The Big Story 

Just like the House, some of the biggest, and most contradictory, tension in the Senate surrounds Medicaid. Several Republican senators have forceful objections to changes to the federal insurance program included in the House-passed bill. 

© The Hill, Greg Nash

Sen. Josh Hawley (R-Mo.) and at least three others are threatening to oppose Medicaid reforms that would cut benefits. While it’s unclear as of yet what changes constitute a benefit “cut” and where they will draw a line, senators are taking a close look at limits in the bill on states’ ability to use health care provider taxes to collect more federal Medicaid funding. 

The senator from Missouri took issue with a part of the bill that would require people earning between 100 percent and 138 percent of the federal poverty level to pay up to $35 per medical service. 

“These are working people in particular who are going to have to pay more,” said Hawley. 

The legislation freezes provider taxes at current levels, and forbids the addition of new ones. Hawley, as well as Sens. Susan Collins (R-Maine), Lisa Murkowski (R-Alaska) and Jerry Moran (R-Kan.) are concerned about the impact the tax freeze will have on rural providers. 

“We’re still trying to figure out what the provider tax reforms are, but I’m very worried about our rural hospitals in Maine,” Collins told The Hill Wednesday. 

The package passed the House on a razor-thin margin, and Speaker Mike Johnson (R-La.) has urged GOP senators to keep any changes to a minimum. 

This opposition comes as no surprise as Hawley has been vocal in his protests to Medicaid cuts. House Republicans maintain the bill only targets waste, fraud and abuse, but the requirements passed by the House could cause more than 7 million people to become uninsured over the next decade, according to the Congressional Budget Office. 

At the same time, some Republicans in the Senate are calling for more stringent restrictions. 

“Medicaid ought to go back and do what it was set up to do. It was set up to take care of poor children and the chronically ill, and that’s what the focus should be,” said Sen. Rick Scott (R-Fla.), noting that Florida didn’t expand Medicaid coverage under the Affordable Care Act. 

Welcome to The Hill’s Health Care newsletter, we’re Nathaniel Weixel, Joseph Choi and Alejandra O’Connell-Domenech — every week we follow the latest moves on how Washington impacts your health.

We will not publish Monday due to the Memorial Day holiday. See you all, Tuesday. 

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