Louisiana hospitals press Johnson over megabill Medicaid cut proposals
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Diverging Reports Breakdown
Senate Republicans Release Updated Draft of Megabill as Deadline Nears
Senate Budget Committee Chair Lindsey Graham (R-S.C.) released a revised version of the One Big Beautiful Bill Act on June 27. The revisions come after the Senate parliamentarian ruled that several provisions were ineligible for passage under the filibuster-proof reconciliation process. A previous draft had drawn criticism from some members in both chambers as Senate Republicans race to pass the 1,000-page budget reconciliation bill. Leaders have been working toward a self-imposed July 4 deadline for presenting the bill to the president. Failure to do so would further delay implementation of Trump’s signature policy initiatives and risk a breach of the nation’s debt ceiling in August. The latest Senate draft now aligns with the House by raising the SALT deduction cap to $40,000 through 2029, with a 1 percent annual inflation adjustment, before reverting to $10,000. The bill would end the $7,500 incentive for new EVs and extend the $4,000 credit for used ones through the end of 2025.
released a revised WASHINGTON—Senate Budget Committee Chair Lindsey Graham (R-S.C.)released a revised version of the One Big Beautiful Bill Act on June 27 in hopes of gaining agreement on the legislation among Republicans in both the Senate and the House.
The revisions come after the Senate parliamentarian ruled that several provisions were ineligible for passage under the filibuster-proof reconciliation process. A previous draft had drawn criticism from some members in both chambers as Senate Republicans race to pass the 1,000-page budget reconciliation , seen as critical for implementing President Donald Trump’s second-term agenda.
Senate parliamentarian Elizabeth MacDonough’s rulings that key portions of the bill did not meet the criteria established by the Byrd Rule, all but required Republicans to cut or revise those sections. If left in place, those elements would require the bill to gain 60 votes to pass the Senate.
The latest version of the bill includes updates made by Senate committees to address her points, although it remains uncertain whether the bill will garner enough support to advance.
Leaders have been working toward a self-imposed July 4 deadline for presenting the bill to the president: Failure to do so would further delay implementation of Trump’s signature policy initiatives and risk a breach of the nation’s debt ceiling in August.
Sen. John Kennedy (R-La.) told Fox News on June 27 that he wanted Senate Majority Leader John Thune (R-S.D.) to bring the bill to the Senate floor for a vote Saturday afternoon.
“If you’re unhappy with that, you’re welcome to fill out a hurt feelings report, and we will review it carefully later,” he told the news outlet. “But in the meantime, it’s time to start voting.”
Republicans must have near unanimity in both chambers to pass the bill, given their slim majorities in each. And with several controversial issues still outstanding, Republicans still appear far from the finish line.
Tax Matters Speaker Mike Johnson (R-La.) had to balance demands from both moderates and fiscal conservatives to shepherd the House version of the bill last Here’s how the bill seeks to unite the party to meet Trump’s Independence Day deadline.Speaker Mike Johnson (R-La.) had to balance demands from both moderates and fiscal conservatives to shepherd the House version of the bill last month
Among the moderates, Rep. Mike Lawler (R-N.Y.) and several other Republicans from blue states sought a higher cap for state and local tax (SALT) deductions, a federal tax break that lets taxpayers write off payments made to state and local governments.
While the House bill set the SALT cap at $40,000, the Senate initially proposed keeping it at $10,000—the same limit imposed under the 2017 Trump tax cuts—as a negotiating position.
The latest Senate draft now aligns with the House by raising the SALT deduction cap to $40,000 through 2029, with a 1 percent annual inflation adjustment, before reverting to $10,000. However, the higher cap phases out for taxpayers earning above $500,000.
For Sen. Rick Scott (R-Fla.), even the $10,000 level was too high. “There should be no SALT deduction,” Scott told reporters on June 24.
Despite the tensions around the SALT issue, Sen. Markwayne Mullin (R-Okla.), a conservative, told reporters on June 27: “It’s not great. I’m not thrilled with it. SALT guys aren’t thrilled with it. But we’re going to hold our nose and accept it.”
The latest Senate version of the bill also fulfills Trump’s campaign promise to end taxes on tips, though with limits. While the House version offered an unlimited exclusion, the Senate plan exempts up to $25,000 in tip income, reducing the benefit by $100 for each $1,000 earned over $150,000.
Beyond the debates over SALT deductions and tip income, electric vehicles (EV) have also been a flashpoint in negotiations over the bill’s tax provisions.
In the latest Senate revision, the bill would end EV tax credits after Sept. 30, 2025, eliminating the $7,500 incentive for new EVs and the $4,000 credit for used ones. By comparison, the House version sought to keep the $7,500 credit for new EVs through the end of 2025, and extend it to the end of 2026 for automakers that haven’t yet sold 200,000 units.
Also, the latest Senate bill would accelerate the end of clean energy incentives created under the Inflation Reduction Act. It proposes terminating the clean electricity production credit for new wind and solar facilities placed in service after December 31, 2027, five years earlier than scheduled. The measure would also move up the end date for the clean hydrogen production credit to Jan. 1, 2028.
The Senate bill also includes a measure to eliminate fines for automakers that fail to meet Corporate Average Fuel Economy standards, in an apparent bid to ease costs for producing gas-powered vehicles. The change would apply only to model years for which the Transportation Department has not yet issued penalty notices.
The latest version of the Senate bill would also exempt interest paid on auto loans from taxes for new cars built in the United States, up to a maximum of $10,000 per year, with the deduction phasing out for individuals earning more than $100,000 annually, and expiring after 2028.
Also, Senate Republicans dropped an earlier bid to force the U.S. Postal Service to scrap thousands of EVs and charging equipment after the Senate parliamentarian ruled it couldn’t be included under reconciliation rules.
Further, the Senate version would also eliminate the $200 tax stamp required for purchasing firearm silencers, also known as suppressors, and would scrap the tax stamp for short-barrel rifles as well. Medicaid, Rural Hospitals Medicaid and funding for rural health care have been major sticking points in negotiations over the budget bill.
The latest Senate version increases funding for rural hospitals to $25 billion between 2028 and 2032, up from an earlier proposal of $15 billion, but still well below the $100 billion sought by Sen. Susan Collins (R-Maine). Under the new plan, the fund would provide $10 billion in 2028, another $10 billion in 2029, $2 billion in both 2030 and 2031, and $1 billion in 2032.
Another contentious issue has been provider taxes—fees that states charge hospitals and other health care providers to help finance their share of Medicaid costs. Although these taxes allow states to increase reported Medicaid spending and draw additional federal funds without necessarily expanding services, many states rely on the mechanism to maintain stable Medicaid programs.
While the House version would keep the current federal cap on provider taxes at 6 percent of a provider’s revenue, the latest Senate bill proposes lowering the cap to 3.5 percent. To ease the transition, the Senate plan phases in the reduction gradually: the cap would drop to 5.5 percent in 2028, 5 percent in 2029, 4.5 percent in 2030, 4 percent in 2031, and finally 3.5 percent in 2032.
Meanwhile, a group of 16 House Republicans, led by Rep. David Valadao (R-Calif.), recently warned that they won’t support the Senate bill unless the current 6 percent cap on provider taxes is maintained. In a letter, they argued that lowering the cap would strain hospital finances and jeopardize Medicaid coverage for vulnerable constituents.
Tensions over Medicaid policy have also been heightened by provisions the Senate parliamentarian ordered stripped from the bill. These included proposals to bar illegal immigrants from accessing Medicaid, prevent refugees and asylum seekers from using Medicare, and prohibit Medicaid funding for transgender-related medical procedures.
Republicans overall have proposed changes aimed at reducing federal Medicaid spending by more than $880 billion over 10 years. The House version of the bill contains measures to tighten eligibility, such as requiring Medicaid recipients to verify eligibility twice a year instead of once, imposing work requirements for able-bodied adults without dependents, and penalizing states that enroll individuals living in the country illegally.
Democrats have strongly objected to these proposed changes to Medicaid, citing their effect on access to health care. A report from the Congressional Budget Office states that this would result in some 7.8 million more people being uninsured by 2034.
Parliamentary Challenges The Senate bill has also received a thorough “Byrd bath,” a reference to the rule named for late West Virginia Sen. Robert Byrd. The Byrd rule limits budget reconciliation bills to fiscal issues. Some Republicans, too, have expressed concerns over the potential impact on rural health care. Sen. Josh Hawley (R-Mo.) has said that he would need to review the details of his party’s plan for Medicaid provider taxes before deciding how to vote on the legislation.The Senate bill has also received a thorough “Byrd bath,” a reference to the rule named for late West Virginia Sen. Robert Byrd. The Byrd rule limits budget reconciliation bills to fiscal issues.
MacDonough ruled against many provisions in the Senate committee drafts of the legislation.
Those provisions include one empowering states to enforce immigration law, multiple provisions relating to the federal workforce, and a provision financially rewarding cost-cutting measures by agencies.
MacDonough also rejected a pay cut for Federal Reserve employees and a repeal of programs authorized by the Biden-era Inflation Reduction Act, among other rulings.
Senate Republicans could overrule the Parliamentarian, a possibility Democrats have argued against.
“It is tantamount to eliminating the filibuster,” Sen. Sheldon Whitehouse (D-R.I.) said in May.
In early June, Thune said overruling the parliamentarian was off the table. Senate, House Agreement Both chambers of the legislature must pass an identical bill for it to become law. Any differences between the proposed Senate bill and the version passed by the House would have to be resolved.
The Senate could change course and pass the House version of the bill. The House could vote again on the bill, passing the version approved by the Senate. Or the bills passed by each House could be resolved through a conference committee.
Amid concerns that the two chambers were at odds, Johnson expressed optimism about passage within the stated time frame.
“This is a one team approach, the House and Senate Republicans working together in tandem with the White House,” Johnson told Fox News on June 24. “There’s no daylight between any of us on the ultimate goal.”
Theorizing that the Senate would pass its bill by June 27, Johnson said he had told House Republicans to keep their schedule flexible over the next several days.
“Everybody can go home and celebrate the Fourth of July with their constituents and their families. But there’s nothing more important that we should be involved in … than getting One Big Beautiful Bill to the president’s desk,” Johnson said.
Meanwhile, Democrats took to social media early Saturday to criticize the Senate Republicans’ megabill, following the overnight release of the legislation’s text.
“At the behest of Big Oil, in the dead of night, Senate Republicans released a new version of their ‘Big, Beautiful Betrayal’ that retroactively raises taxes on energy,” Senate Minority Leader Chuck Schumer (D-N.Y.) posted on the social platform X. “Republicans want to jack up your electric bills and jeopardize hundreds of thousands of jobs, all so they can give billionaires tax breaks.”
Meanwhile, preliminary estimates suggest significant fiscal impacts from the bill. Based on analyses from the Joint Committee on Taxation, official House estimates, and committee reports, the pre-Byrd rule version of the One Big Beautiful Bill Act would boost primary deficits by $2.9 trillion through fiscal year 2034, increasing total borrowing to $3.5 trillion with interest costs, according to the Committee for a Responsible Federal Budget (CRFB).
Stripping out provisions flagged by the Senate parliamentarian as violating the Byrd rule would raise the primary deficit impact to $3.5 trillion and push total borrowing to $4.2 trillion. Depending on final negotiations over measures such as the SALT deduction cap and other measures, total borrowing under the bill could climb as high as $4.5 trillion, per CRFB.
Here’s what’s in the GOP megabill headed for a vote in the Senate
Senate Republicans have released an updated version of the massive spending and tax cut legislation. The updated bill shares many of the same overall policies that narrowly passed in the House of Representatives in May. It includes an extension of Trump’s 2017 tax cuts as well as increased funding for border security, defense spending and energy production. The Senate bill is expected to face pushback from conflicting factions of the party, particularly from fiscal hawks who want to reduce the deficit and lawmakers who have drawn a red line on major cuts to social safety net programs. The process includes an open-ended series of amendments that could stretch into Sunday and may lead to further changes to the bill. The House will need to agree to the same bill if it passes the Senate and then pass it back to its own chamber in the Senate to avoid a potential government shutdown in mid-August. The CBO estimates that without action from Congress, the U.S. will run out of money to pay its bills at some point between mid- August and end of September.
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Senate Republicans have released an updated version of the massive spending and tax cut legislation, containing much of President Trump’s domestic agenda, setting the table for votes on the legislation less than a week ahead of the party’s self-imposed July 4 deadline.
The updated bill shares many of the same overall policies that narrowly passed in the House of Representatives in May, including an extension of Trump’s 2017 tax cuts as well as increased funding for border security, defense spending and energy production.
Republican leaders hope to begin votes on the measure on Saturday. The process includes an open-ended series of amendments that could stretch into Sunday and may lead to further changes to the bill.
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Where Republicans remain divided is how they pay for these priorities. Despite the same toplines, the Senate’s proposed legislation features several changes from the House-passed bill, notably a higher increase to the debt limit and major changes to Medicaid, the insurance program for low-income Americans.
The Senate bill also has modifications made at the advice of the Senate Parliamentarian, Elizabeth MacDonough, who serves in an unelected and nonpartisan role focused on maintaining chamber rules. Over the last week, MacDonough found that a number of provisions in the bill didn’t qualify for a simple majority under reconciliation and needed to be removed.
The Senate bill is expected to face pushback from conflicting factions of the party, particularly from fiscal hawks who want to reduce the deficit and lawmakers who have drawn a red line on major cuts to social safety net programs.
And there is still internal strife over how to address the nation’s borrowing limit. Sen. Rand Paul of Kentucky, has vowed to vote against the bill over the issue.
While some GOP Senators also have concerns about the bill, the bigger fight may rest back in the House, which holds a razor-thin majority and will need to agree to the same bill if it passes the Senate.
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This is a developing story, some elements of the bill were negotiated up until the last minute. What follows is a partial list and will be updated.
Some of the biggest changes
Tax incentives
Congressional Republicans have included many of the president’s tax-related campaign promises in the bill. The Senate’s text includes temporary changes that would allow Americans to deduct up to $25,000 for tip wages and $12,500 for overtime pay through 2028. The Senate version also says that overtime and tip deductions will be reduced for Americans with incomes higher than $150,000. Those limits were not included in the House version.
The Senate bill also increases the child tax credit from $2,000 to $2,200 per child and adjusts the amount for inflation after 2025. It’s slightly different than the House plan to temporarily increase the credit to $2,500 before cutting it back to the current level and adjusting for inflation.
In addition, the Senate text would permanently expand the standard deduction, marking a key difference from the House bill, which temporarily expands it through 2028. Senators also boosted a tax deduction for people over 65 to $6,000 through 2028, compared to $4,000 in the House bill. Both chambers included a phase out for people earning over $75,000.
Increasing the debt ceiling
The Senate is proposing raising the nation’s debt limit by $5 trillion, a sizable increase compared to the House bill, which agreed to $4 trillion.
Lifting the debt limit doesn’t authorize new spending. Instead, it allows the government to pay for programs that Congress has already authorized. If the cap isn’t lifted and the government can’t meet its obligations, then it will be at risk of default — a scenario that economists say would be catastrophic not just for the U.S., but the global financial system as a whole. The CBO estimates that without action from Congress, the U.S. will run out of money to pay its bills at some point between mid-August and the end of September.
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Earlier this month, 38 members signed onto a letter addressed to Senate Majority Leader John Thune, R-N.D., criticizing the size of the increase.
Changes to SNAP
Both the Senate and House outlined reforms for the Supplemental Nutrition Assistance Program, known as SNAP, which provides aid for food to more than 40 million low-income Americans.
The Senate bill includes expanded work requirements that “able bodied adults” continue to work up to age 64. There are exemptions for parents with children under 14 and limits on the ways states can offer waivers for those requirements.
The bill would also force states to take on a greater share of the cost of providing food assistance. The amount a state owes would be based on a formula set by the percentage of erroneous payments reported each year. Those changes would go into effect in 2028.
State and Local Tax Deduction
One of the thorniest issues during negotiations has been the state and local tax deduction, also known as SALT. The deduction is particularly important to a small number of GOP lawmakers in the House from blue states with high taxes, such as California and New York. Trump’s 2017 tax cuts capped the SALT deduction at $10,000. The Senate plan would temporarily lift the cap to $40,000 for married couples with incomes up to $500,000. But that provision would expire after 2028 — an effort to buoy the blue-state Republicans through the 2026 midterm and 2028 election cycles, while limiting the long-term impact of the cuts on federal tax revenue.
“We have about a dozen members that are voting on this bill exclusively based on what happens with SALT. There’s not a single senator on the Republican side that has that same issue,” House Majority Leader Steve Scalise R-La., acknowledged to reporters on Tuesday adding an agreement on SALT “has to get resolved if you’re going to have a bill to pass.”
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Medicaid
The Senate released an updated version of the legislation that includes several proposed changes to Medicaid, the popular, joint federal/state health care program for low-income, elderly and disabled Americans. It’s remained one of the most divisive issues throughout both House and Senate negotiations.
The Senate plan would require able bodied adults to work 80 hours per month until age 65 to qualify for benefits. There are carveouts for parents of children under 14 and those with disabilities.
The plan would also cap and gradually reduce the tax states can impose on Medicaid providers. The phase out would begin in 2028, ultimately ending in a 3.5 percent cap on that tax. Several GOP senators have raised concerns that the tax is a critical funding stream for rural hospitals in particular — which could close if that income stream dries up.
In an effort to alleviate some of those concerns, Senate GOP leaders included a new $25 billion fund to support rural hospitals. That program would also begin in 2028 and funds would be spread out over five years.
What’s stayed mostly the same
Extending the Trump tax cuts
The Senate bill calls for $4 trillion in tax cuts, which is slightly higher than the $3.8 trillion proposed in the House. That move would extend Trump’s 2017 tax cuts, which are set to expire at the end of the year, meaning that without an extension, most households would see their taxes increase.
Billions for border security
Both the Senate and the House bills allocate $46.5 billion toward completing Trump’s border wall. It also puts $5 billion for Customs and Border Protection facilities and $10 billion to be used for border security more broadly. The Senate bill sets aside less funding to hire and retain more agents and officers, proposing $4.1 billion compared to the $6 billion allocated in the House. The legislation also invests in upgraded technology for screenings and surveillance of U.S. borders.
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New immigration fees
Much like the House-passed bill, the Senate legislation includes a handful of new or increased fees for immigration services. The bill would create a $550 charge for work authorization applications with renewal every six months.
However, the Senate parliamentarian determined that a $1,000 fee for asylum applications did not meet the rules necessary to qualify for a simple majority vote.
A student loan overhaul
Like the House-passed bill, the Senate plan would scrap several existing repayment options, including the Biden-era SAVE program that based payments on income and household size. It replaces them with a new, standard repayment plan and an income-based plan Republicans call their “Repayment Assistance Plan.” The bill would also cap the amount that parents and graduate students can take out in federal loans each year.
One difference between the two bills concerns the Pell Grant program for low-income students. The House proposed increasing the credit hours required for full-time and part-time students in order to receive Pell Grants, but the Senate has left current enrollment rules intact. The Senate bill does bar students from qualifying for a Pell Grant if they’ve received a full scholarship through other sources of aid.
Regulating Artificial Intelligence
The Senate proposal allocates $500 million to the Broadband, Equity, Access, and Deployment Program, which is focused on increasing broadband access for Americans, and specifies that the funding can be used for developing artificial intelligence models and systems. But it also requires that states only receive this funding if they do not regulate A.I. for 10 years. That rule was also laid out in the House-passed bill
Why Louisiana is uniquely vulnerable to cuts in Trump’s megabill
Louisiana could lose $4 billion in Medicaid funding. The state is home to 1 in 5 of the nation’s Medicaid recipients. The bill is expected to be passed by the end of the month.
The proposed legislation—central to Donald Trump’s policy agenda—includes deep cuts to Medicaid and food assistance, sparking bipartisan concern in Louisiana, where nearly 35% of residents rely on Medicaid and 1 in 5 depend on SNAP benefits.
While House Speaker Mike Johnson has championed the bill in Washington, Republican lawmakers back home warn the cuts could shutter rural hospitals, slash jobs and leave vulnerable residents without access to basic care. State officials estimate Louisiana could lose $4 billion in Medicaid funding, triggering emergency budget sessions and widespread service reductions.
Despite its strong conservative lean, Louisiana’s unique dependence on federal aid has leaders from both parties pleading for revisions before the bill hits the Senate floor. The state Legislature—controlled by a GOP supermajority—has already passed a resolution opposing Medicaid cuts.
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