Sixteen House Republicans penned a letter to their party’s leadership Tuesday warning that they “cannot support” a final reconciliation bill with the heightened Medicaid and hospital funding cuts included in the Senate’s draft.
The lawmakers told House Speaker Mike Johnson and Senate Majority Leader John Thune they support the “more pragmatic and compassionate standard” to Medicaid reforms outlined in the House’s version of the bill.
The Senate Finance Committee proposal released June 16, however, “undermines the balanced approach taken to craft the Medicaid provisions in H.R. 1—particularly regarding provider taxes and state directed payments,” they wrote.
Whereas the House bill freezes states’ provider taxes at current rates that, for some, are as high as 6%, the Senate’s version would also impose a 3.5% cap. The Senate Finance Committee’s proposal retains the House’s limits for new state directed payments—100% of the published Medicare Payment Rate for expansion states and 110% for nonexpansion states—but requires existing payments to be reduced by 10 percentage points annually until reaching the allowable Medicare-related payment limit.
Provider groups, which were already resistant to limits introduced in the House bill, have said these and other changes from the Senate proposal would devastate hospitals and force service line reductions or full closures. The representatives, in their letter, agreed.
“Protecting Medicaid is essential for the vulnerable constituents we were elected to represent,” they wrote. “Therefore, we cannot support a final bill that threatens access to coverage or jeopardizes the stability of our hospitals and providers.”
The 16 representatives, who hail from a blend of rural and nonrural states, are necessary for Republicans to maintain their slim, eight-member majority in the House ahead of the party-line vote—a political reality they were sure to underscore in the letter. Their stance is at odds with fiscal hawks within the party who argue the House bill and current Senate proposals didn’t go far enough in reducing federal spending.
Thune said this week that voting on the Senate’s version of the bill could begin as soon as Friday—though concessions are still being hammered out to placate rural senators similarly concerned about hospital closures. If passed, it would return to the House for another sign-off. Republican congressional leaders and the White House have said they hope to have the “big, beautiful bill” signed into law by the Fourth of July.
The Senate proposal’s impact on hospitals was front and center of the representatives’ letter, in which they noted hospitals are “already stretched thin by legal and moral obligations to provide care.”
Beyond the changes to provider taxes and state directed payments, the letter also outlined concerns regarding “rushed implementation timelines, penalties for expansion states, changes to the community engagement requirements for adults with dependents, and cuts to emergency Medicaid funding.”
The Republican representatives who signed onto the letter were: David Valadao (California), Juan Ciscomani (Arizona), Rob Breshnahan Jr. (Pennsylvania), Chuck Edwards (North Carolina), Young Kim (California), Andrew Garbarino (New York), Michael Lawler (New York), Jen Kiggans (Virginia), Jefferson Van Drew (New Jersey), Don Bacon (Nebraska), Dan Newhouse (Washington), Zach Nunn (Iowa), Robert Wittman (Virginia), Nicole Malliotakis (New York), Jeff Hurd (Colorado) and Mariannette Miller-Meeks, M.D. (Iowa).
The House’s version of the bill is projected to leave nearly 11 million people without health insurance by 2034, according to Congressional Budget Office analyses that have been rejected by Trump administration health officials.
That reduction and a freeze on state directed payments would bring a $42.4 billion increase in hospitals’ uncompensated care costs due to a combination of fewer insured patients and Medicaid payment shortfalls, industry group America’s Essential Hospitals estimated earlier this month. Bruce Siegel, M.D., the organization’s president and CEO, also wrote to legislative leaders this week warning against the Senate proposal’s changes.