As Congress considers legislation to cut taxes, restrict immigration and bolster domestic energy production, some Republicans are expressing wariness about trying to bring the bill’s cost down through big changes to Medicaid.

Missouri U.S. Rep. Eric Burlison isn’t one of them.

During an interview Friday on the Politically Speaking Hour on St. Louis on the Air, Burlison said the health care program for the poor, disabled and elderly lost its way — and expanded beyond its initial purpose.

“If we're really going to save Medicaid for the people that truly need it, then we must make some reforms to the program,” Burlison said.

Like other Republicans, such as Ways and Means Committee Chairman Jason Smith of Missouri, Burlison supports work requirements for Medicaid. And during an episode of his Fresh Freedom podcast last month, Burlison criticized Medicaid expansion — a key aspect of the Affordable Care Act in which the federal government pays 90% of the cost for enrollees up to 138% of the federal poverty level.

While Burlison said it’s unlikely there would be a critical mass to completely do away with the 90-10 federal Medicaid expansion match, he added that lawmakers shouldn’t cower from talking about its financial impact.

“What I do think that we should do is have a reasonable conversation about whether or not the federal government can afford to continue to match at 90%,” Burlison said. “We're paying the states money to put able-bodied young adults on Medicaid, on the government program. So I think that that's out of whack. We need to rebalance that.”

Robin Rudowitz with KFF, a nonprofit health policy research, polling and news organization, noted that 12 states have so-called trigger laws that would eliminate or reduce coverage if the federal government reduces the Medicaid expansion match. She said states would have to make tough decisions if Congress ends the current Medicaid expansion match.

“States would then need to say, well, am I going to increase my revenue so increase taxes?” Rudowitz said. “Can I cut education? That's the biggest piece of state budgets. Or do I have to make cuts to my Medicaid program?”

If lawmakers were to lower the federal match from 90% to 60%, Missouri Senate Appropriations Committee Chairman Lincoln Hough said it could lead to a budgetary hole of hundreds of millions of dollars. That’s because Missouri’s Medicaid expansion is in the constitution, which means it’s unlikely either lawmakers or Gov. Mike Kehoe could lower eligibility without another statewide vote.

Burlison said that he hasn’t heard any discussion of immediately eliminating the percentage of the Medicaid expansion match, adding that it would likely be phased in over time.

“We can't let the State of Missouri, and because the voters put something into effect, be the tail that wags the dog for the federal government,” he said. “And it's been a massive program that impacts all the other 49 states.”

Burlison takes dim view of town halls

Some GOP lawmakers, including Missouri Congressman Mark Alford , have faced angry crowds at town hall meetings, particularly over federal job reductions. North Carolina Congressman Richard Hudson, who chairs the National Republican Campaign Committee, suggested that his GOP colleagues stop doing in-person town halls.

Asked about Hudson’s comments, Burlison replied, “I think that the town halls create a dynamic where only political nutjobs show up.”

“You're just asking for an in-person version of the Twitter hellscape that sometimes exists,” Burlison said. “Normal people who go about their daily lives do not choose to go to the event. You're creating a dynamic where you're just inviting a very verbally hostile scenario.”

Burlison added there “probably are some people that have got some legitimate concerns” but went on to say there are other ways for members of Congress to go in front of their constituents. They include partnering with the League of Women Voters or a local Rotary Club to appear at a meeting and answer questions.

“That is more important than creating a dynamic that you're inviting all of the most extreme people to come to,” he said.

“ St. Louis on the Air ” brings you the stories of St. Louis and the people who live, work and create in our region. The show is produced by Miya Norfleet , Emily Woodbury , Danny Wicentowski , Elaine Cha and Alex Heuer . Jada Jones is our production assistant. The audio engineer is Aaron Doerr .