Key Takeaways:
- Senate Republicans rush to pass President Trump’s One Big Beautiful Bill Act before July Fourth recess.
- Sen. Josh Hawley opposes proposed Medicaid changes, fearing harm to rural hospitals.
- Conservative hardliners demand steeper spending cuts, while others resist.
- The bill faces opposition from both moderates and far-right Republicans.
- The measure aims to cap state provider taxes, sparking concerns about hospital funding.
- Senate leaders work to address critics but face an uphill battle.
A Divided GOP Rushes to Meet Deadline
Senate Republicans are in a mad dash to pass President Trump’s sweeping tax and spending package before their July Fourth break. But not everyone in the GOP is on board. Senators like Josh Hawley of Missouri are sounding the alarm, saying the proposed changes could hurt rural hospitals and working families.
What’s at Stake? The heart of the debate is a tax states impose on healthcare providers to fund Medicaid. Right now, 38 states tax these providers at over 5.5%. The Senate’s new plan would cap this tax at 3.5% for states that expanded Medicaid under the Affordable Care Act by 2031. But critics say this could drain money from rural hospitals that already struggle to stay open.
Hawley Sounds the Alarm Sen. Josh Hawley, a conservative himself, is leading the charge against the plan. He calls the proposal “bizarre” and says it punishes rural hospitals. “I don’t get why we would punish working people and rural hospitals,” Hawley said. “It’s broken.”
Hawley is not alone. Sen. Jim Justice of West Virginia shares his concerns. Both fear the changes will hit rural areas hardest. “This is like a crisis point,” Hawley said. “We’ve got 35 hospitals in Missouri that have fewer than 25 beds. These are really small hospitals, and they just feel they’re at a breaking point.”
The Administration Weighs In Vice President JD Vance and CMS Administrator Mehmet Oz recently met with Republican senators to push the plan. Oz argued that addressing provider taxes is crucial to stopping “legalized money laundering” in state Medicaid payments. But Hawley says even President Trump expressed surprise at the Senate’s approach during a recent call.
Conservatives Push Back On the other side of the GOP divide, conservatives like Sen. Ron Johnson of Wisconsin want steeper spending cuts. They argue the current plan doesn’t go far enough. Johnson and others oppose the bill because it doesn’t slash spending enough. Sen. Rand Paul of Kentucky, meanwhile, objects to raising the debt ceiling by $4 trillion.
Artificial Deadline? Johnson and others say the July Fourth deadline is unnecessary. “There’s no reason to rush this,” Johnson said. “If we rush, we won’t get a good result.” He wants GOP leaders to slow down and renegotiate the bill after the recess.
A Rocky Road Ahead Despite the internal battles, Senate leaders are pushing forward. They insist the changes will “rebalance the program” and provide better incentives for Medicaid. But with Democrats solidly opposed, Republicans can only afford to lose three votes. For now, the fate of the bill hangs in the balance.
The Bottom Line The debate over Medicaid funding and rural hospitals has exposed deep cracks in the GOP. With time running out, Senate leaders must find a way to unite their divided caucus. If they fail, the bill could stall, leaving rural hospitals and millions of Medicaid recipients in limbo.