Topline
The Senate approved more than $1 trillion in cuts to Medicaid over the next 10 years and changes to federally funded health insurance programs that would leave nearly 12 million people without coverage, according to an estimate from the Congressional Budget Office.
US President Donald Trump speaks with the press on board Air Force One as he travels from Ochopee, ... More
The Senate approved the legislation in a 51-50 vote Tuesday, enacting even steeper cuts than the controversial Medicaid reductions in the House version of the bill, which included $800 billion in cuts.
The nonpartisan CBO estimates the Senate bill would reduce federal spending on Medicaid by more than $1 trillion, and by $1.1 trillion with cuts to Medicare and Obamacare included.
The Medicaid cuts, which will offset the extension of Trump’s tax cuts and additional border wall funding, among other new costs included in the bill, were one of the most contentious provisions, with two of the three Republican senators who voted against it citing the cuts.
Mostly through new work requirements that mandate some Medicaid recipients work or volunteer at least 80 hours a month. It also limits taxes on medical providers that lawmakers argued states sometimes used to reimburse providers, allowing states to report more Medicaid expenses to increase the matching funds they receive from the federal government.
To appease Republicans concerned that the new provider tax mechanism would harm rural hospitals, Senate negotiators added a provision that would double funding for rural hospitals beginning in 2026 over a five-year period. The Senate also added a measure that would apply the work requirements to the parents of older children and childless adults without disabilities, which the CBO estimated would add more than $325 billion in additional cuts over the next decade to the House version of the bill.
While the House bill freezes provider taxes, the Senate wanted to lower them, but the timeline for doing so was delayed a year by the Senate parliamentarian, Elizabeth MacDonough. Her ruling on provider tax limitations, along with determinations that prevent the Senate from enacting some provisions that would limit coverage for non-citizens and prohibit Medicaid funding for gender-affirming care, blocked an estimated $250 billion in additional cuts, Democrats estimated.
That they are aimed at reducing abuse, waste and fraud. “What is so hard about having a work requirement there with someone that has no medical conditions and no dependents?” Sen. Markwayne Mullin, R-Okla., said Sunday on “Meet the Press.” “We don’t pay people in this country to be lazy. We want to give them an opportunity. And when they’re going through a hard time, we want to give them a helping hand. That’s what Medicaid was designed for.” Critics, however, argue most Medicaid enrollees already work and a significant portion of those losing coverage under the new rules would do so only because of paperwork requirements. According to the Kaiser Family Foundation, 64% of Medicaid recipients, ages 19-64, already work, including 44% who work full-time.
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