Senate Republican leaders have raised the budget for rural hospital assistance and altered contentious provisions regarding health provider taxation in late-night efforts to keep President Trump’s ambitious bill on track for a Saturday afternoon vote.
The proposed Rural Hospital Relief Fund has been increased from $15 billion to $25 billion, with the funding set to be distributed over the next five years.
However, this still falls short of the $100 billion requested by Sen. Susan Collins (R-Maine), who is a key swing vote, to support rural hospitals, nursing homes, and community health centers.
The $25 billion fund will allocate $10 billion in 2028, another $10 billion in 2029, and smaller amounts of $2 billion in 2030, 2031, and 2032.
This funding addresses only a small fraction of the federal Medicaid funds that states are projected to lose over the next decade due to limits on healthcare provider funding. For instance, Sen. Tom Tillis (R-N.C.) estimates that North Carolina could forfeit up to $38.9 billion in Medicaid funds between 2026 and 2035 because of capping its provider tax rate.
Republican leaders have also removed provisions that would have established new or increased health care provider tax suspensions in states that opted not to expand Medicaid under the Affordable Care Act, as this didn’t have a significant budgetary impact according to one Republican senator.
Additionally, a gradual reduction to the cap on the state’s healthcare provider tax, which had been tied to the Medicaid expansion under the ACA, has been postponed by a year.
So, rather than reducing the healthcare provider tax from 6% to 5.5% in 2027, this change will now only take effect in 2028.
There’s hope among Republicans that changes related to health care provider taxes can be reconciled with Senate Parliamentarian Elizabeth McDonough.
On Thursday, she ruled that the section regarding the capping of state healthcare provider tax use violates the Bird Rule, making it ineligible for passage through a simple majority vote.
The Republican senator mentioned that McDonough was also against the timeline to lower the cap on healthcare provider taxes for states that expanded Medicaid.
GOP lawmakers are optimistic that legislators might still accept these cap language changes, despite being a year behind schedule.
Senate Budget Committee Chairman Lindsey Graham (R-S.C.) has published the revised text of the extensive bill, which previously passed the House on May 22.
This document is 940 pages long and proposes significantly less federal Medicaid spending compared to the House version.
Senate Majority Leader John Thune (R-S.D.) informed a colleague during lunch on Friday that he intends to vote in favor of the package at noon on Saturday.
If the provisions advance, it will lead to a lengthy debate split between Republicans and Democrats.
Ultimately, senators will cast their vote on the final passage of the bill after the vote-a-rama concludes.
Trump has set a deadline for July 4 to get this bill passed.
