Senate Republicans are steadily moving along in their quest to advance President Donald Trump’s ‘big, beautiful bill,’ but some remain dissatisfied with one of the most crucial portions of the package.
The Senate Finance Committee unveiled its portion of the budget reconciliation package Monday night that deals directly with making the president’s first-term tax cuts permanent and the more controversial proposed changes to Medicaid, niche tax issues and Biden-era green energy subsidies.
Senate Republicans met behind closed doors to get a crash course on the bill, and some left distraught over provisions they hoped they would see on the cutting room floor. Senate Majority Leader John Thune, R-S.D., can only afford to lose three votes in the upper chamber.
And due to the nature of budget reconciliation, which allows lawmakers to skirt the filibuster, he can’t count on Democrats, who would demand serious changes to the broader legislation, to help get the package across the line.
The changes to the Medicaid provider tax rate, which were a stark departure from the House GOP’s version of the bill, particularly ruffled feathers among Republicans who have warned not to make revisions to the healthcare program that could shut down rural hospitals and boot working Americans from their benefits.
‘I want changes,’ Sen. Lisa Murkowski, R-Alaska, said. ‘I’m still not satisfied with where we are on Medicaid.’
The Senate Finance Committee went further than the House’s freeze of the provider tax rate, or the amount that state Medicaid programs pay to healthcare providers on behalf of Medicaid beneficiaries, for non-Affordable Care Act expansion states, and included a provision that lowers the rate in expansion states annually until it hits 3.5 percent.
To date, 41 states and Washington, D.C., have opted into the Medicaid expansion program. The idea behind the changes to the provider rate taxes was to help pay for Trump’s mammoth bill in part and discourage the remaining states from opting into Medicaid expansion.
Sen. Josh Hawley, R-Mo., argued, for a state like his dotted with rural hospitals, that the bill ‘is not a good development’ for their survival.
‘I mean, it’s really not,’ he said. ‘And in order to pay for increased subsidies for the Green New Deal? I mean, it just baffles me.’
The Senate’s version of the tax package does add more flexibility to green energy tax credits than the House’s, an issue pushed for by a handful of Senate Republicans who wanted to see the truncated phase-out of the credits in the House bill slowed down.
Senate Republicans met with Centers for Medicare and Medicaid Services Administrator Dr. Mehmet Oz Tuesday afternoon to discuss the Medicaid tweaks in the bill. Oz said the White House did ‘not believe’ changing the provider tax would influence the ability of hospitals to stay viable.
‘In fact, the provider tax and the state-directed payments are often used to pay institutions that have the best connections to the government of the state, not necessarily the hospitals that need the help the most,’ he said. ‘It is important that we clean up this system.’
Sen. John Hoeven, R-N.D., sought to extinguish anger among his colleagues, noting that Senate Finance Committee Chair Mike Crapo, R-Idaho, and Senate leaders were still working on what the final product would look like.
‘Everybody’s got an opinion, and I think it’s gonna be that way right up until we vote,’ he said.
Fiscal hawks were not pleased with the bill, either.
Sen. Ron Johnson, R-Wis., has stumped for a return to pre-COVID-19 pandemic era spending, a gouge to federal spending that would be trillions of dollars more than the rough goal of $2 trillion in spending cuts that some Senate Republicans are eying.
He believed there was ‘no way’ that the current parts of the broader reconciliation package could be fixed and stitched together by the Senate GOP’s self-imposed July 4 deadline.
‘The problem is it just simply doesn’t meet the moment,’ he said.
But Crapo cautioned he and lawmakers were still working out the kinks and that a resolution to his colleagues’ issues could still be found.
‘All I can say is that we will work it out,’ Crapo said. ‘We have to work that out, not only among our colleagues in the Senate, but with the House and with the White House.’