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Good News, Bad News On Drug Tariffs

President Trump said Tuesday that he could levy up to 200 percent tariffs on pharmaceutical products imported into the U.S. soon. “If they have to bring the pharmaceuticals into the country, the drugs and other things into the country, they’re going to be tariffed at a very, very high rate, like 200 percent,” Trump said during a Cabinet meeting. That is the bad news.

In good news, Trump said any tariffs would not take effect immediately. “We’re going to give people about a year, year and a half, to come in, and after that, they’re going to be tariffed,” Trump said.

America imports the majority of its generic drugs from abroad and Trump wants this production onshored for national security reasons. Many brand drugs are also imported. Levies on drugs would increase already steep spending trends in healthcare.

#tariffs #drugpricing

https://thehill.com/homenews/administration/5390505-trump-200-percent-tariffs-pharma-imports

Gearing Up For 2026 Election and Medicaid

Interesting The Hill article on Medicaid being a huge election 2026 issue. Democrats will try to argue that the $1 trillion in cuts in the budget reconciliation bill will devastate coverage and providers, especially rural ones. Republicans will argue they are attacking fraud, waste, abuse, and improper enrollment. As the article notes, while many policy changes will not  be in effect yet, in prior midyear cycles issues still resonated.

See my recap of what is in the budget reconciliation bill: https://www.healthcarelabyrinth.com/saga-over-big-beautiful-bill-has-passed-for-good-or-bad/

In other news, another study details impacts of healthcare cuts on providers throughout the nation.

As well, Molina Healthcare released preliminary results from its second-quarter financials and is bracing for elevated medical costs. Centene pulled its earnings forecast earlier.

Molina sees ongoing financial troubles in its Affordable Care Act (ACA) Exchange, Medicaid, and Medicare Advantage lines of business. The budget reconciliation bill and expiration of enhanced premiums subsidies at the end of 2025 hurt further.

Additional articles: https://www.modernhealthcare.com/medicaid/mh-medicaid-cuts-tax-bill-states-hospitals/ and https://www.fiercehealthcare.com/payers/molina-healthcare-lowers-2025-guidance-warns-elevated-medical-costs and https://www.healthcaredive.com/news/molina-cuts-earnings-guidance-costs-rise-aca-medicaid-medicare/752297/

(Some articles may require a subscription.)

#election2026 #budgetreconciliation #mediaid #coverage #molinahealthcare

https://thehill.com/homenews/campaign/5384501-trump-democrats-medicaid-cuts-2026-midterms

Big Beautiful Bill Signed

President Donald Trump signed Republicans’ One Big Beautiful Bill and touted it as a landmark major tax and domestic policy bill. The bill extends tax reductions ready to expire and enacts new ones. At the same time, it institutes massive cuts to Medicaid that could remove millions of people from Medicaid and the Exchanges.

The bill was months in the making and Donald Trump is being given considerable credit for its passage. Whatever you think of the bill itself, its passage can be described as a political master stroke given the tight vote count for the GOP in each chamber of Congress. Trump stayed engaged with lawmakers on each vote – the initial House draft, the Senate recrafted one, and the House adoption of the Senate version. He is credited with creating a full course press to pass the bill, including a mixture of cajoling, education, and even threats. Trump, Vice President JD Vance, Centers for Medicare and Medicaid Services (CMS) Administrator Dr. Mehmet Oz, Treasury Secretary Scott Bessent, other Cabinet officials, Speaker Mike Johnson (R-LA), Senate Majority Leader John Thune (R-SD), and other GOP leaders in each house all executed on final passage over several months.

Healthcare policy group KFF has already updated its bill comparison and it is well done as usual. The link is in the additional articles area. I will have a blog Monday that goes through the final language. At a high level, this is what is in the bill:

• Medicaid work requirements for the able-bodied.
• Medicaid eligibility checks every six months for some populations.
• Elimination of a Medicaid eligibility streamlining regulation.
• Medicaid Cost-sharing for some enrollees.
• Medicaid provider tax limitations in non-expansion states and a phasedown from 6% to 3.5% over time in expansion states.
• Limitations on state-directed payments in Medicaid.
• Affordable Care Act (ACA) Exchange subsidy verification and stricter eligibility rules. 
• Limits on immigrant eligibility for Medicare, Medicaid, and ACA premium tax credits. 
• A $50 billion fund for rural hospitals and health systems.
• Prohibition on enforcing a Biden-era nursing home staffing regulation.

Notwithstanding what Republicans say, millions will lose coverage as a result of social barriers, red tape, administrative hurdles, the great inefficiency and lack of infrastructure in state Medicaid agencies, and lower availability of revenue in states to match federal dollars.

The bill does include a temporary 2.5% increase to the Medicare Physician Fee Schedule for 2026.

Additional articles: https://thehill.com/homenews/house/5385546-trump-republicans-megabill/ and https://thehill.com/homenews/administration/5384512-trump-signs-big-beautiful-bill/ and https://www.beckershospitalreview.com/hospital-management-administration/senate-passes-gop-budget-bill-heads-to-house-8-things-to-know/ and https://thehill.com/policy/healthcare/5384707-how-trumps-megabill-will-impact-health-care/ and https://www.kff.org/tracking-the-health-savings-accounts-provisions-in-the-2025-budget-bill/  

#budgetreconciliation #trump #congress #coverage #medicaid #exchanges #aca #obamacare #uninsured

https://www.healthcaredive.com/news/trump-signs-reconciliation-bill-medicaid-cuts/752259/

House Passes Big Beautiful Bill; On To The President

After almost collapsing overnight Wednesday in the House, the Big Beautiful Bill gained just enough votes to pass during the afternoon Thursday. The House had to adopt the Senate version to meet the deadline of July 4. Both moderates and conservatives in the House GOP caucus were highly critical of the Senate version, but all but two relented and voted for the budget reconciliation measure. Conservative Thomas Massie, R-KY, and moderate Brian Fitzpatrick, R-PA, were the only GOPers to vote against it. The bill passed 218-214 and the bill will be signed by President Trump tomorrow, Independence Day.

I had always argued there was an inevitability associated with passage of the bill, whatever healthcare cuts are in or the impact on the deficit. The GOP sees the Big Beautiful Bill as a seminal event for the party and a movement. But for a time, the House vote looked very challenging.

Conservatives criticized the massive additional overall deficit and debt the Senate bill generates against the House version. They issued a memo criticizing both the Speaker and Senate Majority Leader John Thune, R-SD, for moving away from the House framework. At the same time, moderates criticized the fact that Medicaid cuts are actually higher than in the House bill, especially as it relates to greater limitations on the provider tax and its phasedown to 3%. Conservatives especially were converted by explanations of the new Senate Medicaid cuts as well as commitments about how certain policies will be implemented by the administration.

Trump, Vice President JD Vance, CMS Administrator Dr. Mehmet Oz, Speaker Mike Johnson, R-LA, and other House GOP leaders are given great credit for convincing the vast majority of the up to 20 GOP holdouts to support the bill. Trump made calls until about 1:00 AM Wednesday night/Thursday morning.

Reductions in healthcare exceed $1.1 trillion. Medicaid cuts center on work requirements, provider tax limitations, and eligibility tightening. Exchange reductions center on eligibility restrictions and tightening. About 17 million could lose coverage from the bill, the expiration of the enhanced Exchange subsidies, and a new Exchange rule just finalized. As I have argued, the reductions are quite stealthy, but the impact will be real.

The healthcare news website Kaiser Health News had two articles on the bill’s impact. Nineteen Medicaid expansion states are led by GOP governors. They have been mum on the potential fallout of the Medicaid reductions, which are very much focused on expansion states. The governors mostly have said they do favor work requirements. But these governors will struggle with the limitations and phasedown of provider taxes used by states to leverage federal match dollars in Medicaid. They will struggle, too, with the additional administrative requirements tied to eligibility and work requirements in both Medicaid and the Exchanges if their states run their own marketplaces.

Actuarial consulting firm Wakely also issued an analysis of the bill’s impact on the marketplace, arguing the future market will look fundamentally different as enrollment declines. Findings include:

• Gross market average premiums could increase between 7% and 11.5% because of market attrition and residual risk pool morbidity increases, not accounting for incremental claims cost trend impacts.
• Enrollment could be reduced by 22% to 27%, or 5.2 to 6.4 million enrollees. This estimate is higher than those of the Congressional Budget Office (CBO). This does not count the impact of enhanced premium subsidy expiration.

Additional articles:https://kffhealthnews.org/news/article/big-beautiful-bill-trump-medicaid-affordable-care-act-cuts-republican-gop-governors/ and https://kffhealthnews.org/news/article/affordable-care-act-aca-obamacare-coverage-gains-threatened-1bbb-uninsurance/ and https://www.fiercehealthcare.com/providers/house-votes-218-214-send-reconciliation-bill-trumps-desk and https://www.medpagetoday.com/publichealthpolicy/washington-watch/116383 and https://www.wakely.com/blog/new-wakely-white-paper-explores-potential-impacts-of-house-reconciliation-bill-on-aca-individual-market-coverage/ and https://thehill.com/homenews/house/5382837-chip-roy-says-senates-medicaid-cuts-a-bit-better-than-expected/?tbref=hp and https://thehill.com/homenews/house/5384637-house-freedom-caucus-opposition-trump-bill/ and https://thehill.com/homenews/house/5383129-house-gop-big-beautiful-bill-trump/ and https://thehill.com/homenews/administration/5384490-trump-big-beautiful-bill/

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#budgetreconciliation #trump #congress #spending #medicaid #aca #exchanges #obamacare #coverage

https://www.modernhealthcare.com/politics-regulation/mh-tax-bill-house-donald-trump

— Marc S. Ryan

Budget Bill Stalled In House

The House is in flux right now as Speaker Mike Johnson, R-LA, and President Donald Trump are seeking to cajole moderates and conservatives in the GOP caucus to support the Senate version of the Big Beautiful Bill. Conservatives criticize the massive additional overall deficit and debt the Senate bill generates against the House version. They issued a memo criticizing both the Speaker and Senate Majority Leader John Thune, R-SD, for moving away from the House framework. At the same time, moderates are criticizing the fact that Medicaid cuts are actually higher than in the House bill, especially as it relates to greater limitations on the provider tax and its phasedown to 3%.

Trump and Johnson are having some impact. Between six and 20 GOP votes might have been in the “no” column today, but some are now coming around and saying they will vote for the bill or now are open to doing so. Interestingly, one of two no votes on the initial passage of the House bill, Warren Davidson, R-OH, has now said he will support final passage.

A lack of sufficient support from both moderates and conservatives who visited the White House today so far has stalled a series of procedural votes on the floor. The House likely will be in all night in an attempt to move forward to debate and eventually to pass the bill. I have always argued there is an inevitability associated with passage of the bill, whatever healthcare cuts are in or the impact on the deficit. The GOP sees the Big Beautiful Bill as a seminal event for the party and a movement. But right now there are many to convince before final passage.

In other news, Health Affairs Forefront Blog looks at the major administrative costs of carrying out work requirements in six states.

7/3/2024 1:00 PM UPDATE: The House GOP did get a successful vote early Thursday morning to pass a rule governing debate. The vote was 219-212. Debate has happened and now Minority Leader Hakeem Jeffries, D-NY, has all the time he wants as a leader under House rules to give a speech on the bill. At just after 1:00 PM Thursday, Jeffries was still discussing his opposition to the bill and set the record for longest House floor speech, which was about 8.75 hours. A final vote now can occur to adopt the bill.

7/3/2024 3:30 PM UPDATE: The House has passed the Senate version of the Big Beautiful Bill. The vote was 218-214, with just two Republicans voting with all of the Democrats against the measure. The vote caps a saga in the House, then the Senate, and then the House again to ensure enough conservatives and moderates in the GOP caucuses were on the bill.

Additional articles: https://thehill.com/homenews/administration/trump-the-next-100-days/5380399-live-updates-house-gop-trump-bill/ and https://thehill.com/homenews/house/5381728-gop-deficit-hawks-trump-megabill-memo/?tbref=hp and https://thehill.com/homenews/house/5381441-white-house-gop-holdouts-trump-megabill/?tbref=hp and https://kffhealthnews.org/news/article/one-big-beautiful-bill-medicaid-work-requirements-affordable-care-act-immigrants/ and https://thehill.com/homenews/house/5382760-warren-davidson-trump-big-beautiful-bill/ and https://thehill.com/homenews/house/5382215-house-republicans-delay-vote-gop-opposition/ and https://www.healthaffairs.org/content/forefront/recent-experience-shows-national-medicaid-work-requirements-would-create-enormous

(Some articles may require a subscription.)

#budgetreconciliation #trump #congress #spending #coverage #medicaid

https://www.modernhealthcare.com/politics-regulation/mh-medicaid-cuts-tax-bill-one-big-beautiful-bill

Senate Passes One Big Beautiful Bill

It was another wild all-nighter for the Senate GOP caucus Monday in its efforts to pass the One Big Beautiful Bill. But early afternoon Tuesday, the bill was finally passed and now goes back to the House.

A conservative amendment to lower the federal matching percentage in expansion states did not have enough votes to pass. But in the end the conservatives except Rand Paul voted for the measure. Despite helping get a rural hospital fund to $50 billion, moderate Susan Collins voted against the bill along with Thom Tillis.

All eyes Monday were on moderate Lisa Murkowski. She won some SNAP nutrition and Medicaid funding concessions in the bill for Alaska and, with the rural hospital fund increase, voted yes. That gave the bill 50 votes, allowing Vice President JD Vance to cast the tie-breaking vote for approval.

Healthcare providers and health plans universally panned the bill, which is being described by Democrats as the largest rollback of Medicaid ever. The GOP notes that the program grew tremendously since the COVID pandemic and has become unaccountable.

I will inventory all the healthcare reductions soon in an upcoming blog when the House acts. But the big major reductions generating both savings and the vast majority of the lower projected insured are work requirements, limitations on provider taxes, caps on state-directed payments, and tighter eligibility requirements, which in the Senate version phases the allowable rate down over time from 6% to 3.5%. Medicaid is slashed by $940 billion over ten years. More than $200 billion is cut from the Exchanges through various eligibility restrictions and bars on illegal immigrant participation and subsidies. Tighter access restrictions for immigrants apply to Medicare as well.

A limited Medicare physician fix was included, which will not repair the reduced rates in 2025 but boost them by 2.5% in 2026. No structural changes were adopted for the future.

The bill could also trigger mandatory reductions in Medicare due to outyear deficit increases unless the law is overridden later. Medicare cuts could hit at least $45 billion in 2026 and a total of $490 billion in the remainder of the ten-year horizon.

The bill could struggle in the House. Some moderates are not happy with the five-year sunset on the state and local tax deduction increase. Other moderates are upset about increased Medicaid cuts. And conservatives are upset about the increase in deficits and debt. Conservatives could protest at the rules committee level and on the House floor. At least six House members have said they will vote against the bill as of now, which would sink the bill. But let’s see what arm-twisting occurs.

Additional articles: https://www.modernhealthcare.com/politics-regulation/mh-senate-tax-bill-medicaid/ and https://www.modernhealthcare.com/politics-regulation/mh-tax-bill-senate-one-big-beautiful-bill/ and https://www.healthcaredive.com/news/senate-passes-reconciliation-bill-medicaid-cuts/752018/ and https://www.beckerspayer.com/policy-updates/insurers-urge-house-to-reverse-course-on-budget-bill/ and https://thehill.com/homenews/senate/5379770-senate-trump-bill-tax-cuts-medicaid-snap-student-loans/ and https://thehill.com/policy/healthcare/5378970-medicaid-cuts-senate-republicans/?tbref=hp and https://www.kff.org/medicaid/issue-brief/allocating-cbos-estimates-of-federal-medicaid-spending-reductions-across-the-states-senate-reconciliation-bill/ and https://thehill.com/homenews/senate/5380186-trumps-tax-bill-heads-house/ and https://thehill.com/homenews/house/5380166-house-conservatives-threaten-senate-bill/

(Some articles may require a subscription.)

#budgetreconciliation #trump #congress #spending #medicaid #exchanges #coverage

https://www.fiercehealthcare.com/providers/senate-passes-reconciliation-bill-51-50-vote

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/

(Some articles may require a subscription.)

#budgetreconciliation #trump #congress #spending #medicaid #exchanges #coverage #providers #ruralhealthcare  

https://thehill.com/homenews/senate/5377427-trump-megabill-gop-holdouts

Victory For Preventive Services

As expected, the Supreme Court ruled 6-3 in favor of allowing preventive services to continue under the Affordable Care Act (ACA). The majority was a mix of conservatives and liberals. The high court determined that members of the U.S. Preventive Services Task Force, which makes recommendations for coverage requirements under the ACA, are selected within the bounds of the Constitution. The court agreed that the task force is appointed by an executive appointee and could be replaced. The religious arguments on the provision of certain services were largely sidelined.

Additional articles: https://www.fiercehealthcare.com/regulatory/scotus-upholds-aca-preventive-services-task-force-6-3-ruling and https://www.healthcaredive.com/news/supreme-court-aca-preventive-care-mandate-decision-braidwood-kennedy/751806/ and https://www.medpagetoday.com/primarycare/preventivecare/116288 and https://www.modernhealthcare.com/politics-regulation/mh-aca-preventive-care-ruling-reactions/ and https://thehill.com/homenews/ap/ap-business/ap-supreme-court-preserves-key-part-of-obamacare-coverage-requirements/?amp_gsa=1&amp_js_v=a9&usqp=mq331AQIUAKwASCAAgM%253D&tbref=hp

(Some articles may require a subscription.)

#prevention #preventiveservices #aca #obamacare

https://www.modernhealthcare.com/politics-regulation/mh-supreme-court-aca-preventive-coverage

Budget Reconciliation Saga Continues With Parliamentarian Ruling

President Donald Trump took to the so-called campaign trail today to advocate for passage of the tax-cutting Big Beautiful Bill and said he wants the legislation on his desk by July 4. But the “Byrd Bath” process and the Senate parliamentarian threw a monkey wrench into the works today. The parliamentarian, who interprets Senate rules (especially as they relate to the reconciliation process), agreed with Democrats that several provisions on healthcare are not allowable under the Byrd budget reconciliation process rules. In general, provisions in a budget reconciliation bill must be very germane to the process to allow the bill to pass in the Senate with a simple majority and not with a supermajoriy vote of 60.

Majority Leader John Thune, R-SD, said he will not seek to overrule the parliamentarian on a majority vote for fear of setting a huge precedent for what is allowed in budget reconciliation processes in the future. The GOP may rewrite some provisions to see if they can be approved, but the ruling potentially creates huge problems for leaders in both chambers.

While moderates in the House and Senate will like that certain Medicaid and Exchange cuts may not make it, conservatives are insistent that sufficient reductions are in the bill to offset tax cuts and some spending increases. As well, they desperately want to rein in the size, scope, and spending in Medicaid. The struck reductions could mean a loss of spending reductions of several hundred billion dollars over a decade.

The provisions ruled not allowable under the Byrd rule include:

• Capping and limiting provider taxes
• Restricting Medicaid drug spread pricing
• Barring government health insurance participation and funding for those without verified immigration status (all government programs)
• Reductions in federal matching dollars to states that have expanded Medicaid and use funds to offer Medicaid coverage to immigrants without legal status

In other news, Rep. Ryan Zinke, R-MT, said he is a no vote on the Senate version due to a mandate to sell off up to 1.2 million acres of public lands.

Additional news: https://thehill.com/homenews/administration/trump-the-next-100-days/5369987-live-updates-trump-hegseth-iran-supreme-court-senate/ and https://thehill.com/homenews/house/5371828-zinke-senate-gop-bill-public-land/?tbref=hp and https://www.fiercehealthcare.com/providers/provider-tax-changes-some-medicaid-funding-restrictions-ineligible-reconciliation and https://www.beckershospitalreview.com/finance/medicaid-changes-dont-meet-senate-rules-parliamentarian/ and https://thehill.com/homenews/senate/5371008-thune-senate-parliamentarian-medicaid/?tbref=hp and https://thehill.com/homenews/senate/5370671-medicaid-trump-bill-senate-parliamentarian/ and https://thehill.com/homenews/senate/5371057-tuberville-senate-parliamentarian-medicaid/ and https://thehill.com/homenews/5371186-hardline-house-conservatives-senate-parliamentarian-ruling/

#budgetreconciliation #trump #congress #medicaid #aca #obamacare #exchanges #providers #coverage

https://thehill.com/policy/healthcare/5372232-senate-republicans-medicaid-ruling-challenge

Senate And House Jockey On Budget Bill

Senate moderates and pragmatic conservatives are working on a rural hospital relief fund to offset the impact of numerous Medicaid and Exchange cuts in the budget reconciliation bill. Their chief complaint is that the $15 billion budget crafters are willing to put up is clearly inadequate. They believe a fund closer to $100 billion is needed to ensure the hospitals’ solvency. At least three senators are very vocal here, with others certainly sympathetic.

One pragmatic conservative up for re-election, Thom Tillis, R-NC, believes that the healthcare cuts being considered in budget reconciliation will mean the GOP losing control of Congress. His seat is especially vulnerable as a popular moderate Democratic former governor, Roy Cooper, could challenge Tillis in 2026.

Another major sticking point in discussions between the House and Senate is the status of the state and local taxes (SALT) deductions. Primarily to satisfy two dozen or so House moderates from Blue states, the House included a boost in the SALT allowance on federal income tax to $40,000 from $10,000. The Senate stripped the increase entirely. Negotiations continue.

As well, sixteen House members penned a letter to their party’s leadership warning that they cannot support the current Senate draft with the additional Medicaid cuts, including additional provider tax limits.

Additional articles: https://thehill.com/homenews/house/5370059-salt-negotiations-republicans-bessent/ and https://thehill.com/homenews/senate/5369675-senate-republicans-rural-hospital-relief-fund-medicaid/ and https://thehill.com/homenews/senate/5367877-tillis-republicans-mediticaid-cuts/

#budgetreconciliation #trump #congress #spending #coverage #medicaid #ruralhospitals

https://www.fiercehealthcare.com/providers/16-house-republicans-tell-leaders-senates-medicaid-changes-go-too-far-threaten-pulling