U.S. Senate Majority Leader John Thune, R-S.D., speaks to reporters at the Capitol as lawmakers work on the "One Big Beautiful Bill Act" on June 25, 2025 in Washington, D.C.  (Photo by Joe Raedle/Getty Images)

WASHINGTON — U.S. Senate Republicans appeared deeply divided Wednesday over how to establish a fund for rural hospitals to offset the budget impacts of Medicaid cuts in the “big, beautiful bill.”

The hospitals, which are generally already hurting financially, rely heavily on Medicaid, a state-federal partnership that provides health insurance for low-income households and for some people with disabilities.

GOP senators haven’t yet reached agreement on how to structure the fund, or on dozens of other unresolved provisions in the sweeping package, even though leaders hope to begin voting as soon as Friday. Still up in the air were agreements on major provisions of the measure involving the U.S. Department of Agriculture’s food aid program for low-income people and a proposed selloff of certain public lands.

Republican leaders continued to project optimism. “We’re well on our way to getting this bill passed this week,” Senate Majority Leader John Thune, R-S.D., said during a floor speech, continuing to press ahead toward a self-imposed Fourth of July deadline. 

Others saw it differently. Wisconsin Republican Sen. Ron Johnson cast doubt on the short timeframe leaders have set to reach final agreement and move the bill through both chambers.

“We’re still discussing some pretty fundamental issues,” Johnson said. “I’m just laying out the reality of the situation. We’ve got a lot of work to do.”

‘The only person up here that’s ever ran a rural hospital’

Dueling plans to establish the rural hospital fund to ease the threat of Medicaid cuts circulated among senators working to finalize the massive tax and spending cut measure, but an agreement had not surfaced by late afternoon.

Unofficial details showed Senate Republicans eyeing the inclusion of a $15 billion fund — $3 billion a year between fiscal 2027 and fiscal 2031 — to help rural hospitals, according to multiple reports.

But Sen. Roger Marshall, who sits on the Senate Committee on Finance, said he wants to increase that fund to $5 billion annually, with “half of that going to rural hospitals, and half of it going to primary care and prescription drugs and throw in physical therapy and occupational therapy, all the others as well.”

The Kansas Republican and physician said “we should probably only do it for four or five years and then regroup and see where we are.”

“I’m the only person up here that’s ever ran a rural hospital — I actually know something about them,” he added.

While Marshall said he loves “90%” of the broader bill, he said not nearly enough is being cut.

“But I can’t get the votes to do that, so it’d still be the largest cut in spending in my lifetime anyway,” he said, noting that “it’s going to be hard for the House to vote against it.”

Fund size criticized

On a midday call with reporters, Traci Gleason with the Missouri Budget Project said the stabilization fund being batted around by lawmakers “would fall well short of addressing these problems.”

“Forty-three percent of Missouri’s rural hospitals are at risk of closing, and 17% are considered to be at immediate risk,” said Gleason, who spoke during a virtual press briefing organized by the left-leaning Center for Budget and Policy Priorities.

“Those figures don’t account for all of the other health care providers in rural communities, like federally qualified health centers and others that operate on these incredibly thin margins. So the massive cuts to Medicaid are what is creating the problem and the only real way to address it is for Congress to not make these massive cuts,” she said.

‘Problematic’ Medicaid cuts

Sen. Susan Collins was advocating for a much bigger rural hospital stabilization fund, at $100 billion.

“I don’t think that solves the entire problem,” the Maine Republican and chair of the Senate Appropriations Committee said.

“The Senate cuts in Medicaid are far deeper than the House cuts, and I think that’s problematic as well.”

Sen. Jim Justice of West Virginia said that the $15 billion “is better than zero.”

“You know, naturally, I’d want it to be as high as it possibly can,” he said, adding that rural hospitals are the “lifeblood” of his state.

Sen. Josh Hawley of Missouri, a loud voice against Medicaid benefit cuts, said a stabilization fund is a “good idea but we’re still going to have to address the longer term effects of this.”

When asked for a dollar figure, Hawley said “it depends on the structure of it.”

Texas Republican Sen. John Cornyn said he keeps hearing the Senate will take a procedural vote on Friday, though that isn’t set in stone. 

“Should be a fun weekend for all of us,” Cornyn said. “Can’t wait.”

Once the Senate votes on what is called a motion to proceed, there’s a maximum of 20 hours of floor debate before the chamber must begin its marathon amendment voting session and eventually a passage vote.

SNAP provisions

Senate Agriculture Chairman John Boozman, an Arkansas Republican, said a revised version of his committee’s bill had not yet been reviewed by the parliamentarian.

The updated text alters a section restructuring the cost-share of the Supplemental Nutrition Assistance Program, or SNAP, a key food assistance program for low-income people.

The provision would require states for the first time to shoulder some of the cost of the program’s benefits. The amount a state owes would be determined by its error payment rate, with greater error rates requiring a higher state share.

Complex rules govern what can and can’t be included in the measure. The Senate parliamentarian ruled the language in the initial proposal did not comply with the chamber’s reconciliation rules.

The updated proposal would allow states more flexibility during the policy’s phase-in in fiscal 2028, allowing them to choose either the error rate in fiscal 2025 or fiscal 2026.

Boozman told reporters that change sought to respond to the parliamentarian’s ruling.

The parliamentarian “asked us to allow them (states) to use a different time frame — essentially gave them more time to understand what their error rate would be and to plan for it,” Boozman said. “And so we adjusted for that and I think we satisfied it.”

Lee and public lands

Senate Energy and Natural Resources Chairman Mike Lee of Utah reportedly narrowed a provision that would mandate the sale of Bureau of Land Management lands. He has not publicly said where it stands with the parliamentarian.

A committee spokesman did not return messages seeking clarification Tuesday and Wednesday, but a version of the changes obtained by news media shows changes consistent with what Lee proposed Monday.

Those changes include limiting the mandated sales to only the BLM — and not U.S. Forest Service lands, as Lee had initially proposed — and lowering the percentage of the agency’s lands that must be sold to between .25% and .5%. The initial proposal required between .5% and .75%.

The updated provision would also only require lands located within 5 miles of a population center to be sold and exempts lands that are currently used for grazing or another “valid existing right that is incompatible with the development of housing,” according to a copy of the changes obtained by hunting and angling publication Outdoor Life.

The provision has sparked opposition from Western lawmakers, including a handful of conservatives.

But it also has its share of supporters. Alaska Republican Dan Sullivan told reporters he had not seen the updated text but remained supportive of the idea.

“I’ve been supportive of what Sen. Lee is trying to do,” he said. “We have a lot of public lands in Alaska that the federal government abuses. But we’re in a good discussion on that, so I need to see the update.”

 

House Speaker Mike Johnson of Louisiana speaks to reporters about the Republican budget reconciliation package at a weekly press conference on Tuesday, June 24, 2025, at the U.S. Capitol. (Photo by Ashley Murray/States Newsroom)

This report has been updated.

WASHINGTON — U.S. Senate Republicans were scrambling Tuesday to restructure several proposals in the “big, beautiful bill” that don’t meet their chamber’s strict rules for passing a reconciliation package, while GOP lawmakers on the other side of the Capitol warned those changes may doom its passage in the House.

Senate Majority Leader John Thune, R-S.D., said he and several others are working on a way to bolster rural hospitals, which could experience financial strain as a result of the various changes to Medicaid and other health care programs in the package.

“We are working on a solution for rural hospitals and that’s something that’s been in the works now for several days in response to a number of concerns that our colleagues have mentioned in ensuring that the impact on rural hospitals be lessened, be mitigated,” Thune said. “And I think we’re making good headway on that solution.”

Thune said GOP lawmakers shouldn’t let the “perfect be the enemy of the good,” though he predicted there “could be” two or three Republicans who vote against the package.

“We’ve got a lot of very independent-thinking senators who have reasons and things that they’d like to have in this bill that, in their view, would make it stronger,” Thune said. “But at the end of the day this is a process whereby not everybody is going to get what they want. And we have to get to 51 in the United States Senate.”

More objections to Medicaid cuts

Missouri Sen. Josh Hawley, who has been vocal about Medicaid changes and rural hospitals, said he had “no details whatsoever” about the rural hospital fund or how it would work if it’s added to the bill.

But he said he’s not going to support a bill that takes away working people’s health care.

“We’ve got 1.3 million people on Medicaid in Missouri, hundreds of thousands of kids. That’s 21% of my population. Most of these people are working people. They’re on Medicaid, not because they’re sitting around at home; they’re on Medicaid because they don’t have a job that gives them health care and they cannot afford to buy it on the exchange,” Hawley said. “They don’t want to be, but it’s their only option. And I just think it’s wrong to take away health care coverage from those folks. Now if they’re not working, then sure, they should be.”

Senate Republican Policy Committee Chair Shelley Moore Capito, R-W.Va., said she had a “lengthy discussion” with her home state’s hospital association earlier in the day.

“This has a lot of impacts and we want to make sure we have a lot of rural hospitals. That’s why this rural hospital fund idea is developing,” Capito said. “I don’t think anything is set yet but that is an issue. I think Medicaid, we need to preserve it for the people it’s intended for and get rid of the people who don’t deserve it and don’t qualify and are bilking the system.”

Capito said she hadn’t yet formed an opinion on the rural hospital fund since there isn’t yet a formal proposal written down.

Public lands

In one major development, the Senate parliamentarian ruled Monday that a controversial provision championed by Senate Energy and Natural Resources Chairman Mike Lee to mandate the sale of at least 2 million acres of public lands in 11 Western states did not comply with the chamber’s rules for reconciliation.

Lee, a Utah Republican, has said the provision would free up land to build new housing. But Democrats and some Republicans from the affected states strongly opposed it.

Lee said on social media Monday evening that he was working to rewrite the proposal to comply with reconciliation rules. A spokesperson for his office did not return a message seeking comment Tuesday morning.

SNAP cost-sharing under debate

In another turn of events, Senate Agriculture Chairman John Boozman, R-Ark., earlier Tuesday had announced the panel successfully reworked a provision that would transfer some of the cost of the Supplemental Nutrition Assistance Program to state governments.

But a spokesperson for the panel said later that the parliamentarian actually has not yet made a ruling. The spokesperson said “we’ve gotten some clarification from leadership and it’s steering in the direction it would be compliant but not official.”

Boozman earlier had said his proposal would improve SNAP. “Our commonsense approach encourages states to adopt better practices, reduce error rates, be better stewards of taxpayer dollars, and prioritize the resources for those who truly need it,” Boozman wrote in a statement.

The new language, if accepted, would give states the option of selecting fiscal year 2025 or 2026 as the year that the federal government uses to determine its payment error rate for SNAP, which will then impact how much of the cost the state has to cover starting in fiscal year 2028. Afterward, a state’s payment error rate will be calculated using the last three fiscal years.

Any state with an error rate higher than 6% will have to cover a certain percentage of the cost of the nutrition program for lower income households.

Rushing toward deadline

The internal debates among lawmakers about how to rewrite major pieces of the tax and spending cuts package have led to a rushed feeling among Republican leaders, who have repeatedly promised to approve the final bill before the Fourth of July — an exceedingly tight timeline.

Speaker Mike Johnson, R-La., said during a press conference shortly after a closed-door House GOP conference meeting Tuesday that he’s hopeful the final bill that comes out of the Senate won’t make too many changes to what the House approved earlier this year.

“I remain very optimistic that there’s not going to be a wide chasm between the two products — what the Senate produces and what we produce,” Johnson said. “We all know what the touchpoints are and the areas of greatest concern.”

Republicans, he said, know they need to focus on preserving a fragile compromise on the state and local tax deduction, or SALT, that helps offset the cost of living in some higher-tax states like California, New Jersey and New York.

A deal Johnson brokered with GOP lawmakers in the SALT Caucus has been significantly rewritten in the Senate, but is expected to move back toward the House version, though not entirely.

Johnson also mentioned GOP efforts to roll back certain clean-energy provisions that Democrats approved and President Joe Biden signed into law in their signature climate change, health care and tax package, called the Inflation Reduction Act, or IRA, in 2022.

“We’ve got to get the SALT negotiation number right. We’ve got to make sure the IRA subsidies are handled in an appropriate manner,” Johnson said. “Look, you’ve got a number of provisions.”

Johnson said he expects the Senate to vote on its final bill by Friday or Saturday and that he’s told House lawmakers to “keep your schedules flexible” on being in Washington, D.C., for a final House vote. 

Trump goads Republicans

President Donald Trump sought to spur quick approval of a final bill, posting on social media that GOP lawmakers should get the package to him as soon as possible.

“To my friends in the Senate, lock yourself in a room if you must, don’t go home, and GET THE DEAL DONE THIS WEEK. Work with the House so they can pick it up, and pass it, IMMEDIATELY,” Trump wrote Tuesday. “NO ONE GOES ON VACATION UNTIL IT’S DONE. Everyone, most importantly the American People, will be much better off thanks to our work together. MAKE AMERICA GREAT AGAIN!”

Oklahoma Sen. Markwayne Mullin said there are concerns among his fellow Republicans about all of the provisions that must be removed or significantly reworked to meet the complex rules for moving a reconciliation bill through that chamber.

“Every time something comes out that we’re using as a pay for, it takes the deficit reduction down. And they’ve taken out nearly $300 billion so far. We’ve got to make that up,” Mullin said after leaving the closed-door House GOP meeting. “The Senate can’t come in below the House version as far as deficit reduction. So that makes it difficult.”

Mullin, who has been acting as his chamber’s top negotiator with SALT Republicans in the House, told reporters he expects the deduction for state and local taxes to remain at the $40,000 level negotiated in the House. But said the Senate will likely rewrite the $500,000 income ceiling to qualify for the tax deduction.

“I think 40 is a number we’re going to land on,” Mullin said. “It’s the income threshold that’s in negotiations.”

Sen. Kevin Cramer of North Dakota said “most of us would like to make it zero.”

“I hate the idea of $40,000 but if that’s what it takes to pass the bill, I probably could do it. I would like to maybe find some other tweaks to it, somehow, like changing the income levels,” he said.

Treasury Secretary Scott Bessent told reporters he expects a resolution on SALT in the next 24 to 48 hours.

“I had a very successful lunch meeting with the senators. I think that we are on track,” Bessent said.

The ‘red line’ in the House

New York Republican Rep. Mike Lawler told reporters following the closed-door meeting that Senate leaders shouldn’t assume whatever they pass will be accepted by the House.

“I’ve been very clear about where my red line is. So, you know, we’ll let this process play out,” Lawler said. “I think the Senate should recognize the only number that matters is 218, and 50 plus 1. That’s it. And how do you get there?”

Republicans hold 53 seats in the Senate, so leadership cannot lose more than four votes and still approve the package, given that Democrats are universally opposed.

In the House, GOP leaders have 220 seats and need nearly every one of their members to support whatever the Senate sends back across the Capitol for it to make it to the president’s desk before their self-imposed deadline.

In addition to the SALT tax compromise, Lawler said he has concerns about how the Senate has changed other provisions, including those addressing Medicaid, the state-federal health program for lower income people.

“Yeah, there are a number of concerns about decisions that they’re making,” Lawler said. “And obviously, the bill on their side is not final, so we’ll see where it goes.”

Missouri Republican Rep. Jason Smith, chairman of the Ways and Means Committee that crafted the tax provisions in the reconciliation bill, stood by the House’s version of the Opportunity Zone Tax Incentives. The House version extends the incentive from the 2017 Tax Cuts and Jobs Act for a year, while the Senate’s version makes it permanent.

The Opportunity Zone Tax Incentive was pushed by South Carolina Sen. Tim Scott during the first Trump administration, which aimed to create tax cuts for businesses and real estate to invest in low-income communities, but it had mixed results.

“The tax bill that we’re going to deliver is gonna deliver for working families, small businesses and farmers,” Smith said.

Thumbs down from one House Republican

House Freedom Caucus Chairman Andy Harris, R-Md., posted on social media that he doesn’t support how the Senate has changed the bill and that he would seek to block it from becoming law. 

“The currently proposed Senate version of the One Big Beautiful Bill weakens key House priorities—it doesn’t do enough to eliminate waste, fraud, and abuse in Medicaid, it backtracks on Green New Scam elimination included in the House bill, and it greatly increases the deficit – taking us even further from a balanced budget.

“If the Senate tries to jam the House with this version, I won’t vote ‘present.’ I’ll vote NO.”

Rattlesnakes and the Senate

West Virginia Republican Sen. Jim Justice told reporters that it’s important for the Senate to take its time in its changes to the reconciliation package and that GOP lawmakers need to be patient.

“If you’re walking through the woods and you look right over there at that wall and there’s a rattlesnake all curled up there and everything, what do you do?” Justice asked. “Most people just jump and take off runnin’, well … rattlesnakes run in pairs and if you just jump left or right or behind, that one can hurt you right there.”

Rattlesnakes are typically solitary creatures, but new research has shown that rattlesnakes are more social than previously thought.

Justice said the best course of action when dealing with a rattlesnake, or two, is to stand still for a moment.

“Look to the left, look to the right, look behind you, and then decide which way you’re going,” he said. “That’s what I think we need to do (in the Senate).”

U.S. Senate Minority Leader Chuck Schumer, D-N.Y., speaks during a press conference inside the Capitol building on Wednesday, June 18, 2025. Oregon Democratic Sen. Ron Wyden is at right. (Photo by Jennifer Shutt/States Newsroom)

WASHINGTON — The next hurdle for Republican leaders in the U.S. Senate and the “big, beautiful bill”: Democrats — and possibly a few of their own members — in a marathon voting session will make last-ditch attempts to change the tax and spending cut measure.

The vote-a-rama, as it’s known, is expected to begin sometime during the last full week of June as Congress heads toward the Fourth of July recess. It will likely begin in the afternoon and  last overnight into the next morning. Senators will debate and vote on dozens of amendments attempting to revise the massive legislation that could have an effect on nearly every American.

Democrats, who have 47 votes in the Senate compared to 53 for Republicans, plan to zero in on Medicaid, taxes, corruption, policies that could raise energy costs and proposals that would increase the deficit, according to Senate Minority Leader Chuck Schumer.

Senate Majority Leader John Thune, R-S.D., and the committee chairs tasked with drafting pieces of the package have spent weeks combing through the House-passed bill to figure out what needs to be altered to avoid divisive floor votes. 

They’ve rewritten numerous policy proposals to comply with the strict rules that go along with the complex reconciliation process and are now trying to work out disagreements among GOP senators that could doom or complicate a final deal.

The goal is to avoid a protracted debate over core GOP provisions in full public view once the vote-a-rama begins, though some senators are already predicting votes on GOP amendments.

‘A potentially messy process’

Missouri Republican Sen. Josh Hawley, who has raised concerns about the bill’s impact on rural hospitals, said he hopes GOP leaders reach a consensus before vote-a-rama but didn’t rule out offering his own amendments if they don’t settle their disputes.

“Amending it on the floor, that’s a potentially messy process,” Hawley said. “I would hope that we could get to a good place before that. But we have to fix the rural hospital issue.”

Alabama Republican Sen. Tommy Tuberville said he will likely propose amendments during floor debate, though he declined to say what specific policies he’d seek to change or eliminate from the package.

“Yeah, we’ll have some,” Tuberville said. “And we’ve got them all, we just haven’t turned them in yet.”

Thune said he and other negotiators are making “headway” toward consensus on the more significant provisions in the package, which in many respects is far from its final form.

“The meetings right now are on the major provisions in tax and health. We have sort of pre-litigated a lot of that,” Thune said. “But there are a lot of the other provisions in the bill, chapters in the bill that are still subject to going through the Byrd bath, and we’re in the process of doing that. But hopefully that’ll be done by early next week.”

Republicans are using the reconciliation process to pass their sweeping tax and spending cuts package through the Senate with just a simple majority vote, requiring them to comply with the Byrd rules.

That includes the Byrd bath — going before the Senate parliamentarian to explain how each provision has an impact on federal revenue or spending that is not “merely incidental.” Democrats then usually debate before the parliamentarian the various changes that don’t meet that threshold. The process is named after the late Sen. Robert Byrd, a West Virginia Democrat.

Once the parliamentarian rules what elements comply and which need to be removed, the bill can go to the floor and senators can trudge through vote-a-rama. Eventually, all 100 lawmakers will vote to approve or disapprove of the legislation.

GOP senators passing their version of the package would send it back to the House, which passed its version on a slim 215-214 vote earlier this year — and could make yet more changes in the Senate bill.

Democrats develop strategy

Democrats are hoping to highlight policy divisions among Republicans during the vote-a-rama. And even if they don’t succeed in getting any of their amendments adopted, several votes could serve as fodder for campaign ads during next year’s midterm elections.

Schumer said Wednesday during a press conference it would be “difficult” for Democrats to peel off at least four GOP senators from the rest of the party in order to get an amendment adopted, but said he’s hopeful Republicans will “vote with us on some things they’ve all said they’ve agreed with.”

Democratic senators, he said, have created a task force to reach out to Republicans on major issues in the package, including how it would impact rural hospitals.

“Many of these hospital administrators and employees are Republican,” Schumer, a New York Democrat, said. “In many of the rural hospitals, they are the largest employer in the county, and in most they’re the only supplier of health care. It infuriates the rural counties, and they tend to be Republican.”

‘It’s just a show, it’s a charade’

West Virginia Republican Sen. Shelley Moore Capito said she’s not concerned about having to vote on dozens of amendments. 

“We’re here to vote,” Capito said. “As a creature of the House, we voted all the time on everything, so this doesn’t bother me. And, you know, just let the body work its will. If some changes are made, those will have to be dealt with. But I’m not worried about that.”

Arkansas Republican Sen. John Boozman said he expects the vote-a-rama will be “a very late night” and that he’s not planning to offer any of his own amendments.

As chairman of the Agriculture, Nutrition and Forestry Committee, Boozman expects to spend a considerable amount of time during vote-a-rama arguing against amendments seeking to change those provisions — including controversial cuts in the Supplemental Nutrition Assistance Program, which provides food aid for lower-income families.

Wisconsin Republican Sen. Ron Johnson said he plans to spend much of the vote-a-rama “going back and forth from my hideaway,” the ceremonial office that every senator holds in the Capitol building.

But Johnson cast doubt on actually being able to amend the package during that process, saying changes to the various bills that Senate committees have released need to be agreed to before then.

“You’ve got to get this before it ever goes to the floor. I mean, you’re not going to change things substantially or significantly with amendments. I know people have some idealized version that happens. It doesn’t,” Johnson said. “You’ve got to get these things in the base bill. Amendments; it’s just a show, it’s a charade.”

Vote-a-rama after vote-a-rama

The Senate has held two vote-a-ramas so far this year, and both demonstrated how difficult it is to change a piece of legislation.

The first all-nighter in February went along with Senate debate on its budget resolution and included votes on 25 amendments, with lawmakers adopting just two — one from Alaska Republican Sen. Dan Sullivan and one from Utah Republican Sen. Mike Lee.

The second vote-a-rama took place in April just before the Senate voted to approve the budget resolution that ultimately cleared the way for Congress to use the budget reconciliation process to advance the “big, beautiful bill.” Senators debated 28 amendments, voting to adopt one change from Sullivan.

Oregon Democratic Sen. Ron Wyden, ranking member on the Finance Committee, said he and staff on the panel will continue to parse through details of the panel’s bill, which Republicans just released Monday.

Wyden said he plans to hold several town hall meetings in GOP areas of his state over the weekend to gauge how residents there view the policy revisions Republican senators have put forward.

“We’ve had this bill for basically 36 hours. The first time I had it, I stayed up all night, so last night I got a little sleep,” Wyden said on Wednesday. “But on the plane, I’ll be working through it. And I expect to be working through it all through the next few days, except when I’m having these town hall meetings where I’ll have a number of questions.”

Senate Majority Leader John Thune, R-S.D., center, accompanied by Sen. John Barrasso, R-Wyo., left, and Sen. Shelley Moore Capito, R-W.Va., right, speaks to reporters following a weekly Republican policy luncheon at the U.S. Capitol on Feb. 19, 2025 in Washington, D.C. (Photo by Andrew Harnik/Getty Images)

WASHINGTON — U.S. Senate Republican leaders expressed confidence Tuesday they’ll be able to tamp down opposition to various elements of the party’s “big, beautiful bill” in time to approve the measure before the Fourth of July, though they acknowledged there’s considerable work left to do. 

GOP senators from across the political spectrum have debated the broad strokes of the tax and spending cut legislation for weeks, but raised fresh concerns after the influential Finance Committee released its portion of the package, which addresses taxes and Medicaid. Some GOP senators objected to a change in Medicaid policy they said could harm rural hospitals.

Senate Majority Leader John Thune, R-S.D., said during a press conference that reducing the Medicaid provider tax rate that states can charge from the current 6% to 3.5% by 2031 represented “important reforms.”

“We think they rebalance the program in a way that provides the right incentives to cover the people who are supposed to be covered by Medicaid,” Thune said. “But we continue to hear from our members specifically on components or pieces of the bill that they would like to see modified or changed or have concerns about. And we’re working through that.”

While the complex provision is deep in the weeds of Medicaid policy, several GOP senators expressed concern during interviews Tuesday that changing the provider tax rate in states that expanded Medicaid coverage under the Affordable Care Act would be a problem for rural hospitals.

Missouri Sen. Josh Hawley said he opposes that provision and wants to see GOP leaders put back in the House language that would freeze the Medicaid provider tax rate at 6%.

“We have to do something,” Hawley said. “If we pass this as it is, there’s going to be a lot of rural hospitals in Missouri that close. So that’s a big problem.”

West Virginia Sen. Jim Justice said he had “all kinds of concerns” about provisions in the Finance Committee’s portion of the “big, beautiful bill,” which the panel released Monday.

“The House side on the provider tax and everything said, freeze it,” Justice said. “Now there’s a whole lot (of) different gyrations going on with that and everything. And there’s other things that we just need to — just give us some time. We need to work our way through it.”

Justice said he didn’t plan to be a “rubber stamp” on anything and appeared to discourage GOP leaders from bringing the package to the floor next week ahead of their self-imposed Fourth of July deadline.

“I would love to get it done, like the president wants to get it done, by the Fourth of July. I would love for us to be able to do that and everything,” Justice said. “But I think, way more importantly than anything, we got to get it right.”

Other Medicaid issues

Alaska Sen. Lisa Murkowski declined to weigh in on the changes to the Medicaid provider tax rate since her state doesn’t use it the way many others do.

“I don’t have a dog in that fight, because we don’t have provider taxes in Alaska,” Murkowski said. “We’re the only state that’s actually maybe playing by the rules.”

But Murkowski told reporters she does have issues with other ways the legislation would change Medicaid, the state-federal health program for lower income people, and expects the bill will undergo revisions before a final floor vote.

“I don’t think it’s going to stay in this form, let’s just put it that way,” Murkowski said.

Wisconsin Sen. Ron Johnson said he’d vote against the package if leaders bring it to the floor next week as planned and said he expects that if they rush floor consideration, the entire bill will fail to pass.

“I hope not because my guess is it’ll fail and I don’t want to see it fail. I want this thing to succeed,” Johnson said. “Again, the ball has been in the Senate court for two weeks — two weeks. But now we’re seeing language. Now we’re finally seriously considering some of these ideas, let’s have time to seriously consider it and hopefully get them incorporated in the bill.”

The House voted mostly along party lines to approve its version of the package in late May, but Senate Republicans have been reworking the bill in the weeks since.

Among the changes in the Senate, Republicans plan to raise the country’s debt limit by $5 trillion, a full $1 trillion more than House GOP lawmakers proposed in their version.

Possible recess delay

Arkansas Sen. John Boozman said that if the Senate doesn’t vote to approve the package the week of June 23, they’ll likely stay in town the following week to debate the bill, instead of heading home for the Fourth of July week break.

But he cautioned that “the longer it hangs out, the more difficult it is” to pass.

Iowa Sen. Chuck Grassley declined to answer questions about whether he supports or wants to change his chamber’s newly unveiled Medicaid provisions.

“Ask me that question in a couple days because there’s still discussion going on about it,” he said.

Sen. James Lankford praised aspects of the bill, including, “long-term tax policy that’s actually permanent,” which he said is “important for individuals and for small businesses.”

“We’re doing the full expensing, making that permanent — that doesn’t change a dollar as far as the income coming into the Treasury, but very significant for our economy,” the Oklahoma Republican said.

Lankford said he also likes “the R&D tax credit piece to make sure we’re competing with China on it,” “modernization of the air traffic control system,” as well as “some dollars that are going to border security, which has been very important to me, which they have been asking for for a long time and trying to get into structural things to the border that are needed there.” 

The U.S. House will begin debate in committee this week on a bill that would cut Medicaid spending. (Getty Images)

WASHINGTON — U.S. House Republicans plan to debate and approve the three final pieces of their “big, beautiful bill” in committee this week, including the tax measure, major spending cuts to Medicaid that will change how states run the program and an agriculture bill.

At least $880 billion over the next 10 years would be slashed under the piece of the bill that covers energy and health care, including from Medicaid. Republicans would add new Medicaid work requirements for some able-bodied adults; seek to penalize the dozen states that allow immigrants living in the U.S. without legal status in the program; and require states to more frequently check Medicaid enrollees’ eligibility, among other changes.

An estimate was not yet available for exactly how much that would save in Medicaid spending or how many people enrolled might lose coverage. Earlier projections of various other scenarios by the Congressional Budget Office had placed the numbers of displaced enrollees in the millions, and Democrats predicted the same effect from the newest plan.

House panels have already signed off on eight of the 11 bills that will make up the sweeping reconciliation legislation. And if all goes according to plan, that chamber should approve the entire package before the end of the month.

Debate is expected to begin Tuesday in each of the panels and last hours, possibly into Wednesday. Democrats will offer dozens of amendments seeking to change the bills and highlighting their disagreement with GOP policy goals.

Internal Republican disputes between centrists and far-right lawmakers over numerous tax proposals and funding changes to Medicaid will also likely lead to debate on GOP amendments.

With paper-thin majorities in the House and Senate, nearly every Republican needs to support the overall package for it to move through both chambers and to President Donald Trump.

If Republicans fail to reach agreement during the next couple months, it would put nearly every aspect of their agenda in jeopardy. GOP leaders would also need to negotiate a bipartisan debt limit agreement before the August recess, should the reconciliation package fall apart, since they plan to include debt limit language as well.

GOP divided over Medicaid cuts

Kentucky Republican Rep. Brett Guthrie, chairman of the committee that oversees energy and Medicaid, wrote in a statement last week announcing the markup that his panel’s measure would “end wasteful government spending, unleash American energy and innovation, and strengthen Medicaid for mothers, children, individuals with disabilities, and the elderly.”

But the bill released this weekend might not have support from far-right members in the House and seems to be running into opposition from some GOP senators as well. 

Texas Republican Rep. Chip Roy, of the hard right, wrote on social media that he hoped “House & Senate leadership are coming up with a backup plan…. ….. because I’m not here to rack up an additional $20 trillion in debt over 10 years or to subsidize healthy, able-bodied adults, corrupt blue states, and monopoly hospital ceos…”

Missouri Republican Sen. Josh Hawley, who has voiced concern for months about potential cuts to Medicaid, wrote an op-ed published in The New York Times on Monday highly critical of a “contingent of corporatist Republicans” who support lower federal spending on the program.”

“This wing of the party wants Republicans to build our big, beautiful bill around slashing health insurance for the working poor,” Hawley wrote. “But that argument is both morally wrong and politically suicidal.”

The entire House package will be open to amendment if the legislation makes it to the Senate, where several GOP lawmakers are expected to rework or even eliminate entire sections.

Work requirements

The Energy and Commerce Committee’s bill is the one that would cut federal spending by at least $880 billion during the next decade including on Medicaid, the state-federal health program for lower income people.

The legislation would institute work requirements nationwide for able-bodied adults between the ages of 19 and 65, with several exceptions, including for pregnant people, enrollees with certain disabilities or serious medical conditions, and parents of dependent children.

People not exempted from the requirements would need to work, engage in community service, or enroll in an education program for at least 80 hours a month.

A staffer on the panel told reporters during a background briefing Monday that Republicans tried to learn from challenges certain states had in the past when they implemented work requirements.

After discussions with current and former state Medicaid directors, the staffer said the committee wrote a bill that they are confident “states will be able to implement effectively.”

The work requirements take into account various unexpected circumstances, like if someone were to be hit by a bus and unable to complete the 80-hours-per-month requirement on time because they were hospitalized, the staffer said.

“We did try to be very thoughtful about any kind of circumstance that could happen,” they said.

Immigrant coverage, eligibility checks

The Medicaid legislation also seeks to encourage states who include undocumented immigrants in their program to stop doing so or lose some federal funding.

The federal government currently pays 90% of the cost of covering enrollees who are eligible for Medicaid under the 2010 Affordable Care Act expansion. That would decrease to 80% for the expanded population if states choose to keep covering undocumented immigrants.

The committee staffer said this would impact California, Colorado, Connecticut, the District of Columbia, Illinois, Maine, Massachusetts, New Jersey, New York, Oregon, Utah, Vermont and Washington states if they don’t change their policies regarding undocumented immigrants.

Additionally, states would need to check eligibility for all of their Medicaid enrollees every six months, instead of once a year for the expanded population. This likely would lead to some people being kicked out of the program.

Committee staff members were unable to share exactly how each of the Medicaid provisions would affect the federal budget or how many people could lose access to the program if Congress were to implement the legislation as written.

But the nonpartisan Congressional Budget Office wrote in a letter Monday that it estimates the Energy and Commerce Committee met its target of cutting at least $880 billion in spending “over the 2025-2034 period and would not increase on-budget deficits in any year after 2034.”

Staff on the committee said they don’t expect to have the full CBO score before the markup begins Tuesday and didn’t have an estimate for when that information will be out.

Energy and Commerce Committee Ranking Member Frank Pallone, D-N.J., wrote in a statement the GOP bill would lead to millions of people losing access to Medicaid.

“This is not trimming fat from around the edges, it’s cutting to the bone,” Pallone wrote. “The overwhelming majority of the savings in this bill will come from taking health care away from millions of Americans. No where in the bill are they cutting ‘waste, fraud, and abuse’—they’re cutting people’s health care and using that money to give tax breaks to billionaires.”

Repealing clean-energy funds

The Republican proposal would repeal more than a dozen sections of Democrats’ 2022 reconciliation law related to energy and environment programs.

The law, known as the Inflation Reduction Act, included hundreds of billions in tax credits for renewable energy and energy-efficiency measures. It was considered the largest investment by the United States in tackling climate change.

The House bill would repeal sections including the $27 billion Greenhouse Gas Reduction Fund, which helps finance clean-energy projects, and a $40 billion Department of Energy loan program meant to stimulate production of clean-energy infrastructure.

Sections targeting carbon emissions, air pollution, offshore wind transmission, and other programs would also rescind any unspent funds for those purposes appropriated in the Biden-era law.

The measure would allow pipeline builders to pay fees to bypass environmental review. Natural gas pipelines could pay $10 million to access an expedited approval process and liquified natural gas exports could pay $1 million for the Energy Department to deem them “in the public interest.”

Rep. Kathy Castor, the ranking member on the Energy and Commerce Energy Subcommittee, said the proposal would sabotage efforts to drive down prices for consumers.

“Cleaner, cheaper energy for consumers gets left behind,” the Florida Democrat wrote in a statement. “Dismantling our landmark Inflation Reduction Act will kill jobs, hurt businesses, and drive-up Americans’ energy costs.”

Tax cuts

The Ways and Means Committee released its 28-page starter bill late last week and the full 389-page version Monday afternoon, but Republicans on the panel could add to it during the Tuesday markup.

House GOP tax writers propose making permanent the underlying 2017 tax law provisions while temporarily expanding several of them, including the child tax credit and standard deduction.

The child tax credit would increase to $2,500, up from $2,000, until 2028. The refundable amount of the tax credit per child — meaning how much taxpayers could get back — would now reach up to $1,400. Taxpayers claiming the credit would now have to provide a Social Security number, as well as the SSN of a spouse.

The standard deduction for single and married joint filers would temporarily increase until 2029 up to $2,000, depending on filing status.

Trump’s campaign promises, including no tax on tips, also made it into the proposal, though only until 2028. Those claiming the tax break on tips will also need to provide a Social Security number as well as the SSN of their spouse, if married.

Trump’s promise to eliminate taxes on car loan interest, also set to expire in 2028, would not apply to any vehicle that was not finally assembled in the U.S.

Tax writers increased but ultimately left a cap on the amount of state and local taxes, commonly referred to as SALT, that households can deduct, an incredibly contentious issue for lawmakers with constituents in high tax areas like New York and California. GOP lawmakers increased the SALT cap to $30,000, up from $10,000.

That level, however, might not have the support needed among Republicans’ extremely thin majorities and will likely lead to heated debate during markup, or on the floor.

Republicans from higher-tax states have repeatedly said they will not vote for the entire package unless they feel their constituents will benefit from raising the SALT cap.

The dispute has spilled over several times already, including in a statement last week from four New York Republicans, who wrote, “The Speaker and the House Ways and Means Committee unilaterally proposed a flat $30,000 SALT cap — an amount they already knew would fall short of earning our support.”

“It’s not just insulting—it risks derailing President Trump’s One Big Beautiful Bill,” they wrote. “New Yorkers already send far more to Washington than we get back—unlike many so-called ‘low-tax’ states that depend heavily on federal largesse.

“A higher SALT cap isn’t a luxury. It’s a matter of fairness.”

New York Republican Rep. Nick LaLota wrote on social media Monday afternoon: “Still a hell no.”

How much the tax proposal will cost has not yet been released, but government deficit watchdogs estimated a wholesale extension of the 2017 Tax Cuts and Jobs Act, without the enhancements, would cost north of $4 trillion over the next decade.

Erica York, vice president of federal tax policy at the Tax Foundation, said the proposal provides some certainty to individual taxpayers but it also adds complexity in many areas.

“You can clearly see the thinking here was probably just a straight-up extension (of the 2017 law), people wouldn’t feel like they got a tax cut because it’s just continuing. So they had to do something to make it feel like there’s a larger tax cut,” York said.

Ag cuts remain a mystery

The House Agriculture Committee, led by Pennsylvania Republican Glenn ‘GT’ Thompson, hadn’t released its bill as of Monday afternoon but was scheduled to begin the markup on Tuesday evening.

That panel is supposed to cut at least $230 billion in federal spending during the next decade, some of which will likely come from reworking elements of the Supplemental Nutrition Assistance Program, or SNAP.

Committee leaders are also planning to include elements of the much overdue farm bill, though those provisions could run into issues in the Senate if they don’t have a significant impact on federal revenue or spending.

Republicans are using the complex reconciliation process to move the package through Congress with simple majority votes in each chamber, avoiding the Senate’s 60-vote legislative filibuster, which would otherwise require bipartisanship. 

Reconciliation measures must address federal revenue, spending, or the debt limit in a way not deemed “merely incidental” by the Senate parliamentarian. That means the GOP proposals must carry some sort of price tag and cannot focus simply on changing federal policy.

Jacob Fischler and Ashley Murray contributed to this report.