Budget Reconciliation Bill Flounders
Senate Majority Leader John Thune, who won his position with backing from prominent conservatives, threw his weight behind budget-cutters in the reframing in the Senate of the House bill. But the move seems to have backfired on him.
He has two conservative holdouts on the bill. He also has an uprising from moderates and pragmatic conservatives due to the Medicaid reductions, which are even deeper than the House had included. Thune essentially ignored a fundamental part of his caucus.
The moderates are worried about impacts on states and providers as well as what will happen to the uninsured rate. At least three moderates or pragmatic conservatives – Josh Hawley, Susan Collins, and Lisa Murkowski – have been vocal on the cuts and expressed doubts about voting for the bill. But there are still others that could vote against them due to the Medicaid cuts. Right now, the unveiled bill likely does not have enough votes to pass.
What’s more, there is an uprising in the House over the Senate version, with conservatives decrying certain changes and moderates up in arms about the fact that the Senate refuses to increase the state and local tax (SALT) deductions.
Strap in for a long rollercoaster ride.
In addition to adding to work requirements for some and furthering limitations on provider taxes, the bill does not include the Affordable Care Act (ACA) ICHRA/HSA insurance-funding expansion provisions or Exchange program integrity provisions. Further, it does not include a physician rate fix in Medicare.
In other news, the Commonwealth Fund released an analysis of the benefits of coverage expansion and found that the uninsured rate for working adults fell from over 20% in 2013 to 11% in 2023. The reconciliation bill could add 16M to the ranks of the uninsured.
As well, healthcare policy group KFF finds that 22 states would have to amend their provider taxes due to the Senate limitations.
Additional articles: https://thehill.com/homenews/senate/5355927-thune-senate-medita-cuts/ and https://www.politico.com/news/2025/06/17/hospitals-senate-medicaid-megabill-taxes-00410769 and https://thehill.com/policy/healthcare/5355932-senate-medicaid-cuts-concern/?tbref=hp and https://www.healthcaredive.com/news/uninsured-rate-falls-across-states-federal-policies-medicaid-cuts-commonwealth-fund/750994/ and https://www.kff.org/policy-watch/which-states-might-have-to-reduce-provider-taxes-under-the-senate-reconciliation-bill/
#budgetreconciliation #congress #trump #medicaid #medicare #obamacare #aca #exchanges #coverage
https://thehill.com/homenews/house/5355954-gop-bill-opposition-house-medicaid-salt/?tbref=hp
— Marc S. Ryan
