As Senate Majority Leader John Thune tries to get his conference in line for the reconciliation bill, a group of House Republicans is warning that they won’t support the Senate bill over that chamber’s proposed Medicaid cuts.
A group of 16 House Republicans — led by more moderate Rep. David Valadao — sent a letter to Thune and Speaker Mike Johnson on Tuesday suggesting they are prepared to vote against the legislation that comes out of the Senate if it includes a cut to the Medicaid provider tax.
At the moment, the Senate is considering lowering the tax that states can levy on medical providers to 3.5%, effectively shrinking the amount states can use to fund their share of Medicaid programs. The tax cut would disproportionately affect rural hospitals — and these members have grave concerns about that.
“Throughout the budget process, we have consistently affirmed our commitment to ensuring that reductions in federal spending do not come at the expense of our most vulnerable constituents. We write to reiterate that commitment to those we represent here in Washington,” the members wrote.
While all the members who signed the letter voted for the House’s reconciliation bill, which included roughly $700 billion in Medicaid cuts over the next 10 years, the GOP lawmakers say the Senate’s proposal “undermines the balanced approach taken to craft the Medicaid provisions” in the House bill.
The House legislation froze the current federal cap on state provider taxes, and the members argue in their letter that the Senate version treats Medicaid expansion and non-expansion states “unfairly.”
They said the Senate bill “fails to preserve existing state programs, and imposes stricter limits that do not give hospitals sufficient time to adjust to new budgetary constraints or to identify alternative funding sources.”
The House members also say they’re concerned about the “rushed implementation timelines, penalties for expansion states, changes to the community engagement requirements for adults with dependents, and cuts to emergency Medicaid funding.”
“These changes would place additional burdens on hospitals already stretched thin by legal and moral obligations to provide care,” the members wrote.
Included on the letter are some of the most vulnerable Republicans in the House, including Valadao, Rob Bresnahan, Young Kim, Mike Lawler, Juan Ciscomani, Chuck Edwards, Andrew Garbarino, Jen Kiggans, Jeff Van Drew, Dan Newhouse, Rob Wittman, Mariannette Miller-Meeks, Don Bacon, Zach Nunn, Nicole Malliotakis and Jeff Hurd.
And because of their concerns, the members are drawing a red line for reconciliation.
“Protecting Medicaid is essential for the vulnerable constituents we were elected to represent. Therefore, we cannot support a final bill that threatens access to coverage or jeopardizes the stability of our hospitals and providers,” the members wrote.
A similar group of Republican members plans to bring up the Medicaid provider tax during a lunch with Johnson this afternoon, a source familiar with the situation told NOTUS.
It’s yet another wrinkle complicating reconciliation, which is already plenty complicated enough for Republicans.
President Donald Trump said Tuesday that “no one goes on vacation” until reconciliation is done, though it was unclear if he was arguing that the Senate should stay until the bill passes that chamber, or whether he meant that both chambers should stay in session until reconciliation is completely finished.
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Reese Gorman is a reporter at NOTUS.