Big Beautiful Bill in Trouble?

POLITICO (“Thune faces brewing megabill mutiny“):

Sen. Thom Tillis warned his colleagues during a closed-door meeting Wednesday that he would not vote to take up the party’s sweeping domestic policy bill without further clarity on Medicaid changes, a person granted anonymity to disclose private discussions said.

“He said he wouldn’t vote for a motion to proceed until he got some clarity on what’s going to happen with the provider tax,” the person said, referring to a funding mechanism Senate GOP leaders are hoping to curtail. Tillis has been trying to get details on how the Senate language will impact North Carolina, the person added.

Tillis wasn’t alone.

Multiple other Republican senators warned Majority Leader John Thune during the lunch that they were not ready to vote to launch floor debate on the megabill, according to three attendees. But it’s Tillis, who is up for reelection next year, who has emerged as a key vote to watch as Thune moves to try and meet a July 4 target for final passage of the bill.

Tillis told colleagues he spoke recently with CMS Administrator Mehmet Oz about the provider tax’s impact on North Carolina but said he believed the numbers provided by Oz and his team underplayed the impact. Tillis handed out a document to his colleagues earlier this week that estimated his state’s losses at more than $38 billion.

“He said just now in this meeting, … ‘If you proceed on this provider tax like you’re going to do right now, you won’t have a member from North Carolina sitting at this table after next year,’” the person added. (Though North Carolina has two Republican senators, Tillis appeared to be referring to his own endangered re-election bid.)

It was just the latest instance of Tillis raising concerns privately about the Senate’s Medicaid proposal. While the House-passed bill freezes existing provider taxes, the Senate’s bill incrementally rolls back an existing federal cap.

Senate leaders made their opening offer on a rural hospital relief fund Wednesday morning. But that figure, $15 billion, is sparking pushback publicly and privately from Tillis and others.

Sen. Susan Collins (R-Maine), who is undecided on the reconciliation bill, told reporters Wednesday that “any money is helpful, but, no, it is not adequate.” She floated a $100 billion fund but added, “I don’t think that solves the entire problem.”

On the other end of his conference, Thune is facing GOP senators who want the rural hospital fund to be shrunk further. He’s not just facing pushback over health care provisions; a clutch of deficit hawks also still aren’t on board with the bill.

The ongoing negotiations have some of his members openly questioning whether they will be able to meet his goal of passing the bill in the Senate this weekend. Thune can lose three GOP senators and still have Vice President JD Vance break a tie.

“Well, I mean, everybody’s got their vote,” Thune said when asked about the holdouts. “We’re working with all of their members to try to get people comfortable with the bill, and hopefully in the end, they’ll be there.”

Other Republicans are banking that their colleagues’ rhetoric is a negotiating tactic and that they will ultimately fall in line — potentially with leadership agreeing to changes to assuage their concerns.

“All of our guys are going to keep advocating for what they want until we pass it,” said Sen. John Hoeven (R-N.D.), predicting that GOP leaders will ultimately get votes to proceed with the bill.

NPR (“Trump’s signature policy bill is facing trouble on multiple fronts in the Senate“):

Senate Republicans are racing the clock, trying to meet President Trump’s demand that they pass his domestic agenda bill by July 4th as they work to resolve major sticking points inside the GOP conference.

While Senate committee leaders have made several significant changes to the bill in recent days, the issue of funding for rural hospitals has emerged as a major roadblock.

Senate GOP leaders are also waiting to learn if major tax provisions in the bill meet strict Senate rules for what can be included in the bill and still pass with a simple majority vote. The Senate parliamentarian — a non-partisan member of the body’s professional staff — is still reviewing those elements to make sure each has a direct impact on the budget, among other regulations. Several provisions in the House version, such as one barring nationwide judicial injunctions, have already been cut in that review.

[…]

Medicaid — which provides health coverage to low-income people and is one of the largest payers for health care in the United States — has been among the most difficult provisions in the bill. At issue is a directive that states cut the tax they impose on Medicaid providers from 6% down to 3%. Critics say that tax is an important part of the funding equation in many states. They say the change will result in major challenges for rural hospitals that rely on that money. It is part of a complex formula that determines how much federal funding is received as part of the joint program run with states.

Mehmet Oz, Trump’s director of the agency overseeing the Medicaid program, met with Senate Republicans last week and defended the need to crack down on how states finance Medicaid. He called the bill “the most ambitious health reform bill ever in our history.”

He argued the changes will curb the growth of the program and add new work requirements that will preserve the program for the most vulnerable.

But Sen. Josh Hawley, R-Mo., has argued that President Trump negotiated the House bill and the changes would force the Senate to enter into drawn-out negotiations with the House.

Hawley noted that his legislation to provide health care to those impacted by exposure to radiation from the testing of atomic weapons was included in the package. “But they have to have a hospital to go to,” he added. “So it’s a problem.”

In an effort to win over Republicans like Hawley, the Senate Finance Committee on Wednesday put out a new compromise to set up a stabilization fund to help rural hospitals. The plan would direct $15 billion over a 5-year period to states in need. However, that falls short of what other senators say is needed.

[…]

Other Republicans are concerned about the overall impact of changes to Medicaid resulting in major cuts in the rolls in their states — which would mean shifting costs to states to cover those low-income, elderly and disabled patients who rely on the program.

Sen. Rick Scott, R-Fla., is one of a group of conservatives who are pressing for deeper spending cuts in the bill and told reporters he met with the president recently. He said he wants to pass a bill, but “we’ve got to have to have fiscal sanity.”

Sen. Ron Johnson, R-Wisc., continues to say Congress needs to roll back spending levels to pre-pandemic levels, and that the legislation adds to the deficit.

Fiscal hawks in the Senate have also raised concerns about the fate of energy tax credits. Republicans chose to roll back or end many of the credits included in the Inflation Reduction Act that was passed under President Biden in order to find more cost savings. But that plan has frustrated even some in their own party who say constituents and businesses are already using those credits and would be negatively affected if they are eliminated.

[…]

Even if Thune is able to resolve all of the issues in his chamber, several different factions of House Republicans are warning they will oppose the latest bill that’s emerging from the Senate.

The tax debate also includes a side negotiation with House GOP lawmakers who represent districts in New York and California who insist the Senate needs to preserve a state and local tax break, known as SALT, that was negotiated with House Speaker Mike Johnson, R-La., for their constituents who pay high state and local taxes.

They have threatened to vote against the bill if it clears the Senate without the break intact.

Most Senate Republicans have ignored their threats, and the issue isn’t a priority with no Senate Republican representing the blue states that are affected.”

Referring to the so-called “SALT caucus” in the House, Sen. Jon Hoeven, R-N.D., told reporters the Senate will come up with the bill they believe is the best deal.

“They’re still going to decide whether they agree or not. I think there’ll be a lot of pressure because, look, will produce a good product for them to just go ahead. But they get to make that call.”

On Tuesday afternoon, Sen. Markwayne Mullin, R-Okla., said he had spoken with nearly all of SALT caucus, and that while they were getting closer to a deal, he speculated that it’s unlikely “we’re going to get to a place that everybody loves … But we’re going to get someplace that may be palatable for people.”

He added that once lawmakers reach an agreement on SALT and changes to Medicaid, they will be “good to go.”

“All of us have some concerns with the bill,” Mullin said. “But that’s what happens when you’re negotiating the bill in here and you get 535 opinions.”

Ordinarily, I would expect the SALT cap to be raised and the cuts to wildly popular programs to be eliminated, as that’s what an overwhelming majority of Members want. Hell, I’m pretty sure that’s what President Trump wants. But these things have been written into the “BBB” by ideologues and Trump is now wed to getting it passed intact, with any changes from the House version requiring re-negotiation.

Thus far, though, Congressional Republicans have proven themselves spineless. If I were forced to bet, it would be that they will fall in line, despite these measures being objectively bad for their constituents.