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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

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

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

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

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 Senate Schedules A Saturday Budget Vote, But Outcome Uncertain Changes to the Senate version of the budget reconciliation bill is due out Friday night and a vote to proceed on the bill is set for Saturday,

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

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