WASHINGTON — Senate Republican leaders are rushing to pass President Donald Trump’s One Big Beautiful Bill Act before their July Fourth recess, but rank-and-file Republicans from both sides of the party are tapping the brakes on the effort.
While conservative hardliners continue calling for steeper spending cuts, Sen. Josh Hawley (R-MO), a far-right conservative himself, has become one of the loudest voices of opposition to proposed changes to how states pay for Medicaid.
“I don't get it. I don't get why we would punish working people and rural hospitals, and I don't know. I don't understand. It's broken,” Hawley told Raw Story about his party's fixation on slashing care relied on by millions. “I think it's bizarre.”
For now, Republican leaders are barreling forward, even as they don’t seem to have the 51 votes needed to pass Trump’s sweeping tax cut package.
Hawley and a handful of other Republicans, like Sen. Jim Justice (R-WV), are up in arms over a new Senate GOP plan that slashes a tax states levy on health care providers to pay for Medicaid.
While 38 states slap more than a 5.5 percent tax on health care providers — known as a “provider tax” — under the new Senate proposal, states that expanded Medicaid via the Affordable Care Act would be capped at taxing providers at 3.5 percent by 2031.
The new proposal also phases out clean energy mandates slower than the House-passed measure, which Hawley opposes.
“I'm totally surprised by what they proposed to do on the provider tax. I don't know why we would defund rural hospitals to pay for Chinese solar panels today,” Hawley said.
“It's a huge change from the House framework. It's a big change from what we had previously been discussing, certainly what I discussed with leadership. It's really surprising, and I think it's potentially really bad for rural hospitals.”
It’s all hands on deck for GOP leaders and Trump officials. On Tuesday, Vice President JD Vance and Centers for Medicare & Medicaid Services Administrator Mehmet Oz joined Republican senators for their weekly policy lunch at the Capitol where each delivered the administration’s pitch.
“We do not believe that addressing the provider tax effort is going to influence the ability of hospitals to stay viable,” Oz told reporters. “The framework of addressing the legalized money laundering with state-directed payments and provider taxes must be in this bill, it should be in this bill.”
That’s news to Hawley, who said Trump hummed a different tune when they spoke earlier this week.
“We just discussed the big changes made by the Senate, and he said that he was also surprised by what the Senate had done,” Hawley said of his call with the president. “But I’m gonna leave that to him.”
Hawley says rural hospitals in his state are freaking out.
“This is like a crisis point. 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,” Hawley said.
“I'm open to any ideas about how we safeguard rural hospitals. That's my bottom line in this, I want to see rural hospitals safeguarded. There's nothing for rural hospitals, nothing but bad, nothing but pain for rural hospitals in this bill. I'm totally stunned by what they've chosen to do here. It is not at all what we have been discussing.”
Hawley’s fine with adding work requirements to Medicaid, but says he’s told party leaders he can’t back a measure that punishes rural hospitals. That’s why he was so surprised to see Senate GOP leaders get behind this new effort to cap state’s provider taxes.
“Ball’s in their court. I mean, I've met with them a billion times,” Hawley said. “They know where I stand on this.”
On the other side of the great GOP divide are conservatives clamoring for steeper cuts than are in the House-passed measure, which the nonpartisan Congressional Budget Office estimates would add $2.8 trillion to the national debt over a decade.
With all Democrats opposed to Trump’s tax and spending priorities, Republicans only have three votes to spare. Sen. Rand Paul (R-KY) opposes the package because it includes raising the debt ceiling by $4 trillion, while Sen. Ron Johnson (R-WI) and others from the far right of the party oppose the measure because it doesn’t cut spending enough.
Johnson wants GOP leaders to hit pause until after the recess.
“There's no way you can get this right by July Fourth, so I'm just suggesting we take all of July, let's properly define the problem. Then let's get serious about making this a much better bill,” Johnson told reporters.
“This is an artificial deadline. There's no reason to be trying to rush this. If we rush it, we're not going to get it as a good result. We won't.”
Senate Republican leaders behind the proposed Medicaid changes say they’re working with critics like Hawley to try and find an acceptable fix, even as they work to win over conservatives who want to cut even deeper.
“We think [the changes] rebalance the program in a way that provides the right incentives to cover the people who are supposed to be covered,” Senate Majority Leader John Thune (R-SD) told reporters after the weekly party lunch Tuesday.
“We continue to hear from members specifically on components or pieces of the bill they want to see modified or changed, and we are working through that.”
