Early Fireworks Accompany Senate Reconciliation Votes
Early Fireworks Accompany Senate Reconciliation Votes
President Trump and Congressional Republican leaders continue to call for enactment of the One Big Beautiful Bill Act by July 4th. The fireworks are already here.
The 940-page bill cleared a key procedural hurdle on June 28th, passing 51-49.
Senators Rand Paul (R-KY) and Thom Tillis (R-NC) opposed the procedural vote, over the bill’s deficit impact and Medicaid cuts, respectively.
The Early Fireworks
Sen. Thom Tillis (R-NC), fresh off announcing his retirement, described the bill’s Medicaid impact as “betraying” President Trump’s campaign promises on Medicaid.
He also shared in public remarks that he told the president the bill:
“will hurt people who are eligible and qualified for Medicaid”.
Senator Tillis’ opposition emerged in response to the bill’s structural changes to Medicaid, including limits on provider taxes and other flexible financing tools.
He has raised concerns about the bill’s impact on rural hospitals, and the 663,000 North Carolinians who could lose coverage if it’s enacted.
The bill is now going through reconciliation's vote-a-rama; seemingly interminable votes on non-binding amendments; expect many on Medicaid.
Clearing the procedural vote does not guarantee Senate passage.
Senate GOP leaders negotiated an array of amendments to secure that vote, including timing tweaks for Medicaid financing rule changes.
On June 29, the Senate parliamentarian rejected a carefully crafted provision boosting Medicaid payments to Alaska and Hawaii.
That key change was meant to earn support from Senator Lisa Murkowski (R-AK), who has expressed significant concern about the bill’s cuts to safety net programs.
What Comes Next
Expect a long vote-a-rama full of contentious amendments, including Senator Rick Scott’s (R-FL), which would reduce federal funding to states with expanded Medicaid.
Senators Paul and Tillis remain likely “no” votes on final passage.
Senate passage, still not a given, also does not make House passage inevitable.
The Senate bill has generated House Republican opposition over its differences from what the House passed; it both adds more to the deficit and cuts more from Medicaid.
If this week’s ambitious deadline slips, passage is still possible.
The real timing driver to watch remains the debt limit, which the bill lifts.
That could let negotiations stretch into August.