Thune, Vance cut deal with Senate conservatives to save GOP megabill

The Hill

a day ago

Senate Majority Leader John Thune (R-S.D.) and Vice President Vance struck a deal Saturday night with a group of Senate conservatives who want bigger Medicaid spending cuts to save President Trump's 'big, beautiful bill' from stalling.
The deal hatched in Thune's office late Saturday evening paved the way for Sen. Ron Johnson (R-Wis.) to flip his 'no' vote on proceeding to the bill to 'aye' and for Sens. Rick Scott (R-Fla.), Mike Lee (R-Utah) and Cynthia Lummis (R-Wyo.) to also vote for the bill.
Without their votes, the 940-page bill to boost spending on border security, immigration enforcement and the military and to cut an array of taxes could not have advanced on the Senate floor. It advanced 51-49.
The vote to proceed to the sprawling budget reconciliation package remained open on the Senate floor for more than three and a half hours, stuck for a long time at 47 yes's and 50 no's.
For much of that time, the four conservatives — Johnson, Scott, Lee and Lummis — huddled off the Senate floor to negotiate a way to add new language to the bill to further cut federal Medicaid spending.
The language in the revised Senate bill is projected to reduce Medicaid spending by $930 billion over the next decade, according to a preliminary analysis by the Congressional Budget office.
But Scott and his allies wanted to do more to reduce the amount of money spent on able-bodied adults who are allowed to enroll into Medicaid in states that expanded the program under the Affordable Care Act, which was former President Obama's signature domestic achievement.
'I met with the president today, met with him quite a bit. Met with the vice president. We all wanted to get to yes and we're all working together to make sure that happens,' Scott told reporters after voting to advance the bill.
He said conservatives want to 'stop Blue State governors from taking advantage of Red States.'
'Paying for health care for illegal immigrants with federal tax dollars is going to end,' Scott said.
Senate conservatives say that Thune and Trump have committed to support Scott's proposal to lower the 90 percent federal matching share for new Medicaid enrollees in expansion states.
'We have been working behind the scenes,' Johnson told reporters who flipped his initial 'no' vote on beginning debate on the GOP megabill to 'aye' to allow it move forward.
Johnson said conservatives got an agreement from leadership to vote on an amendment 'that we're confident of.'
'At a certain point we just don't allow single working-age, able-bodied childless adults to sign onto ObamaCare expansion and get that 9-1 match,' he said.
Johnson said that states receive a much lower federal matching share for disabled children enrolled in regular Medicaid.
He said that conservatives whipped 'something very similar' Scott's proposal within the Senate GOP conference and asserted 'it's very close' to getting the 50 votes in needs to be included into the legislation.
Senators will now spend up to 20 hours debating the reconciliation package before holding a marathon series of amendment votes known as a vote-a-rama. A final vote may not happen until Monday.
Senate conservatives feel confident that Trump can help secure a majority vote for cutting the federal Medicaid match share in expansion states, even though the proposal is likely to be a hard sell with Republicans who have already complained loudly about the Medicaid cuts already in the bill.
'The leadership wants to do this, too,' Johnson said. 'This is what was key about the two-hour meeting with the president.'
He said Trump is 'willing to do what needs to be done to put this nation on a path of eventually balancing our budget.'
The cap on enrolling new people into expanded Medicaid would be implemented at a future date to give states some time to adjust to the change.
Selling the proposal to more centrist Republicans in both the Senate and House, however, won't be easy.
Speaker Mike Johnson (R-La.) declared in early May that a proposal to directly reduce the enhanced federal match for states that expanded Medicaid was off the table.
And Sen. Josh Hawley (R-Mo.), who negotiated with Thune to increase funding for a rural hospital relief fund and to increase the flow of federal Medicaid dollars to Missouri over the next four years, warned GOP colleagues to stay away from bigger cuts to the program.
'I think that this effort to cut Medicaid funding is a mistake,' he said. 'We've been able for Missouri to delay it. … That's not true of all the states. And unless changes are made, after 2030 you'll see Medicaid reductions in my state. I'm going to do everything I can to defeat that.'
'I think that this has been unhappy episode here in Congress, this effort to cut Medicaid. And I think, frankly, my party needs to do some soul-searching. If you want to be a working-class party, you've got to deliver to working-class people. You cannot take away health care from working people,' he said.
Sen. Susan Collins (R-Maine), who has also voiced strong concerns about the Medicaid funding cuts in the bill, said she voted to proceed to the bill Saturday out of deference to her leadership but warned that does not mean she will necessarily vote for the bill on final passage.