For the past several weeks, Andrea Carr has spent long stretches of the night awake, unable to stop worrying. Carr is a personal support worker. She gets paid by Medicaid to help her daughter who is, in her words, an 8-year-old trapped in a 33-year-old’s body.

Carr is worried about what the looming federal budget cuts to Medicaid, part of a wide-ranging policy bill President Donald Trump recently signed into law, could do to her family’s stability.

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Without the funding from Medicaid, she said, “We could be destitute in two months. We would be out in the street.”

Carr lives in the unincorporated community of Sprague River, with a population of around 70 people, an hour or so away from Klamath Falls. Across the state, caregivers of all types — those helping members of their own family, like Carr, to those caring for seniors or those with terminal illness — are worrying about reductions to Medicaid. That money helps pay their salary and in some cases, their own health insurance.

Earlier this month, the President signed a wide-ranging spending and tax bill known as the “big, beautiful bill.” The bill is paid for partially by making cuts to programs like Medicaid.

There are a lot of unknowns about how the changes to Medicaid could affect Oregonians. Some estimates put Oregon as one of the most vulnerable states, with more than 20% of people currently enrolled who could lose their coverage.

Activists with the Poor People’s Campaign protest against spending reductions across Medicaid, food stamps and federal aid in President Donald Trump’s spending and tax bill being worked on by Senate Republicans this week, outside the Supreme Court in Washington, Monday, June 2, 2025. (AP Photo/J. Scott Applewhite) J. Scott Applewhite / AP

Oregon is also expected to take a hit because it relies on a high rate of provider taxes, which are levied on healthcare providers like hospitals.

Provider taxes are a crucial revenue source to pay for Oregon’s portion of Medicaid. The state provider tax dollars are matched by federal dollars and go toward funding Medicaid. Oregon may have to reduce the amount of provider taxes it levies under the new federal law, according to the health research publication KFF. Those dollars help pay for home-and community-based care programs.

The Trump administration said the “One Big Beautiful Bill” will not cut Medicaid, but strengthen it for those who rely on it. Disability advocates and others are worried that won’t be the case.

“We’re all bracing for the impact of Medicaid cuts — we don’t know exactly how they will impact Oregon, but we do know it’s going to be bad for people with disabilities,” Jake Cornett, executive director and CEO at Disability Rights Oregon, wrote in an email.

Cornett said Oregon has been at the forefront of ensuring those with disabilities can live full lives, hold jobs, build friendships and create their own future.

“Looking at the next few years, one thing is certain, we will not be forced back into institutions with the isolation, abuse, and neglect that comes along with those settings,” Cornett said.

All the uncertainty, Carr said, has brought its own turmoil.

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“It’s totally turned my life and every other personal support worker in Oregon upside down,” she said.

In the most recent Oregon legislative session, which concluded on June 27, state lawmakers considered a measure to stabilize the caregiving population in Oregon. The workforce, which is responsible for taking care of some of the state’s most vulnerable, is often in a precarious financial position themselves. The bill would have created a new board charged with improving caregivers’ working conditions.

The measure envisioned a board whose members were appointed by the governor and overseen by an executive director. It would have had members who represent employers, employees and customers. The board would set pay and staffing standards for the some 50,000 caretakers in the state.

Despite support from top lawmakers, the union-backed bill failed.

Opponents of the measure said it created more unnecessary bureaucracy and would have given an unelected board a lot of power to set staffing and wage standards for the industry.

Lois Gibson, the executive director of the Oregon Resource Association, which represents those who provide services to intellectually- and developmentally-disabled people across the state, opposed the measure for many reasons. The association said the board would have duplicated work already being done, would have been costly to set up and its authority would have been too broad.

The most pressing way to stem the crisis, Gibson said, simply boils down to wages.

“It’s related to wages more than anything else,” she said. “We are just staying a bit ahead of workers in fast food and retail.”

But Melissa Unger, executive director of SEIU Local 503, which backed the legislative effort, said the union has spent the last decade pushing for rate increases for this workforce. With Oregon’s growing elderly population, it is crucial to figure out a more sustainable way to support caregivers, she said.

“The challenge is, this is a complex workforce that is government funded,” Unger said. “So the idea that legislators can come in every two years and know all the ins and outs (isn’t realistic).”

Putting both the workforce and employers in a room to tackle the challenges on an ongoing basis, she said, makes sense. Unger added the union plans to resurrect the legislation at some point.

Shaun Notdurft, a 57-year-old caregiver in Springfield, said he was supportive of the idea of a workforce standard board primarily so people in his occupation had a voice in the discussions. He spent more than three decades as a caregiver and was still making less than $21 an hour while working in a group home.

“The principal challenges that every (direct support professional) faces at every company is the company and rules from the state that need to evolve,” he said. “Even well-meaning companies, they don’t listen to us. They consider the workforce undereducated … and it’s extremely frustrating when you deeply care about the work.”

A spokesperson said in a statement that Oregon Gov. Tina Kotek has directed all state agencies to “urgently evaluate impacts of the federal budget to Oregon.”

Carr, who takes care of her daughter every day in Sprague River, has spent time trying to connect with politicians who are supporting slashing Medicaid.

“I’m not understanding what is going through these folks’ minds right now,” she said. “But I know what’s going through mine and it’s sheer, holy terror.”

CNN —

The Senate worked overnight into the early hours of Thursday morning as it weighed whether to claw back $9 billion in federal funds already congressionally approved for foreign aid and public broadcasting programs as a deadline to act on the White House priority looms.

A “vote-a-rama” on the administration’s request – known as a “rescission package” on Capitol Hill – began Wednesday afternoon after senators narrowly cleared two procedural hurdles late Tuesday to move closer to a final vote. If passed, the GOP effort would effectively codify a small portion of the Department of Government Efficiency’s spending cuts.

The Senate and House must pass the legislation by Friday, under an obscure presidential budget law used to circumvent the filibuster, or be forced to start over at a later date. It was not immediately clear when a final vote would take place, but it appeared poised Wednesday afternoon to pass with a potential tie-breaking vote from the vice president.

The effort appeared to get a boost Tuesday when Senate Republicans signaled resolution on sticking points related to a key global health initiative and rural radio access. Despite that progress, three GOP senators joined Democrats in voting against the measure later that night, forcing party leadership to once again summon Vice President JD Vance to the Capitol to help advance it.

Sen. Lisa Murkowski, who along with top Senate appropriator Susan Collins and former Senate GOP Leader Mitch McConnell voted against the package Tuesday, defended her vote in the face of a threat from President Donald Trump to withhold support from any Republican who opposes the bill.

The Alaska Republican said she took the legislative power of the purse “personally,” adding, “So I’m going to execute on it. The president can say what he’s going to say, but that’s fine. I’m going to do what I’m going to do.”

Murkowski declined to say how she would vote after the marathon voting session on amendments.

Unlike in other vote-a-ramas, the amendments offered to the rescissions package must be “germane” to the bill, which limits the kinds of amendments lawmakers can offer. Still, the process allows Republicans to make changes to the legislation and provides Democrats an opportunity to force their Republican colleagues to vote on politically difficult issues.

Sticking points

Among the changes Republicans are expected to make to the bill is the removal of a controversial $400 million cut that senators believed would impact the President’s Emergency Plan for AIDS Relief, or PEPFAR.

Gavi, an organization focused on providing vaccinations for children around the world, would also not face cuts in the package, Senate Majority Leader John Thune told reporters. “We were reassured by the [White House Office of Management and Budget] director that would not be affected in this process,” he said.

On another front, Sen. Mike Rounds announced he would back the measure after working out an agreement that would keep funds flowing to rural radio stations in his state of South Dakota, an issue he’s been working for weeks to resolve.

Rounds said of his negotiations on X: “We wanted to make sure tribal broadcast services in South Dakota continued to operate which provide potentially lifesaving emergency alerts,” and said that he worked with the Trump administration to find “money that could be reallocated to continue grants to tribal radio stations without interruption.”

The OMB director projected confidence about the package, despite the expected changes to it.

“We’re fine with adjustments. This is still a great package,” Russ Vought told reporters after a closed-door meeting with GOP senators Tuesday.

The Senate, he added at the time, “has to work its will and we’ve appreciated the work along the way to get to a place where they think they’ve got the votes.”

White House Office of Management and Budget Director Russ Vought speaks to reporters on Capitol Hill in Washington, DC, on Tuesday. Ken Cedeno/Reuters

Despite the OMB director’s visit to the Senate GOP lunch, Collins and Murkowski, in explaining their votes, argued they had not received specific information from the administration on how the cuts could affect global health programs and public broadcasting.

Murkowski also argued that the rescissions package from the White House sets a harmful precedent undermining Congressional authority.

“We’re lawmakers. We should be legislating. What we’re getting now is a direction from the White House and being told, ‘This is the priority. We want you to execute on it. We’ll be back with you with another round,’” she said ahead of the procedural votes on the package. “I don’t accept that. I’m going to be voting no.”

Thune on Wednesday acknowledged concerns from the three Republican senators over how specific cuts would be carried out, saying they made a “fair point.”

“The administration needs to be more specific. I think that’s a fair point. But this is an area of the law historically where it isn’t as specific. In most cases, when it comes to the State Department, grant a good deal of flexibility about how to allocate some of the resources that Congress appropriates. But I don’t disagree. I think that more specificity would be a good thing,” the Republican leader said.

Thune said despite the lack of details, he and most members of his conference felt like they had enough information to advance the bill that’s expected to pass Wednesday or Thursday.

House test on the horizon

Since senators are planning to make changes to the bill, it is expected to have to return to the House for final passage – marking the second time this month the Senate GOP would be jamming the House on a Trump priority.

House Speaker Mike Johnson earlier in the day encouraged the Senate to send the package back to his chamber “as is” due to the House Republicans’ narrow majority.

The Louisiana Republican said he’s urged the Senate “as I always do, to please keep the product unamended, because we have a narrow margin and we got to pass it.”

“We’re going to process whatever they send us, whenever they send us. I’m hopeful that it will be soon,” Johnson said Tuesday.

This headline and story have been updated with additional developments.

CNN’s Lauren Fox, Alison Main, Manu Raju, Casey Riddle, Veronica Stracqaulursi, Maggie McCabe and Sarah Ferris contributed to this report.