U.S. Senate Majority Leader Sen. John Thune, R-S.D., left, listens as Sen. Mike Crapo, R-Idaho, center, speaks to reporters outside of the West Wing of the White House on June4, 2025 in Washington, D.C.  (Photo by Anna Moneymaker/Getty Images)

WASHINGTON — U.S. Senate Republican Leader John Thune will spend a crucial next few weeks working behind the scenes with other top GOP senators to reshape the party’s “big beautiful bill” — a balancing test accompanied in recent days by incendiary exchanges between President Donald Trump and billionaire Elon Musk over whether the current proposals are so bad that Congress should just go back to the drawing board.

South Dakota’s Thune will need to gain support from deficit hawks, who want to see the mega-bill cut at least $2 trillion in spending, and moderates, who are closely monitoring how less federal funding for safety net programs like Medicaid and food assistance could harm their constituents and home-state institutions like rural hospitals.

Interviews by States Newsroom with Republican senators in early June showed many major elements of the package could change, including provisions that would put states on the hook for unanticipated costs. Arkansas Sen. John Boozman, for example, indicated the Senate may rewrite a proposal in the House-passed bill that would shift some of the cost of the Supplemental Nutrition Assistance Program, which provides food aid to low-income people, to state governments.

“We can do whatever we want to do,” the Agriculture, Nutrition and Forestry Committee chairman said when asked by States Newsroom about amending that policy.

The final deal — intended to extend the 2017 tax cuts — cannot lose more than three GOP senators and still make it back across the Capitol to the House for final approval, since all Democrats are expected to oppose the bill. Thune only needs a majority vote in the Senate for the special process being used by Republicans.

Internal debates about just how to rework the Trump-backed tax and spending cuts measure began in the first week of June during meetings on Capitol Hill and at the White House, as GOP senators began critiquing the House-passed package line-by-line to ensure it complies with their strict rules for the complex reconciliation process and their policy goals.

Republicans said during interviews that several provisions in the House version likely won’t comply with the chamber’s Byrd rule, which could force lawmakers to toss out some provisions.

Complicating all of it was the very public back-and-forth between not just Trump but GOP leaders and former White House adviser Musk over the bill, which Musk on social media labeled “a disgusting abomination” and a “big, ugly spending bill” for its effect on the deficit and debt limit. “KILL the BILL,” Musk said on X, the platform he owns. Senate leaders so far have dismissed Musk’s criticisms.

Fragile House coalition

The talks, and whatever the legislation looks like after a marathon amendment voting session expected in late June, have already raised deep concerns among House GOP lawmakers, who will have to vote on the bill again in order to send it to Trump.

The extremely narrow majorities mean House Republican leaders cannot lose more than four of their own members if all the lawmakers in that chamber vote on the party-line bill.

Any changes the Senate makes could unbalance the fragile coalition of votes Speaker Mike Johnson, R-La., cobbled together last month for a 215-214 vote. But GOP senators are adamant they will amend the legislation.

Complicating matters is a new report from the nonpartisan Congressional Budget Office that shows the proposed changes to tax law, Medicaid, the Supplemental Nutrition Assistance Program and higher education aid wouldn’t actually help to reduce deficits during the next decade but raise them by more than $2.4 trillion.

The numbers are the exact opposite for what Republicans hoped their sweeping tax and spending cuts package would accomplish.

Scrutiny begins

The first stop for the House-passed reconciliation package in the Senate appears to be the parliamentarian’s office, where staff have begun evaluating whether each provision in the current version of the bill complies with the upper chamber’s strict rules.

Boozman said staff on his panel have already begun meeting with the parliamentarian to go over the House provisions within its jurisdiction.

He expects that section of the package will have to change to comply with the strict rules that govern the reconciliation process in the Senate and to better fit that chamber’s policy goals.

“We can’t really decide exactly what we want to use in the House version until we know what’s eligible,” Boozman said. “We’ve got some other ideas too that we asked them about. But we need to know, of the ideas that we have, what would be viable options as far as being Byrd eligible.”

The Byrd rule, which is actually a law, requires reconciliation bills to address federal revenue, spending, or the debt limit. This generally bars lawmakers from using the special budget process to change policies that don’t have a significant impact on those three areas.

Alabama Sen. Tommy Tuberville, who is campaigning to become his home state’s next governor, said pushing some of the cost of the nutrition program to states may be problematic.

“We’re trying to send more costs to the states. Most states can’t afford that, so we want to take care of people, but we need people to go back to work,” Tuberville said. “It’s not a forever entitlement. It’s for part-time, you know, take care of yourself until you get a job, go back to work and let people that need it really, really get it.”

Rural hospitals on edge

Senate GOP leaders will have to navigate how best to reduce federal spending on Medicaid, the state-federal health program for lower-income people and some with disabilities, that is relied on by tens of millions of Americans, many of whom are loyal Republican voters.

The nonpartisan Congressional Budget Office projects that 7.8 million people would lose access to Medicaid during the next decade if the House’s policy changes are implemented as written.

There are also concerns among GOP lawmakers about how losing the revenue that comes with treating Medicaid patients would impact rural health care access and hospitals.

Missouri Sen. Josh Hawley said under no circumstances would he vote for a bill that cuts benefits to Medicaid recipients and is worried about how provisions in the House package would affect rural hospitals.

“They’re very concerned about it, rightly so,” Hawley said, referring to conversations he’s had with health care systems in his home state.

“This is something that we need to work on. I don’t know why we would penalize rural hospitals,” he added. “If you want to reduce health care spending, then cap the price of prescription drugs. I mean, that’s the way to do it. If you want to get major savings in the health care sector, don’t close rural hospitals, don’t take away benefits from working people. Cap the costs, cap the price that (the Centers for Medicare & Medicaid Services) is going to pay for prescription drugs.”

West Virginia Sen. Shelley Moore Capito said she’s not yet come to a decision about whether to keep, amend, or completely scrap some of the House changes to Medicaid.

“I talked to a lot of our hospitals when I was home to see what the impacts would be, because we have a very high Medicaid population,” Capito said. “I want to see it work and be preserved, but I want it to be there for future generations. And it’s just getting way out of control on the spend side. So right now, we’re looking at everything.”

Louisiana Sen. Bill Cassidy — chairman of the Health, Education, Labor and Pensions Committee — said he doesn’t expect all of the health care provisions in the House bill make it through the “Byrd bath” with the parliamentarian. But he declined to go into detail.

“Some of it is more regulatory, that’s all I can say,” Cassidy said.

West Virginia’s Sen. Jim Justice said he is in favor of requiring some Medicaid enrollees to work, participate in community service, or attend an educational program at least 80 hours a month to stay on the program, a sentiment shared by many of his GOP colleagues.

“I’m good with every bit of that,” he said. 

But Justice expects the Senate will make its own changes to the package and that it will be “proud of their own pond.”

“Any frog that’s not proud of your own pond’s not much of a frog,” Justice said.

He did not go into detail on what those changes would entail.

SALT shakers

The state and local tax deduction, or SALT, represents another tightrope  for Thune, who is no fan of the changes made in the House. But he has said repeatedly this week he understands altering that language too much could mean a Senate-amended version of the bill never makes it back through the House to actually become law.

Thune said outside the White House following a June 4 meeting with Trump and others that there will very likely be changes to SALT.

“There isn’t a single Republican senator who cares much about the SALT issue,” Thune said. “It’s just not an issue that plays.” States that are most affected generally don’t elect Republicans to the Senate.

The House tax-writing panel originally proposed raising the SALT cap from $10,000 to $30,000, but Johnson had to raise that to $40,000 in order to secure votes from House Republicans who represent higher tax states like California, New Jersey and New York. The revised cap would benefit more high-income taxpayers in their states.

“In 2017, that was one of the best reforms we had in the bill,” Thune said. “But we understand it’s about 51 and 218. So we will work with our House counterparts and with the White House to try to get that issue in a place where we can deliver the votes and get the bill across the finish line.”

Republicans hold 53 seats in the Senate, but can rely on Vice President J.D. Vance to break a tied vote if necessary.

At least 218 House lawmakers must vote to pass bills when all 435 seats are filled. But with three vacancies at the moment, legislation can move through that chamber with 216 votes. The GOP has 220 seats at the moment, meaning Johnson can afford four defections on party-line bills.

North Dakota Sen. John Hoeven told reporters this week that he’d like to see GOP senators rework the SALT section of the bill, even if that causes challenges for Speaker Johnson’s ability to pass a final version.

“Let’s talk about SALT, for example. The House has a very large SALT number. The Senate is probably going to take a look at that,” Hoeven said. “There’ll be a lot of areas we can look at. There’ll be other things we’re going to look at. We’d like to get to $2 trillion in savings.”

Ohio Sen. Bernie Moreno joined in putting his House colleagues on notice that they likely won’t get the agreement they struck with the speaker in the final version of the bill.

“I think we’re going to make common-sense changes. For example, the SALT cap, by the way, something that definitely helps very wealthy people in blue states,” Moreno said. “I think that cap, the 400% increase, is too much, so we’re going to work on tweaking that.”

Hawley, of Missouri, speaking more generally about the tax provisions, said he would like the Senate to make sure middle-class Americans benefit from the tax changes, just as much as companies.

“I want to be clear, I’m in favor of additional tax relief for working people. So my view is this corporate tax rate, which they lowered in 2017, they made that permanent back then. I know some workers that would like permanent tax relief,” Hawley said. “So I think it’s imperative that we do some addition to tax relief for workers. So I think that’s important.”

A new $4 trillion debt limit

Deficit hawks in the Senate have also voiced objections to raising the nation’s debt limit by $4 trillion, arguing that GOP leaders haven’t done enough to assuage their concerns about the nation’s fiscal trajectory.

Kentucky Sen. Rand Paul argued that the debt limit increase is more about next year’s midterm elections than good governance.

“​​This is really about avoiding having to talk about the debt during election times because people like to go home and talk to the Rotary or the Lions Club and tell them how they’re fiscally conservative and they’re against debt,” Paul said. “It’s embarrassing to them to have to vote to keep raising the debt. But they’re unwilling to have the courage to actually look at all spending.”

Paul suggested that House Republicans created problems by inflating some of the spending levels in their package, including to continue construction of a wall along the U.S.-Mexico border. Paul is chairman of the Homeland Security and Governmental Affairs Committee.

“The $46.5 billion for the wall is eight times higher than the current cost of the wall. If you’re going to do 1,000 miles, you can actually do it for $6.5 billion. They want $46.5 billion,” Paul said. “We can’t be fiscally conservative until it comes to the border, and then we’re no longer fiscally conservative.”

The border wall has been a constant focus for Trump, who made it a central part of his 2016 presidential campaign, when he said repeatedly that the United States would build it and Mexico would pay for it.

South Carolina’s Lindsey Graham, chairman of the Budget Committee, hinted during a brief interview that Congress can only cut so much spending without going near programs like Social Security, which accounted for $1.5 trillion in expenditures last year, or Medicare, which spent $865 billion. Both are normally considered untouchable.

“I think we’re going to make some changes to try to find more spending reductions. I think that’s a fair criticism of the bill, but you can’t do Social Security by law,” Graham said, referring to one of the many rules that govern the reconciliation process. “Nobody’s proposed anything in the Medicare area.”

Graham added that “trying to make the bill more fiscally responsible is a good thing, but we need to pass it.” 

People wait outside of the Lyndon B. Johnson Hospital in Houston. For years, states have taxed hospitals and other health care providers to draw down federal matching funds and help finance their Medicaid programs. Now, states may lose their ability to raise or implement new taxes. (Photo by Brandon Bell/Getty Images)

The tax and spending bill the U.S. House approved targets a strategy states have used to boost the Medicaid dollars they get from the federal government. The measure would cap or freeze the taxes states levy on medical providers, potentially leaving states with major holes in their Medicaid budgets.

As a result, states would face the choice of either replacing the lost federal money with state dollars, scaling back services or providing coverage to fewer people.

Medicaid is a joint state-federal program, primarily for people with low incomes. For the traditional Medicaid population — children and their caregivers, people with disabilities and pregnant women — the federal government matches state Medicaid spending on a sliding scale, ranging from 50% for the wealthiest states to 77% for the poorest ones.

Consider a state that gets half of its Medicaid funding from the federal government. If that state collects $100 million by taxing providers, it can use $50 million of the revenue to draw down $50 million in federal matching funds, which it can use to expand Medicaid coverage to more people. Then it can take the remaining $50 million in revenue and use that money to draw down $50 million in federal dollars to pay providers more for caring for Medicaid patients.

Forty-nine states — all but Alaska — use the strategy. In 2018, the most recent year for which data is available, states relied on provider taxes to fund 17% of their Medicaid spending, up from 7% in 2008, according to the U.S. Government Accountability Office.

As part of their effort to cut federal Medicaid spending by roughly $625 billion over the next decade, House Republicans have proposed capping the state provider taxes and freezing them in place, preventing states from raising them or implementing new ones in response to inflation. Under current law, states can levy taxes of up to 6% on tax providers’ net revenue. The GOP measure also would add work requirements for Medicaid recipients, a step that would save money by reducing the rolls.

A report from the Congressional Budget Office, the bipartisan research arm of Congress, says eliminating the taxes entirely could save the federal government hundreds of billions of dollars over the next decade.

Many conservatives say the taxes are an accounting trick that allows states to draw down money from the federal government without having to front their true share of the Medicaid program. Some have even called the provider taxes a “money laundering” scheme.

“States are gaming the system — creating complex tax schemes that shift their responsibility to invest in Medicaid and rob federal taxpayers,” Dr. Mehmet Oz, the administrator of the federal Centers for Medicare & Medicaid Services, said in a May 12 news release.

Brian Blase, president of the Paragon Health Institute, a conservative policy group that is working with Republicans to formulate Medicaid cuts, described provider taxes as “a way that states and providers can rip off the federal government.”

“States need to have some accountability for the spending in their programs,” Blase said.

But advocates of these taxes, including state Medicaid directors and even the hospitals that pay the taxes, describe them as legal and legitimate financial tools that have helped providers cover essential services and states fund their Medicaid programs for years. The result of eliminating these taxes or freezing them, they say, will be hospital closures and service cuts.

“We don’t like to pay these taxes, but the alternative is resources or access to care aren’t there for that community,” said Jason Pray, vice president of legislative affairs at America’s Essential Hospitals, an association representing about 350 hospitals. “The state would more than likely have to then tax individuals to make up for that, to keep the services at the same level and keep the resources at the same level.”

Blase said the provider taxes allow hospitals to make windfall profits from the additional federal matching funds that flow back to them, representing a type of “corporate welfare.”

But Pray said often hospitals in his association are losing money. By allowing states to boost payments to hospitals and other providers that serve Medicaid patients, he said, the tax enables hospitals to stay open in the long run, not garner a windfall.

Pray also noted that in the past, support for the taxes has been bipartisan.

“Republicans for years have shown they support provider taxes and have understood the value of them,” he said.

Edwin Park, a research professor at the Georgetown University McCourt School of Public Policy, pointed out that some hospitals pay the tax and don’t get much back, because they serve few Medicaid patients. The hospitals that benefit most are the so-called safety net hospitals that do care for many low-income patients, he said.

Park said he is worried that once the strategy is off the table, states will have to cut their Medicaid spending to balance their budgets.

Jay Ludlam, deputy secretary for North Carolina Medicaid, is worried about that, too. In North Carolina, Ludlam said, almost all of the tax revenue the state collects from providers helps pay for Medicaid services.

“The money goes to providers when they provide services. It’s not special. It’s just another way that states tax themselves and put money into the program,” Ludlam told Stateline. “If it means that there’s going to be less money in Medicaid … we’ll have to cut eligibility, cut benefits, cut provider rates, in order to maintain the program.”

Stateline reporter Shalina Chatlani can be reached at schatlani@stateline.org.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org.

Proposed changes to higher education policy in congressional Republicans’ tax and spending bill could weaken protections for student borrowers, advocacy groups say.  (Photo illustration via Getty Images)

WASHINGTON — The massive tax and spending package U.S. House Republicans narrowly advanced last week could hinder accountability for for-profit colleges and weaken student-borrower protections, student advocates say.

The bill, now headed to the Senate, calls for sweeping changes to education policy under what GOP lawmakers deem “regulatory relief.” 

That includes eliminating a rule governing for-profit schools, removing “gainful employment” as a goal for colleges receiving federal funds and hindering consumer protections for borrowers defrauded or facing school closures.

GOP lawmakers are aiming to slash billions of dollars in federal spending to offset the cost of President Donald Trump’s tax cuts, border security and defense spending through the complex budget reconciliation process, which allows Congress to skirt the Senate’s 60-vote threshold that generally requires bipartisanship. The package, which the House passed 215-214 last week, will likely undergo significant changes in the Senate.

The House Committee on Education and Workforce’s portion of the reconciliation package also includes significant changes to how student loans are repaid, cuts to federal student aid and new eligibility requirements for the Pell Grant, a government subsidy that helps low-income students pay for college.

Student advocates and congressional Democrats have opposed the bill, emphasizing the impact of the proposed changes on higher education affordability and access as well as the weakening of protections for defrauded borrowers and fewer guardrails to hold for-profit schools accountable. 

Kyle Southern, associate vice president for higher education quality at the Institute for College Access & Success, said the bill would “put higher education further out of reach for low-income students, students of color (and) many first-generation students.”

“It would also make it a riskier investment, because it … weakens or rolls back many critical student protections that have been put in place as guardrails to help ensure the quality of post-secondary programs across sectors,” he said.

The nonprofit advocacy group aims to advance affordability, accountability and equity in higher education.

Here’s a closer look at the bill’s key education provisions related to institutional accountability and borrower protections:

Repealing the 90/10 rule

The bill repeals the Education Department’s “90/10 rule,” which requires that at least 10% of the money for-profit institutions receive derives from non-federal sources.

The regulation initially did not apply to student veteran benefits, creating a loophole that pushed for-profit schools to target veterans in their programs.

Though Congress did eventually close the loophole in a provision of the massive COVID-19 relief package Congress passed in 2021, the current bill would slash the rule altogether.

Carrie Wofford, president of Veterans Education Success, said the 90/10 rule “stops federal funds from being used to prop up otherwise failing college companies.”

Wofford said “it’s very shocking and upsetting to all the veterans and military leaders who worked for a decade to get this done and had a bipartisan agreement and had Republican leadership completely signing off,” referencing the efforts to close the earlier loophole.

Veterans Education Success, a group which advocates for the rights of student veterans, service members and their families, wrote to the Senate Committee on Health, Education, Labor and Pensions last week urging the panel to not include the repeal of the 90/10 rule in the chamber’s version of the bill.

Gainful employment

The bill would also strike the phrase “gainful employment” from several definitions within the Higher Education Act, a law providing financial assistance for students and higher education institutions.

As the Institute for College Access & Success notes in a fact sheet, the Gainful Employment rule, an Education Department regulation, helps “ensure that career education programs receiving federal student aid prepare students for gainful employment in a recognized occupation” and aims to “protect students from low-value programs that leave graduates with unaffordable debt and poor job prospects.”

Striking the term from the definitions likely sets the stage for the Education Department to rescind the rule, according to Sarah Austin, a policy analyst at the National Association of Student Financial Aid Administrators.

“Presumably, what we kind of took (striking the phrase) to mean is that that would lead to them rescinding gainful employment rules because the definitions in statute were what they’ve always kind of used as showing their legal authority to regulate on gainful employment,” Austin said.

“Without those definitions in there, not only does that seem to say that they would not have these gainful employment regulations, but also would kind of stop future administrations from having any sort of gainful employment framework because the definitions are not even in the Higher Education Act anymore.”

Borrower protections

As for borrower protections, the bill would also repeal 2022 versions of the Closed School Discharge and Borrower Defense to Repayment rules, reverting to what they looked like before the Biden administration.

While the Closed School Discharge rule provides debt relief to a borrower whose school shuts down, the Borrower Defense to Repayment provision helps forgive debt for students whose institution defrauded them.

Austin said that “with the 2022 rules, there was automatic closed school discharge, so if a school closed, a borrower may be entitled to have their loans automatically discharged, not require any action on their behalf, where the prior set of rules, they would actually have to apply for the closed school discharge, so this would be reverting back to that if it was to move forward as law.”

Under the bill, the Borrower Defense to Repayment provision would fall back to a 2019 rule that then-Education Secretary Betsy DeVos put into place.

Southern, of the Institute for College Access & Success, said that 2019 rule “made the process essentially so onerous and arbitrary that qualifying people would not be able to receive the relief that federal law entitles them to.”

Boxes of sugary cereal, including those from General Mills, fill a store's shelves on April 16, 2025, in Miami, Florida. (Photo by Joe Raedle/Getty Images)

The U.S. House Agriculture Committee’s portion of Republicans’ massive taxes and spending bill would partially shift to states the costs of the country’s largest food assistance program, which some experts and Democrats predicted will lead to major cuts in the program — and possibly even an end to it in some states.

The measure will be taken up by the panel Tuesday night and is expected to be voted on late Tuesday or early Wednesday, after which it will be folded into a larger reconciliation package with 10 other bills passed out of committees and sent to the floor. The entire House is set to vote on the legislation before Memorial Day.

The federal government currently pays for all Supplemental Nutrition Assistance Program, or SNAP, benefits. A provision in the Agriculture Committee’s piece of Republicans’ “big, beautiful bill” to enact President Donald Trump’s agenda would transfer between 5% and 25% of that cost to states, depending on each state’s payment error rate, starting in 2028.

The program provided about $100 billion in food assistance to nearly 42 million Americans last year, according to data from the U.S. Department of Agriculture. Eligibility currently depends on tests related to income, assets, work requirements and more.

But the change in cost structure could lead states to opt out entirely, said Ty Jones Cox, vice president for food assistance at the left-leaning economic think tank Center for Budget and Policy Priorities, leading some needy families unable to pay for groceries.

“The language is unclear, but it could end SNAP entirely in some parts of the country if states decide the new state funding requirements are impossible for them to meet,” Cox said in a statement late Monday after the bill’s release. “The bill’s massive cuts disguised as ‘cost shifts’ pass the buck to states – but ultimately would leave families holding an empty grocery bag when states aren’t willing or able to backfill for lost federal funds.” 

Republicans plan to use the reconciliation package to permanently extend the 2017 tax law, increase spending on border security and defense by hundreds of billions of dollars, overhaul American energy production, restructure higher education aid and cut spending.

“Our budget reconciliation text restores SNAP to its original intent—promoting work, not welfare—while saving taxpayer dollars and investing in American agriculture,” House Committee on Agriculture Republicans said on X on Monday night.

Funding tied to error rate

Under the bill, states’ responsibility would rise with the broadly defined error rate of payments, which includes fraud as well as paperwork mistakes by a beneficiary or caseworker.

States with an error rate of 6% or less would be responsible for paying 5% of benefits, and those with an error rate higher than 10% would shoulder one-quarter of the cost of benefits.

Two other intermediate categories would exist for states with error rates between 6% and 10%.

Based on current data, more than half of states would fall into the highest category of error rates. The national average is 11.7% and more than two dozen states and territories have rates higher than 10%.

The states are: Alaska, Arizona, California, Delaware, Florida, Georgia, Hawaii, Indiana, Kansas, Maine, Maryland, Michigan, Mississippi, Missouri, New Hampshire, New Jersey, New Mexico, New York, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee and West Virginia. The District of Columbia also has an error rate over 10%, as do Guam and the Virgin Islands.

Alaska’s nation-leading 60% error rate would be nearly impossible to bring under 10% by the time the provision goes into effect, Jones Cox said in a Tuesday interview.

Only seven states — Idaho, Iowa, South Dakota, Utah, Vermont, Wisconsin and Wyoming — would qualify for the lowest state cost-share.

$290 billion in cuts overall

The measure would incentivize states to control the $13 billion per year in erroneous payments, a House Agriculture Committee summary of the legislation said. The bill as a whole would cut $290 billion in federal spending over a 10-year budget window, according to the summary.

While congressional Republicans can claim they are not cutting benefits with the bill, the program would shrink with a lower federal cost-share, Jones Cox said.

“They can say it’s not a cut, because they’re going to say it’s just shifting those costs to the states,” she said. “But it is a cut because states, if they cannot fill the gap… that brings down the program, period.”

The changes would force state budget officers to choose from among a host of unattractive options: cutting SNAP, offsetting costs with corresponding cuts to other programs or raising revenues through taxes or other measures.

States “have a few options,” Jones Cox said. “None look good.”

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.

Democrats slam bill

On a press call Tuesday, Democratic officials and an anti-hunger nonprofit blasted the proposal.

Sen. Peter Welch, a Vermont Democrat, expressed skepticism that U.S. DOGE Service head Elon Musk could find a more efficient use of the $2 per meal SNAP provides during the call with other Democratic senators, Oregon Gov. Tina Kotek and the nonprofit, Hunger Free Vermont.

“This is not a waste, fraud and abuse deal,” Welch said. “This is really about taking away basic nutritional security that is so absolutely essential to the well-being of our families and our kids in Vermont and in every single state across the nation.”

Kotek, who started her political career as a policy advocate for the Oregon Food Bank, said she saw firsthand the effect of food insecurity. More than 700,000 Oregonians receive benefits from SNAP, and every dollar spent on SNAP generates another $1.50 to $1.80 in economic activity at grocery stores, farmers’ markets and other local businesses, Kotek said.

“When you cut SNAP, you’re not cutting bureaucracy,” she said. “You’re cutting a child’s dinner. You’re cutting their breakfast. You’re cutting their family’s dignity.”

One in four New Mexicans rely on SNAP, said Sen. Ben Ray Luján, D-N.M. The farmers and ranchers he represents also plan their farming season based on what grocery stores and food banks will need, and farmers already planted seeds with the idea that those vegetables will be used for school lunches and other food programs.

“The way to look at this is it’s not fiscally responsible,” Luján said. “It’s taking away from the hungry across America to make billionaires and millionaires even wealthier, and it’s going to even explode the deficit.”

Capitol Police remove a protester in a wheelchair from the House Energy And Commerce Committee hearing room during the committee markup of part of the budget reconciliation package on May 13, 2025 in Washington, D.C. (Photo by Jemal Countess/Getty Images for Protect Our Care)

WASHINGTON — The U.S. House committee tasked with overhauling energy policy and Medicaid to achieve $880 billion in spending cuts on Tuesday began what was expected to be a long, grueling session with debate on dozens of amendments.

Republicans on the panel argued during opening statements the proposed changes are necessary to realign several programs with President Donald Trump’s campaign promises and some long-standing GOP policy goals, primarily an extension of the 2017 tax cuts.

Democrats contend the legislation, one of 11 measures that will make up the GOP’s “big, beautiful bill,” would kick millions of people out of Medicaid, the state-federal program for lower income Americans, some people with disabilities and a considerable number of nursing home patients.

Energy and Commerce Committee Chairman Brett Guthrie, R-Ky., said the GOP bill is aimed at reducing waste, fraud and abuse within Medicaid “by beginning to rein in the loopholes, by ensuring states have the flexibility to remove ineligible recipients from their rolls and removing beneficiaries who enrolled in multiple states.”

“We make no apologies for prioritizing Americans in need over illegal immigrants and those who are capable but choose not to work,” Guthrie said. “Our priority remains the same: strengthen and sustain Medicaid for those whom the program was intended to serve — expectant mothers, children, people with disabilities and the elderly.”

Democratic New Jersey Rep. Frank Pallone, ranking member on the panel, rejected comments that the GOP bill was “moderate” and said it clearly was not aimed at addressing waste, fraud and abuse.

“Medicaid is a life-saving program that 80 million Americans count on every day,” Pallone said. “It provides health care to 1 in 3 Americans and nearly half of all children in the United States. It covers close to half of all births. And it’s the largest source of funding for long-term care for seniors and people living with disabilities. With this bill, Republicans are essentially telling millions of Americans, ‘Gotcha, no more health care for you.’”

Pallone added that Republican lawmakers were “intentionally taking health care away from millions of Americans, so they can give giant tax breaks to the ultra-rich, who frankly don’t need them.”

Just before Pallone spoke, several protesters in the room, including at least three people in wheelchairs, began chanting “No cuts to Medicaid” and were led out by U.S. Capitol Police, who charged 25 people with illegally demonstrating in the Rayburn House Office Building.

Photos of constituents

Democrats gave numerous opening statements at the start of the markup, each holding up a large photograph of one of their constituents on Medicaid and sharing stories of how the program helped them get or keep access to health care after complex diagnoses, like congestive heart failure, leukemia and cerebral palsy.

Democratic lawmakers expressed concern those people would lose access to the health care program if the GOP bill becomes law.

“You don’t just gut the largest insurer of low income Americans without real harm,” said Illinois Democratic Rep. Robin Kelly. “Call it what it is — abandonment, disinvestment and pure disregard for human life.”

Florida Republican Rep. Kat Cammack rebuked some of the Democrats’ comments, which she said sought to fearmonger and lie to people about what was in the GOP bill.

“The posters that our colleagues on the left have held up are touching. The stories, they’re very emotional. And I agree that we want to protect those most vulnerable,” Cammack said. “As a pregnant woman, I want to make sure that pregnant women, expectant mothers have access to resources around the country.”

Cammack added that “not a single person in those posters is going to be impacted by this legislation.”

Floor action as soon as next week

Republicans have already approved eight of the reconciliation bills in committee and are scheduled to wrap up work on the remaining three measures this week. The Ways and Means Committee began debating the tax bill shortly after Energy and Commerce began its markup, and the Agriculture panel was scheduled to begin its debate Tuesday evening.

Later this week, the House Budget Committee plans to bundle all 11 bills together and send the full package to the floor. The entire House is set to vote on the legislation before Memorial Day.

GOP leaders cannot afford much disagreement over the entire package, given their paper-thin majority in the House. If all of the current members are present at the vote, just three Republicans can oppose the package and still have it pass.

The same margin exists in the Senate, which is expected to make substantial changes to the package should the House approve the measure and send it across the Capitol.

$880 billion cut

The Energy and Commerce Committee’s bill up for debate Tuesday met the panel’s goal of cutting at least $880 billion in federal spending during the next decade, according to a letter from the nonpartisan Congressional Budget Office.

Congress’ official scorekeepers, however, hadn’t released their full analysis of the panel’s bill before the start of the debate and amendment process, known in Congress as a markup.

Once those details are made public, lawmakers and the voters who elected them will have a much more detailed look at how each of the proposed changes will affect federal revenue, spending and the number of people who could lose access to Medicaid.

Democrats released a CBO analysis last week showing the impact of various proposals, though Energy and Commerce GOP staff cautioned Monday during a background briefing that what they proposed in the actual bill didn’t completely align with those scenarios.

The bill would make considerable changes to Medicaid if the House and Senate approve the legislation as written, which seems highly unlikely, given objections from several GOP senators, including Missouri’s Josh Hawley.

The House legislation would require able-bodied people between the ages of 19 and 65 to work, participate in community service, or attend an education program for at least 80 hours a month. There would be exceptions for pregnant people, Medicaid enrollees with dependent children and people with complex medical issues, among other exclusions.

That provision would take effect on Jan. 1, 2029, according to an explainer on the bill from nonpartisan health research organization KFF.

States would be required to check eligibility for all Medicaid patients every six months, lowering the threshold from one year for people eligible for the program under the expansion in the 2010 Affordable Care Act. That would need to begin by Oct. 1, 2027.

Republicans are seeking to get the 12 states that allow immigrants without legal status into their Medicaid programs to change course by lowering the percent the federal government pays for those states’ expansion population enrollees from 90% to 80%. That would take effect Oct. 1, 2027.

The legislation seeks to block Medicaid funding for a narrow subset of health care providers who offer abortion services, which appeared to target Planned Parenthood.

The prohibition would apply to “providers that are nonprofit organizations, that are essential community providers that are primarily engaged in family planning services or reproductive services, provide for abortions other than for Hyde Amendment exceptions, and which received $1,000,000 or more (to either the provider or the provider’s affiliates) in payments from Medicaid payments in 2024,” according to a summary of the GOP bill. It would take effect as soon as the bill becomes law and last for a decade.

The Hyde Amendment allows federal funding for abortions that are the result of rape, or incest, or that endanger the life of the pregnant patient.

Planned Parenthood, SBA Pro-Life react

Planned Parenthood Action Fund President and CEO Alexis McGill wrote in a statement that defunding the organization and overhauling Medicaid would mean that “cancers will go undetected; it will be harder than ever to get birth control; the nation’s (sexually transmitted infection) crisis will worsen; Planned Parenthood health centers will close, making it significantly harder to get abortion care; and people across the country will suffer — all so the supremely wealthy can become even richer.”

SBA Pro-Life America President Marjorie Dannenfelser applauded the potential change to federal funding.

“It’s time to stop forcing taxpayers to fund the Big Abortion industry. Thanks to Speaker (Mike) Johnson and Energy and Commerce Committee Chairman Brett Guthrie, this year’s budget reconciliation bill contains the commonsense language to make that happen,” Dannenfelser wrote. “Taxpayers should never be mandated to prop up an industry that profits from ending lives and harming women and girls.”

More than 80 organizations, including the National Women’s Law Center and the Center for Reproductive Rights, wrote in a letter to congressional leaders that cutting off Medicaid funding for Planned Parenthood “would be catastrophic, shutting down health centers and stripping millions of patients across the country of access to essential and affordable health care.”

“In many communities, Planned Parenthood health centers are the only affordable provider with expertise in sexual and reproductive health,” the organizations wrote. “For those communities, the gap left by Planned Parenthood health centers would mean that many patients would have nowhere to turn for care.”

President of the American College of Obstetricians and Gynecologists Stella Dantas wrote in a statement the GOP’s changes to Medicaid might create challenges for pregnant patients seeking to access care and that some states may roll back their expansion of postpartum coverage from a full year.

“Pregnant patients who keep their coverage under Medicaid will still face challenges accessing care as labor and delivery unit closures escalate as a result of Medicaid cuts, leaving patients to travel longer distances to give birth,” Dantas wrote. “Ob-gyns are also concerned that the cuts will threaten the 12 months of postpartum coverage that we have fought so hard to achieve, and which will leave so many without access to medical care during the year after delivery when two-thirds of maternal deaths occur.

“Backsliding on our recent progress in increasing access to postpartum coverage puts lives at risk.”

American Public Health Association Executive Director Georges Benjamin wrote in a statement that House Republicans’ planned overhaul of Medicaid “does nothing to improve public health.”

“Instead, it would undermine much of the progress we have made to expand access to affordable, quality health insurance and implement other evidence-based measures to protect the public’s health,” Benjamin wrote. “We urge the House to reject this bill and instead work in a bipartisan manner on legislation to improve public health and expand access to health care for all Americans.”