Two days before the act passed, the Congressional Budget Office estimated the federal government would spend $698 billion less on Medicaid in the nine years starting Oct. 1.
By June 4, that had ballooned $863.3 billion less with 7.8 million fewer people insured under Medicaid by 2034.
The CBO, required by law to remain non-partisan, estimates the costs and other effects of legislation for Congress.
A week before the act passed, the Center on Budget and Policy Priorities, a non-partisan think tank with liberal leanings, estimated a minimum 358,000 Pennsylvania Medicaid recipients would lose coverage because of the work requirements alone.
That includes 28,000 in the 8th district, according to the center.
The center presumes many Medicaid recipients won’t want to deal with filling out forms and other bureaucratic entanglements to prove they meet the work or “community engagement” requirements. The act also requires regular re-application.
The center specifically cites a decline in Medicaid enrollment when Arkansas imposed a work requirement and calculates cuts based on that and other factors.
Many Democrats ripped the act, including Gov. Josh Shapiro, who called it “a bad bill.” Shapiro said more than 300,000 Pennsylvanians could lose Medicaid coverage and 25 struggling rural hospitals that rely on Medicaid could face further strain.
That means, he said, “that after a decade of our hard work to reduce the number of uninsured Pennsylvanians by nearly 50%, we will go backwards and 10% of our Medicaid population will lose coverage and become uninsured.”
“This will raise health care costs for all Pennsylvanians – including those with private insurance,” Shapiro said. “Any lawmaker in D.C. who thinks the Commonwealth can backfill this massive hole they’ve created is wrong.”
Trump pressuring Senate
The Senate faces a July 4 deadline to get a bill done.
On Tuesday, President Trump urged them to get a bill done by then.
"To my friends in the Senate, lock yourself in a room if you must, don’t go home, and GET THE DEAL DONE THIS WEEK," Trump wrote on Truth Social. "Work with the House so they can pick it up, and pass it, IMMEDIATELY. NO ONE GOES ON VACATION UNTIL IT’S DONE."
