Senate Acting On Budget Bill
The Senate began debating the budget reconciliation bill and the process will go late into Monday at a minimum before any final vote. A procedural vote to open debate passed on a 51-49 vote Saturday, with conservative Rand Paul, R-KY, and pragmatic conservative Thom Tillis, R-NC, voting “no.” Paul likely will never support the bill due to debt concerns. The debt limit is actually hiked $5 trillion vs. $4 trillion earlier. Tillis opposes the deep Medicaid reductions. But the bill’s passage is by no means certain right now. A lot has to happen before final passage. The bill went through a wide-ranging debate over the weekend and a Vote-a-Rama (unlimited amendment offerings) started on Monday.
Four other conservatives – Ron Johnson, R-WI, Rick Scott, R-FL, Mike Lee, R-UT, and Cynthia Lummis, R-WY – only voted “yes” on the bill after commitments from leaders that a vote will be held on reducing Medicaid expansion matching rate for new enrollees (not existing ones) who are able-bodied. What if the amendment fails? Will one or more of the conservatives jump off the bill? Johnson and Scott have not said they will vote for the final bill yet. Further, moderates Lisa Murkowski, R-AK, and Susan Collins, R-ME, are concerned about the Medicaid and Exchange reductions and one or both of them could still vote “no” on final passage. (Sen. Josh Hawley, R-MO, now seems OK with the latest draft.)
Moderates did win a $25 billion rural hospital fund (over five years) to offset some of the reductions in Medicaid. But they wanted $100 billion and Collins is expected to offer an amendment to make the fund at least $50 billion by taxing the super-rich. The bill does put the state and local tax deduction back in at a cap of $40,000 for five years. Some House moderates could still oppose the compromise. The House had no sunset. Modifications to the nutrition program were made to satisfy some moderates.
The provider tax limitations that were struck by the Senate parliamentarian because they did not meet the Byrd rule were re-written by the GOP. The provisions now have a one-year delay (from 2027 to 2028) before the phasedown of the provider tax from 6% to eventually 3.5% begins. The House had a more limited provider tax reform, which sought to put a moratorium on new or increased taxes. The stricter provider tax limitations worry both Senate and House moderates.
A big fight occurred on whether the bill is truly consistent with the Byrd rules under reconciliation as the GOP is using the “current policy” vs. “current law” to determine fiscal impacts. The Senate parliamentarian agreed with the GOP that the Senate Finance Chair decides the issue. This allows the GOP to extend the 2017 tax cuts under a “current policy” basis and still meet the Byrd rules to pass the bill with a simple majority. My view is this is a budget gimmick and fiscally irresponsible. A vote to stay with “current law” scoring failed on a party-line vote of 53-47.
Despite all this drama, I would expect that the bill will pass with either a 51-49 vote or 51-50 — Collins voting “no” in the end (she is up for re-election in a Democratic-leaning state), with the vice president casting a tie-breaking vote in favor. Then, it would return to the House, where things could still be tough.
In other news:
A new Congressional Budget Office (CBO) analysis estimated that the Senate’s legislation would lead to about 900,000 more than the House bill. So, the total potential uninsured count would increase now by about 17M when counting the expiration of enhanced Exchange subsidies and a regulatory change in the Exchanges.
A conservative amendment to be voted on would prevent new enrollees in Medicaid expansion states from receiving the 90% Federal Medical Assistance Percentage (FMAP) if they are nondisabled and don’t have dependent children. The reduction would occur in 2031. It would further reduce Medicaid spending by about $300 billion over ten years. House Speaker Mike Johnson, R-LA, previously poured cold water on a similar proposal in the House.
Sen. Thom Tillis, R-NC, said Sunday that the Senate version of President Trump’s massive spending bill “will betray the very promise” the president made to not interfere with people’s Medicaid benefits. Trump attacked Tillis over his vote against moving forward with the bill. Tillis has announced since then he will not run for re-election.
The House hopes to vote on any Senate-passed bill Wednesday morning. But 16 Republican representatives wrote a letter to Senate Majority Leader John Thune, R-SD, and Speaker Johnson saying they “cannot support” a final reconciliation bill that includes the provider tax limits, changes to state directed payments, and other changes affecting hospital funding. At least six have said they will vote “no” when the bill returns to the House. Johnson has pleaded with the Senate to keep the bill as close to the House version as possible, but to no avail. Conservatives and moderates in the House are busy attacking the Senate version for different reasons – due to greater Medicaid cuts and for more spending.
Additional articles: https://thehill.com/homenews/senate/5376782-susan-collins-amendment-tax-rate-rural-hospitals/?tbref=hp and https://thehill.com/homenews/house/5376299-house-could-vote-on-big-beautiful-bill-by-wednesday-morning-emmer-announces/?tbref=hp and https://thehill.com/homenews/senate/5376251-tillis-criticizes-trump-medicaid-bill/ and https://thehill.com/business/budget/5377378-gop-senators-vote-trump-tax-priorities/?tbref=hp and https://thehill.com/homenews/senate/5376222-scott-pushes-medicaid-reduction/?tbref=hp and https://www.fiercehealthcare.com/providers/provider-tax-changes-some-medicaid-funding-restrictions-ineligible-reconciliation and https://thehill.com/homenews/house/5377946-house-gop-senate-megabill/ and https://thehill.com/homenews/administration/trump-the-next-100-days/5376452-live-updates-trump-senate-big-beautiful-bill/ and https://www.modernhealthcare.com/politics-regulation/mh-trump-republicans-tax-bill-medicaid/
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#budgetreconciliation #trump #congress #spending #medicaid #exchanges #coverage #providers #ruralhealthcare
https://thehill.com/homenews/senate/5377427-trump-megabill-gop-holdouts