Brett Guthrie has an $800 billion problem

Rep. Brett Guthrie is on the spot.

As the newly installed chair of the House Energy and Commerce Committee, the Bowling Green Republican is expected to magically find savings amounting to $880 billion over the next 10 years in programs that come under his panel’s purview. The slash and burn instructions are contained in the budget proposal adopted by the lower chamber this week to compensate for, among other things, the cost of extending the tax cuts passed under the direction of President-Cum-Dictator Donald J. Trump during his first go-round in the White House in 2017.

The cuts, which mainly benefit businesses and the well-to-do, are scheduled to expire for individual tax filers on Dec. 31, meaning increased levies for currently eligible folks during the 2026 tax season if Congress fails to act. The whole mélange gets tangled up even further considering the impact retaining the tax cuts will have on the national debt, $33 trillion and growing, and the Republican desire to throw billions of dollars to defend the southern border.

To this point, Guthrie, a former state senator serving his eighth term in DC, has been the most anonymous member of the Kentucky delegation other than Rep. Morgan McGarvey (D-Louisville), who is serving in the minority in only his second term and has plenty of time to earn a reputation. That dull background on the national scene actually speaks well of Guthrie given that three of his Kentucky cohorts — Rep. Jamie Comer (R-TheFrankfortloop), Rep. Andy Barr (R-Lexington), and Rep. Thomas Massie (R-SomewhereOrOtherLewisCounty) — are among the biggest stooges you’re likely to find in DC, a town renowned for its stooginess.

Guthrie is, as you might imagine, a pretty conservative guy unlikely to rock the right-wing vote, which explains how he managed to grab the committee chair. Now that he has risen to the position of high muckety-muck, he needs to find $880 billion and determine what it means for Medicaid.

Ah, Medicaid. One of the nation’s most popular health care programs, serving about 75 million individuals nationwide, mostly the poor and disabled who don’t have job-related health insurance and aren’t old enough to qualify for Medicare. It also provides some coverage for mentally and/or physically disabled children, and offers financial help for the elderly restricted to nursing homes.

And the funding helps keep rural hospitals, that might otherwise go under, to keep operating.

It ain’t cheap. I remember back in the late ‘80s, Sen. Benny Ray Bailey (D-Hindman), then-chair of the Senate Health and Welfare Committee in the Kentucky General Assembly (always enjoyed talking to Benny Ray), exasperatingly explaining one time about the Medicaid program, “We gave them an unlimited budget and they exceeded it.”

State and federal governments share the tab, with the feds picking up no less than half the costs. In Kentucky, according to the Kaiser Family Foundation, 28 percent of the residents are on Medicaid/Chips, almost 1.5 million people in a state of 4.6 million. Washington is picking up 71 percent of traditional Medicaid costs, 90 percent for those receiving benefits under an expansion program adopted under the Obamacare law in 2010.

Total federal spending on Medicare, according to the Congressional Budget Office, is expected to increase from around $550 billion in fiscal year 2023 to almost $800 billion in fiscal year 2033. In Kentucky, the total currently is about $14.6 billion.

One more interesting statistic – 45 percent of all births in Kentucky are covered by Medicaid. So, the program is popular, even among conservative Republicans in rural states whose constituents rely on it while simultaneously helping small hospitals. Kaiser said 76 percent of those questioned nationwide maintain a favorable view of the program.

Which is kind of a problem, especially for Guthrie.

Medicaid isn’t specifically cited for cuts in the House budget document, but any review of the programs under the jurisdiction of the House Energy and Commerce Committee – the lower chamber’s longest tenured standing committee, by the way — will have to raise most of the $880 billion by raiding the vital program. Any significant change would logically shift more of the costs to the states. That can only result in the states either dropping some recipients or finding money in the their budget to compensate for the loss. The latter possibility is highly unlikely in an economically challenged Kentucky where the General Assembly, stupidly, is already planning to cut the income tax again.

Gov. Andy Beshear, a Democrat, has taken notice of the situation and he isn’t thrilled.

“Folks in Kentucky, Medicaid is the driving force behind rural health care,” Beshear said in a video on Bluesky that he said was filmed on his way to church on Sunday (nice touch). “Without it we’ll see hospital closures. We’ll see losses of jobs for nurses, doctors, and everybody else who works in those facilities. But the worst thing is we’ll see our families having to drive two hours sometimes just to get a regular appointment to keep them healthy.”

Beshear went on to call health care “a basic human right” and “you should be able to see your doctor in your own community.” He urged those viewing to contact their lawmakers.

Guthrie is on record favoring cuts to the program. He has in the past expressed interest in changing the federal funding system, switching from providing a percentage of the total costs to what is being referred to as a “per capita cap,” reimbursing the states a fixed maximum amount for each recipient.

Guthrie said he first became aware of the funding problems associated with Medicaid during his days in the Kentucky legislature, discovering that the program “just overwhelmed state budgets.”

“What I’ve learned is as we keep subsidizing health care, the price keeps going up,” he told Axios. “So my idea with per capita allotments has always been that’ll control costs.”

The problem with Guthrie’s logic, if that’s what you want to call it, is that switching to per capita caps on the federal side could only add to those “overwhelmed state budgets.” It might, as he said, “control costs” on the federal level but it will spiral costs further out of control on the state side.

“I’ve talked to a lot of providers, other groups, and they’re concerned,” Guthrie said, “no doubt about that. I’m not saying they’re not, but I think we can do it in a way that people get service. The president’s clearly said everybody’s going to get their service they need in a way that’s responsible to the budget.”

Yeah, right.

He told Politico, “I’d personally love per-capita allotments for Medicaid. I’m not sure we’re going to be able to get 218 votes for that.”

Adding to Guthrie’s headache is the president-cum-dictator who recently told Fox News in an interview that Medicaid wouldn’t be “touched” in this budgetary round. But, well, you know, our boy Trump says a lot of things, only rarely settling on anything resembling the truth, and when he does it’s usually by mistake. So this might just be another one of his little games where Guthrie may ultimately wake up on the underside of a Trailways.

Guthrie has made the traditional noise about waste, fraud, and abuse, the last refuge of a desperate man. Last April, while he was still chair of the House Subcommittee on Health, he mentioned concerns about a couple of regulations that he maintains bogs the system.

Perhaps, but there ain’t $880 billion to be found in that forest.

Of course, the logical thing to do here, given the need for Medicaid and the $33 trillion debt, would be to punt on extending the tax cuts and work on developing a national health care system that works for everyone.

Go ahead and laugh – I’ll join you.

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Written by Bill Straub, a member of the Kentucky Journalism Hall of Fame. Cross-posted from the NKY Tribune.