Senate Majority Leader John Thune (R-S.D.) has begun meeting privately with Senate Republicans who are threatening to derail President Trump’s “big, beautiful bill” over what they fear could be substantial cuts to Medicaid.
Senate GOP sources say there’s a group of five to seven Republican senators who are concerned about the Medicaid reforms included in the House budget reconciliation package, which Speaker Mike Johnson (R-La.) wants to pass by Memorial Day.
Some of these GOP senators are threatening to oppose the House bill if it limits states’ ability to receive more federal Medicaid funding through health care provider taxes and if it requires more working-class people to pay more into the program.
“There’s probably five, six, seven of us who if you do anything that cuts into benefits, you’re going to have a real problem. The leader is aware of that,” said a Republican senator who requested anonymity to comment on internal deliberations.
Thune has already begun whipping his Senate GOP colleagues to support the 1,116-page House bill, even though it has yet to pass the lower chamber.
Republican lawmakers say that Thune right now is listening to his colleagues’ concerns about the bill, which mainly revolve around the Medicaid provisions.
Thune and Senate Finance Committee Chair Mike Crapo (R-Idaho) met with a group of senators from rural states, which could be severely impacted by reductions in federal Medicaid funding to states, at the Capitol on Wednesday afternoon.
The group included Sens. Ted Budd (R-N.C.), Rick Scott (R-Fla.), Eric Schmitt (R-Mo.) and Jon Husted (R-Ohio), all staunch Trump supporters who have kept a low public profile on the subject of Medicaid so far.
Sen. Jerry Moran (R-Kan.), who warned colleagues in a floor speech earlier this year that he would not support Medicaid reforms that threatened rural hospitals, also attended the meeting.
Republicans came out of the meeting saying they would hold off on commenting on the House bill until it comes over to the Senate.
“Yeah, probably going to hold tight on commenting on that right now,” Budd told The Hill.
Thune has also met with Sen. Josh Hawley (R-Mo.), an outspoken critic of Medicaid cuts, in a one-on-one meeting earlier this week. The point of the meeting was for Thune to gain a better understanding of Hawley’s position on Medicaid, according to a source familiar with the discussion.
A group of Senate Republicans, including Hawley, who has raised concerns about the Medicaid cost-sharing and health care provider tax reform provisions, is expected to push for changes to the House bill.
But that could threaten the delicate political balance that the Speaker is trying to put together to get it out of the House.
Johnson told senators during a lunch meeting Tuesday that they need to be mindful about not shattering the fragile coalition he’s trying to put together in the House by insisting on big changes once the legislation reaches the Senate.
“When it comes over here, I think he would like to see as little change to the product as possible because they cobbled together a very delicate balance over there,” Thune told reporters Wednesday, referring to Johnson’s hope that senators only make a few light changes to the bill.
But Thune acknowledged GOP senators will insist on changes.
“The Senate will have its imprint on it. But we’re coordinating with them, and the committees are working closely” together, he said.
Thune has a 53-seat majority and can only afford three defections from his ranks and still pass the massive budget reconciliation bill, which would extend the expiring 2017 tax cuts, provide roughly $150 billion for immigration enforcement and border security and $150 billion in new funding for the Pentagon.
He is expected to lose one Republican vote right off the bat because Sen. Rand Paul (R-Ky.) has said he will not vote for the bill if it includes a multitrillion-dollar increase in the federal debt ceiling.
Paul is demanding steep cuts to federal spending in exchange for increasing the government’s borrowing authority.
Sens. Susan Collins (R-Maine) and Lisa Murkowski (R-Alaska), the Senate GOP’s leading moderate voices, have both raised deep concerns about the prospect of cutting Medicaid benefits.
Collins told The Hill on Wednesday that she is open to supporting new work requirements that House Republicans drafted for Medicaid, but she warned that other provisions, such as the crackdown on the use of health care provider taxes to increase federal Medicaid funding to the states, could hurt rural hospitals in Maine.
“I’m sure it will be looked at carefully, and I understand that it’s still being negotiated,” she said of the Medicaid reforms in the House bill.
“I looked at the work requirements, which seemed to me to be carefully drawn,” she added, noting that the House-drafted work requirements for Medicaid wouldn’t apply to people who are going to school or engaged in cost-sharing.
Asked about the health care provider tax reforms and expanded cost-sharing, Collins said: “We’re still trying to figure out what the provider tax reforms are, but I’m very worried about our rural hospitals in Maine.”
Moran laid down a marker with his leadership last month when he announced on the Senate floor that he would not support any Medicaid reforms that threatened the fragile finances of rural hospitals.
“I want to make certain that my colleagues know my view [on] the value of making certain we do no harm to those in desperate need of health care in Kansas and across the country,” Moran said at the time.
The big fight Speaker Johnson had with Republicans from New York, New Jersey and California over lifting the cap on state and local tax (SALT) deductions is less of an issue in the Senate.
Republican senators told Johnson at Tuesday’s meeting that they would give him room to cut a deal with New York Rep. Mike Lawler (R) and other blue-state Republicans on raising the SALT cap, according to a senator who attended the meeting.
Thune told reporters that he won’t face any similar demands from GOP senators on SALT.
“It’s not an issue in the Senate. It’s not an issue for us,” he said.
Johnson announced Wednesday morning that he reached an agreement with Republican holdouts to raise the cap on SALT deductions from $10,000 to $40,000 for the next 10 years.
The higher cap would phase out for annual incomes above $500,000.
