'You leave us with only one path': Red states furious at section in Trump's bill

H.R. 1, President Donald Trump's so-called "One Big Beautiful Bill Act," contains one provision that may prove to be both financially and politically costly for Republicans — particularly those from the reddest states in the U.S.

Politico reported Friday that the legislation contains a provision that would end up forcing all states to expand Medicaid under the Affordable Care Act (ACA), which is something Republican-run states have been hesitant to do since the ACA became law in 2010. South Carolina Hospital Association chief executive Thornton Kirby warned that the legislation "affects the viability of the whole [healthcare] system" in the Palmetto State.

Under H.R. 1, states that haven't yet expanded Medicaid would take a significant financial hit, as they would reduce what health insurance companies pay states who contract with them to provide Medicaid coverage in order to pay for the 10-year extension of Trump's 2017 tax cuts (which are overwhelmingly skewed in favor of the wealthiest Americans). Kirby said in South Carolina alone, the legislation could cost $2.3 billion per year.

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"If you take away this alternative way to balance the budget, you leave us with only one path ... Medicaid expansion," he said.

However, under the ACA, significant federal subsidies are provided to all states that expand Medicaid, meaning red states like South Carolina would need those federal subsidies to shore up their finances. Kirby told Politico he's been pushing Rep. Russell Fry (R-S-C.), Sen. Tim Scott (R-S.C.) and Governor Henry McMaster (R) to push for the final bill to exclude the restrictions on state-directed payments to insurers.

“I don’t want to put him in the hot seat,” Kirby said of the governor. “He doesn’t want to see [Medicaid] upended.”

H.R. 1 has already underwent significant changes in the Senate since passing the House in May. Even though Republicans enjoy a 53-47 majority in the upper chamber of Congress, the bill's passage is far from assured, with senators with a high concentration of Medicaid beneficiaries like Josh Hawley (R-Mo.) communicating that they're unlikely to vote for any bill that would significantly cut the heath insurance program for low-income and disabled Americans.

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Click here to read Politico's full article.