Majority Leader John Thune's 'old-fashioned' approach to the Senate has kept Trump on board so far
WASHINGTON — The Senate, once again, was working into the early morning hours Friday with its new majority leader, Republican John Thune , setting the pace.
It wasn't until just after 2 a.m. that the last of the senators had straggled into the chamber to cast their vote on the confirmation of retired Air Force Lt. Gen. Dan 'Razin' Caine for chairman of the Joint Chiefs of Staff. The vote capped a grinding start to the year for the Senate that included several all-night floor sessions and — importantly for Thune — the quickest top-level Cabinet confirmation process in the past 20 years.
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8 minutes ago
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Twin federal proposals threaten provider taxes, key source of Medicaid funding for states
Republican efforts to restrict taxes on hospitals, health plans, and other providers that states use to help fund their Medicaid programs could strip them of tens of billions of dollars. The move could shrink access to health care for some of the nation's poorest and most vulnerable people, warn analysts, patient advocates, and Democratic political leaders. No state has more to lose than California, whose Medicaid program, called Medi-Cal, covers nearly 15 million residents with low incomes and disabilities. That's twice as many as New York and three times as many as Texas. A proposed rule by the Centers for Medicare & Medicaid Services, echoed in the Republicans' House reconciliation bill, could significantly curtail the federal dollars many states draw in matching funds from what are known as provider taxes. Although it's unclear how much states could lose, the revenue up for grabs is big. For instance, California has netted an estimated $8.8 billion this fiscal year from its tax on managed care plans and took in about $5.9 billion last year from hospitals. California Democrats are already facing a $12 billion deficit, and they have drawn political fire for scaling back some key health care policies, including full Medi-Cal coverage for immigrants without permanent legal status. And a loss of provider tax revenue could add billions to the current deficit, forcing state lawmakers to make even more unpopular cuts to Medi-Cal benefits. 'If Republicans move this extreme MAGA proposal forward, millions will lose coverage, hospitals will close, and safety nets could collapse under the weight,' Gov. Gavin Newsom, a Democrat, said in a statement, referring to President Donald Trump's 'Make America Great Again' movement. The proposals are also a threat to Proposition 35, a ballot initiative California voters approved last November to make permanent the tax on managed care organizations, or MCOs, and dedicate some of its proceeds to raise the pay of doctors and other providers who treat Medi-Cal patients. All states except Alaska have at least one provider tax on managed care plans, hospitals, nursing homes, emergency ground transportation, or other types of health care businesses. The federal government spends billions of dollars a year matching these taxes, which generally lead to more money for providers, helping them balance lower Medicaid reimbursement rates while allowing states to protect against economic downturns and budget constraints. New York, Massachusetts, and Michigan would also be among the states hit hard by Republicans' drive to scale back provider taxes, which allow states to boost their share of Medicaid spending to receive increased federal Medicaid funds. In a May 12 statement announcing its proposed rule, CMS described a 'loophole' as 'money laundering,' and said California had financed coverage for over 1.6 million 'illegal immigrants' with the proceeds from its MCO tax. CMS said its proposal would save more than $30 billion over five years. 'This proposed rule stops the shell game and ensures federal Medicaid dollars go where they're needed most — to pay for health care for vulnerable Americans who rely on this program, not to plug state budget holes or bankroll benefits for noncitizens,' Mehmet Oz, the CMS administrator, said in the statement. Medicaid allows coverage for noncitizens who are legally present and have been in the country for at least five years. And California uses state money to pay for almost all of the Medi-Cal coverage for immigrants who are not in the country legally. California, New York, Michigan, and Massachusetts together account for more than 95% of the 'federal taxpayer losses' from the loophole in provider taxes, CMS said. But nearly every state would feel some impact, especially under the provisions in the reconciliation bill, which are more restrictive than the CMS proposal. None of it is a done deal. The CMS proposal, published May 15, has not been adopted yet, and the reconciliation bill is likely to be altered significantly in the Senate. But the restrictions being contemplated would be far-reaching. A report by Michigan's Department of Health and Human Services, ordered by Democratic Gov. Gretchen Whitmer, found that a reduction of revenue from the state's hospital tax could 'destabilize hospital finances, particularly in rural and safety-net facilities, and increase the risk of service cuts or closures.' Losing revenue from the state's MCO tax 'would likely require substantial cuts, tax increases, or reductions in coverage and access to care,' it said. CMS declined to respond to questions about its proposed rule. The Republicans' House-passed reconciliation bill, though not the CMS proposal, also prohibits any new provider taxes or increases to existing ones. The American Hospital Association, which represents nearly 5,000 hospitals and health systems nationwide, said the proposed moratorium on new or increased provider taxes could force states 'to make significant cuts to Medicaid to balance their budgets, including reducing eligibility, eliminating or limiting benefits, and reducing already low payment rates for providers.' Because provider taxes draw matching federal dollars, Washington has a say in how they are implemented. And the Republicans who run the federal government are looking to spend far fewer of those dollars. In California, the insurers that pay the MCO tax are reimbursed for the portion levied on their Medi-Cal enrollment. That helps explain why the tax rate on Medi-Cal enrollment is sharply higher than on commercial enrollment. Over 99% of the tax money the insurers pay comes from their Medi-Cal business, which means most of the state's insurers get back almost all the tax they pay. That imbalance, which CMS describes as a loophole, is one of the main things Republicans are trying to change. If either the CMS rule or the corresponding provisions in the House reconciliation bill were enacted, states would be required to levy provider taxes equally on Medicaid and commercial business to draw federal dollars. California would likely be unable to raise the commercial rates to the level of the Medi-Cal ones, because state law constrains the legislature's ability to do so. The only way to comply with the rule would be to lower the tax rate on Medi-Cal enrollment, which would sharply reduce revenue. CMS has warned California and other states for years, including under the Biden administration, that it was considering significant changes to MCO and other provider taxes. Those warnings were never realized. But the risk may be greater this time, some observers say, because the proposed changes are echoed in the House-passed reconciliation bill and intertwined with a broader Republican strategy — and set of proposals — to cut Medicaid spending by close to $800 billion. 'All of these proposals move in the same direction: fewer people enrolled, less generous Medicaid programs over time,' said Edwin Park, a research professor at Georgetown University's McCourt School of Public Policy. California's MCO tax is expected to net California $13.9 billion over the next two fiscal years, according to January estimates. The state's hospital tax is expected to bring in an estimated $9 billion this year, up sharply from last year, according to the Department of Health Care Services, which runs Medi-Cal. Losing a significant slice of that revenue on top of other Medicaid cuts in the House reconciliation bill 'all adds up to be potentially a super serious impact on Medi-Cal and the California state budget overall,' said Kayla Kitson, a senior policy fellow at the California Budget & Policy Center. And it's not only California that will feel the pain. 'All states are going to be hurt by this," Park said. Wolfson writes for KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. Sign up for our Wide Shot newsletter to get the latest entertainment business news, analysis and insights. This story originally appeared in Los Angeles Times.
Yahoo
28 minutes ago
- Yahoo
Florida's long-awaited budget cuts spending, saves money for future downturns
TALLAHASSEE — After weeks of infighting and stalled negotiations, Florida's legislative leaders released a slimmed-down budget for the next fiscal year on Friday. The $115.1 billion spending plan is supposed to limit what lawmakers say has been a trend of runaway spending in Tallahassee and counter uncertainty over federal funding from Washington. Lawmakers are slashing more than 1,700 vacant positions across state government and stashing millions of dollars for the state's rainy day fund, but are still funding priority projects with millions of dollars. 'We thought this day would never come, but it did,' Senate budget chairperson Ed Hooper said Friday. Lawmakers are set to vote on the budget Monday evening, ending one of the most contentious legislative sessions in recent memory and setting up a potential clash with Republican Gov. Ron DeSantis. Unlike a typical year, where lawmakers produce a budget within Florida's usual 60-day session, lawmakers took 102 days to put together their final product. That's partly because legislators have been feuding with DeSantis since January, when he called lawmakers in for a special session to address immigration without any clear goals or proposed legislation. The three special sessions ate up critical time that would have been used to work on the budget. 'There were contributing factors that largely were out of the control of either chamber,' said Republican Rep. Lawrence McClure, the House budget chairperson. DeSantis, who has been ruthless in cutting lawmakers' projects in happy times, has until the end of this month to issue vetoes. Earlier this year, amid the feud with DeSantis, the House overrode some of his budget vetoes from last year. The Senate did not. Although lawmakers didn't give DeSantis everything he wanted in the amounts he wanted — including money for his priority Hope Florida program — they still gave him millions for the Florida State Guard and the Florida Job Growth Grant Fund. Millions also stayed with first lady Casey DeSantis' cancer research fund. The idea that 'the governor's priorities are being funded at a lower rate' is wrong, McClure said. Overall spending was smaller across the board, he said. Despite producing a smaller budget than the year prior, Florida's budget has still grown by more than 26% since DeSantis came into office in 2019. The budget's growth has outpaced population increases and often outpaced inflation. House Speaker Daniel Perez, R-Miami, pushed for a leaner budget this year, saying state government spending had swollen and run afoul of conservative values. 'We spend every new dime of recurring revenue while congratulating ourselves for giving easy-to-fund, non-recurring sales tax holidays,' Perez said on the opening day of the session in March. McClure blamed too much federal money in previous years for Florida's 'not sustainable' spending habits. About a third of the state's budget is federal money. But lawmakers are now facing a potentially abrupt reversal from the feds. Under President Donald Trump and the Republican-controlled Congress, federal lawmakers could pass major cuts to Medicaid, food assistance and other social programs. There are also discussions about ending the Federal Emergency Management Agency. Senate President Ben Albritton said that if the federal government cuts costs, he thinks Florida wouldn't be able to avoid shouldering some of the burden. State lawmakers are also preparing for a potential recession, socking away at least $750 million for the state's rainy day fund and proposing making the annual funding permanent through a constitutional amendment next year. The last time the fund was used was during the Great Recession, prompting lawmakers at the time to consider raising taxes. 'I never want a future Legislature to have to be in that position,' Perez said last week. But some Democrats have raised concerns about this year's budget tying the state's hands. 'I think that the state actually should be preparing to help carry its people through that tough time, not looking for ways to cut funding,' said House Democratic Leader Fentrice Driskell. House lawmakers this year took particular interest in DeSantis' spending habits and governance, focusing in part on the thousands of vacant positions across state agencies. To slim the budget, they're slashing many of those positions for the next year, including more than 1,000 in Florida's health care agencies, including the Department of Children and Families and the Department of Health. Lawmakers also set aside a smaller amount of money than usual for teacher and school employee raises — $100 million instead of previous years' roughly $250 million. And they're also not funding $2 million for DeSantis' Hope Florida program, which is supposed to steer constituents in need from state services to local churches and nonprofits. Lawmakers' scrutiny has caused DeSantis to rage against them in news conferences and online videos this year. But he's still getting much of what he requested. For the Florida Job Growth Grant Fund, lawmakers set aside $50 million, $25 million less than he wanted. A state cancer grant fund, backed by the first lady, got $60 million. And while the Legislature put more than $500 million toward the Comprehensive Everglades Restoration Plan, it fell short of the more than $600 million DeSantis wanted, with lawmakers pointing to how much of the prior funding remained unspent. Some of the ideas in the budget popped up in the final days of negotiations, including a $3 million fund to give grants to local jails that contract with U.S. Immigration and Customs Enforcement for immigration enforcement. The Florida Senate also put aside $23 million to fund the Florida State Guard, which DeSantis has used as a tool in his immigration enforcement and deportation plans. But Hooper, R-Clearwater, said that the funding had more to do with the possibility of FEMA being dissolved than it had to do with immigration enforcement. Both chambers together supported more than $100 million to increase the nursing home reimbursement rate. About $28 million will go toward a farmer food share program prioritized by Albritton, along with about $104 million for another priority of his: citrus research. Lawmakers this year are cutting taxes — but mostly for businesses. Legislative leaders are eliminating the business rent tax, saving companies across the state about $900 million per year. DeSantis also proposed eliminating it in his budget. They're not taking any action to reduce property taxes, however, and the House's plan for a sweeping sales tax cut has been whittled down to a limited sales tax reduction plan, which includes making the back-to-school sales tax holiday a permanent event every August and permanently exempting taxes on some items, like sunscreen and life jackets. Though lawmakers initially billed the tax package as being targeted to benefit Florida families, the final package exempts or reduces taxes on things like NASCAR tickets, card rooms and slot machine licensing fees. The final tax bill also sets aside $1 million for Florida's Office of Economic and Demographic Research to do a study on the state's property taxes. DeSantis has proposed cutting or eliminating property taxes, which could leave local governments without a critical revenue source. But he proposed no concrete ideas for how to do that. The governor in March offered a temporary plan to use $5 billion to give people a $1,000 homestead property tax rebate. But neither the House nor the Senate took up the idea. A month into the legislative session, Perez made a surprise announcement that the House wanted to cut the state's sales tax from 6% to 5.25%. It would have been the largest state tax cut in Florida's history, saving Floridians nearly $5 billion per year. But the Senate wouldn't go along with the plan. When asked why lawmakers decided to give businesses the largest tax break this year, Perez said the ultimate goal was to cut the amount of money lawmakers could spend. 'We have become accustomed to spending recurring dollars,' Perez said, adding: 'What we are trying to do is stop that from happening into the future.' Times reporter Jeffrey S. Solochek contributed to this report.
Yahoo
28 minutes ago
- Yahoo
What's left for the Supreme Court to decide? 21 cases, including state bans on transgender care
WASHINGTON (AP) — The Supreme Court is in the homestretch of a term that has lately been dominated by the Trump administration's emergency appeals of lower court orders seeking to slow President Donald Trump's efforts to remake the federal government. But the justices also have 21 cases to resolve that were argued between December and mid-May, including a push by Republican-led states to ban gender-affirming care for transgender minors. One of the argued cases was an emergency appeal, the administration's bid to be allowed to enforce Trump's executive order denying birthright citizenship to U.S.-born children of parents who are in the country illegally. The court typically aims to finish its work by the end of June. Here are some of the biggest remaining cases: Tennessee and 26 other states have enacted bans on certain treatment for transgender youth The oldest unresolved case, and arguably the term's biggest, stems from a challenge to Tennessee's law from transgender minors and their parents who argue that it is unconstitutional sex discrimination aimed at a vulnerable population. At arguments in December, the court's conservative majority seemed inclined to uphold the law, voicing skepticism of claims that it violates the 14th amendment's equal protection clause. The post-Civil War provision requires the government to treat similarly situated people the same. The court is weighing the case amid a range of other federal and state efforts to regulate the lives of transgender people, including which sports competitions they can join and which bathrooms they can use. In April, Trump's administration sued Maine for not complying with the government's push to ban transgender athletes in girls sports. Trump also has sought to block federal spending on gender-affirming care for those under 19 and a conservative majority of justices allowed him to move forward with plans to oust transgender people from the U.S. military. Trump's birthright citizenship order has been blocked by lower courts The court rarely hears arguments over emergency appeals, but it took up the administration's plea to narrow orders that have prevented the citizenship changes from taking effect anywhere in the U.S. The issue before the justices is whether to limit the authority of judges to issue nationwide injunctions, which have plagued both Republican and Democratic administrations in the past 10 years. These nationwide court orders have emerged as an important check on Trump's efforts and a source of mounting frustration to the Republican president and his allies. At arguments last month, the court seemed intent on keeping a block on the citizenship restrictions while still looking for a way to scale back nationwide court orders. It was not clear what such a decision might look like, but a majority of the court expressed concerns about what would happen if the administration were allowed, even temporarily, to deny citizenship to children born to parents who are in the country illegally. Democratic-led states, immigrants and rights groups who sued over Trump's executive order argued that it would upset the settled understanding of birthright citizenship that has existed for more than 125 years. The court seems likely to side with Maryland parents in a religious rights case over LGBTQ storybooks in public schools Parents in the Montgomery County school system, in suburban Washington, want to be able to pull their children out of lessons that use the storybooks, which the county added to the curriculum to better reflect the district's diversity. The school system at one point allowed parents to remove their children from those lessons, but then reversed course because it found the opt-out policy to be disruptive. Sex education is the only area of instruction with an opt-out provision in the county's schools. The school district introduced the storybooks in 2022, with such titles as 'Prince and Knight' and 'Uncle Bobby's Wedding.' The case is one of several religious rights cases at the court this term. The justices have repeatedly endorsed claims of religious discrimination in recent years. The decision also comes amid increases in recent years in books being banned from public school and public libraries. A three-year battle over congressional districts in Louisiana is making its second trip to the Supreme Court Lower courts have struck down two Louisiana congressional maps since 2022 and the justices are weighing whether to send state lawmakers back to the map-drawing board for a third time. The case involves the interplay between race and politics in drawing political boundaries in front of a conservative-led court that has been skeptical of considerations of race in public life. At arguments in March, several of the court's conservative justices suggested they could vote to throw out the map and make it harder, if not impossible, to bring redistricting lawsuits under the Voting Rights Act. Before the court now is a map that created a second Black majority congressional district among Louisiana's six seats in the House of Representatives. The district elected a Black Democrat in 2024. A three-judge court found that the state relied too heavily on race in drawing the district, rejecting Louisiana's arguments that politics predominated, specifically the preservation of the seats of influential members of Congress, including Speaker Mike Johnson. The Supreme Court ordered the challenged map to be used last year while the case went on. Lawmakers only drew that map after civil rights advocates won a court ruling that a map with one Black majority district likely violated the landmark voting rights law. The justices are weighing a Texas law aimed at blocking kids from seeing online pornography Texas is among more than a dozen states with age verification laws. The states argue the laws are necessary as smartphones have made access to online porn, including hardcore obscene material, almost instantaneous. The question for the court is whether the measure infringes on the constitutional rights of adults as well. The Free Speech Coalition, an adult-entertainment industry trade group, agrees that children shouldn't be seeing pornography. But it says the Texas law is written too broadly and wrongly affects adults by requiring them to submit personal identifying information online that is vulnerable to hacking or tracking. The justices appeared open to upholding the law, though they also could return it to a lower court for additional work. Some justices worried the lower court hadn't applied a strict enough legal standard in determining whether the Texas law and others like that could run afoul of the First Amendment.
