GOP leader aggressively woos GOP Medicaid holdouts on Trump bill

The Hill

7 hours ago

Senate Majority Leader John Thune (R-S.D.) is making an aggressive bid to win over Senate Republican colleagues who have balked at hundreds of billions of dollars in Medicaid spending cuts, hoping to clear obstacles in time to bring the bill to the floor next week.
Thune is under pressure to speed up the pace of talks in order to meet the July 4 deadline President Trump set for Congress to pass the bill — a deadline the Senate risks blowing past.
Republican senators who have voiced concerns about tough new restrictions on states' ability to use health care provider taxes to collect more federal Medicaid funding say they are working with Thune on proposals to help rural hospitals in their states from going out of business.
GOP senators are in discussion with Thune and Senate Finance Committee Chair Mike Crapo (R-Idaho) about provisions related to Medicaid's work and eligibility requirements.
They are also hashing out their concerns that the Senate bill would shift too much of Medicaid's costs onto the states and lower-income Americans.
'We're looking for solutions, and without getting into specifics or the details, but we're just talking through some potential options,' Thune told reporters Wednesday afternoon.
Republican sources familiar with the negotiations say they expect Senate GOP leaders and the holdouts to work out some sort of deal to provide direct financial assistance to rural hospitals that would be in danger of closing if the Senate bill passes in its current form.
'I have been supporting the inclusion of a provider-relief fund aimed at rural hospitals, nursing homes and community health centers,' Sen. Susan Collins (Maine), one of the Republican holdouts, told The Hill.
Collins has repeatedly voiced her concern that limiting states' ability to collect more federal funding through health care provider taxes could have a devastating effect on rural hospitals in Maine.
GOP senators say Thune is under pressure to move quickly to round up Senate Republican holdouts to meet Trump's July 4 deadline.
White House chief of staff Susie Wiles told Republican senators at a lunch meeting Wednesday that Trump expects them to stick to his timeline.
Sen. Kevin Cramer (R-N.D.) said after the lunch meeting that the plan is to get the bill to the floor by the end of the day Wednesday.
'My expectation is there will be concessions all around,' he said of Thune's negotiations with Republican lawmakers who are balking at the cuts to Medicaid spending in the bill.
'There are still things to work out to get to a majority. Sometimes that can't really happen until you start putting things on the floor,' he added.
He said that Wiles told GOP senators: 'Get [it] done and let's finish it next week.'
Sen. Josh Hawley (R-Mo.), who has criticized the Senate bill sharply for cutting off a major supply of funding for rural hospitals, said he's proposed several options to Senate GOP leaders to keep hospitals in his home state in business.
He has argued that rural hospitals should not lose money to slow down the phaseout of renewable energy tax credits, another key component of the Senate legislation.
'The right thing to do is not defund rural hospitals to pay for your pet projects,' Hawley said. 'If you want your pet project in the bill, go find your own money. Don't defund rural hospitals.'
Sen. Lisa Murkowski (R-Alaska) said the talks with leadership are moving in the right direction.
'There's still a lot of moving parts,' she said, adding that the recent discussion has been 'more encouraging.'
'We're still working through some of the impacts on the smaller and rural hospitals,' she said.
'From Alaska's perspective, it's getting a little bit better,' she said.
Murkowski noted that while Alaska is the only state in the country that does not use health care provider taxes to draw down more federal Medicaid funding, kicking people off Medicaid with changes to work and eligibility requirements would still hurt small and rural hospitals.
'For so many of our smaller hospitals, Medicaid is your payer. If you have people who are pushed out of it, what's the impact to that hospital?' she said.
'We have made incremental gains,' she said of the discussions with GOP leaders.
Murkowski said she's not opposed to requiring people to work to receive Medicaid benefits, but she has concerns about the implementation of unwieldy work requirements across her large state in a short period of time.
'It's because of our [Medicaid system's] architecture. It's not requiring people to work — it's how we document all of that within our system. That's our big challenge,' she said. 'If we got some flexibility to give us some breathing space, that makes it more doable.'
Thune still needs to iron out some concerns with Murkowski and other GOP senators over changes to the Supplemental Nutrition Assistance Program (SNAP), another source of funding in the bill targeted to offset the cost of new tax cuts.
The Senate bill would reduce federal SNAP funding to states but also give states the opportunity to mitigate funding reductions by improving their error rates in delivering benefits. States with error rates of 6 percent or above would have to pay between 5 and 15 percent of the cost of federal food assistance benefits.
'We still have some challenges when it comes to SNAP implementation,' Murkowski said.
Thune told reporters Wednesday that he is also working with Republican colleagues who are concerned about the timeline for phasing out various renewable energy tax breaks.
'That issue is not totally settled yet,' he said.
Sen. Shelley Moore Capito (R-W.Va.) says she's not happy about language in the bill that would abruptly terminate tax credits for clean hydrogen production facilities that are not under construction by the end of the year.
Capito said she talked to Crapo, the Finance Committee chair, about her concerns.
The Senate bill is more favorable to nuclear, geothermal and hydropower energy tax credits, which it would extend into the 2030s. That's a win for Sen. Thom Tillis's (R) home state of North Carolina, where Duke Energy is proposing a new nuclear power plant in Stokes County.
Tillis said he's asking about a 'couple' of the termination dates for renewable energy tax credits.
'Couple of ones I'm asking about,' he said, voicing his concern about stranding investments already made in clean-energy projects.