In keeping with our ongoing efforts to update you on policy developments related to Medicaid, we are writing to inform you that, on Monday, the Senate Finance Committee released draft text of their legislative recommendations for budget reconciliation. You can read the draft text and a section-by-section summary of the text.

The Senate Finance Committee, which has jurisdiction over Medicaid within the Senate, has kept intact many of the Medicaid provisions from H.R. 1, the One Big, Beautiful, Bill Act (text of that legislation; summary of some of the bill’s key Medicaid provisions). Overall, while many elements of the House and Senate bill are similar or identical, the Senate text seeks deeper Medicaid savings than the House bill. Some notable changes including the following:

• Provider Taxes: The Senate text proposes lowering the maximum allowable rate of provider taxes from 6% to 3.5% in Medicaid expansion states for all facilities other than nursing homes and intermediate care facilities. Provider tax rates would be reduced by 0.5% annually after the bill is enacted and until the 3.5% level is reached.
  • The Senate text makes no changes to the maximum allowable rate of provider taxes in non-expansion states but keeps in place the moratorium on new provider taxes proposed by H.R. 1.
  • Lauri’s add-on:  Notably, the bill does not seek to repeal New York’s exception to these rules for the HCRA tax system, which may continue so long as HCRA does not change and the enabling federal statute is in place. This change will therefore have a limited effect on New York specifically.
• Work/Community Engagement Requirements: The work/community engagement requirements are largely the same among the House and Senate bills. However, H.R. 1 exempted anyone who is the parent, guardian or caretaker of a person with disabilities or a dependent child, whereas the Senate text limits this exemption to parents, guardians, and caretakers of children 14 years old or under and people with disabilities, meaning parents, guardians and caretakers of individuals 15 and above would not be exempted.
  • Exemptions from H.R. 1 for those participating in a “drug addiction or alcoholic treatment and rehabilitation program” and individuals with a “disabling mental disorder” or “substance use disorder” are maintained in the Senate text.
• State-Directed Payments: H. R. 1 provided that state-directed payments to providers cannot exceed 100% of the equivalent Medicare published payment rate for those services in Medicaid expansion states (110% for non-expansion states), unless previously approved before the bill’s effective date. In the absence of a published Medicare rate, an equivalent Medicare rate must be used. The Senate text specifies that in the absence of a published Medicare rate, the payment rate under a Medicaid State plan, rather than an equivalent Medicare rate, must be used. The Senate bill also modifies the existing grandfathering provision, setting conditions on it so as to lower all payments down to the 100% or 110% rate (depending on the state) eventually.  Lauri’s add-on:  In New York, this could be an additional cut each year of about $300 million.  

The new provider tax provisions in particular could prove especially damaging, significantly impacting Medicaid financing in a number of states and risking the support of moderate Republicans in both chambers. Sen. Josh Hawley (R-Mo.) called the proposed Senate changes to Medicaid a “hard sell in Missouri,” and some swing-district House Republicans may also be reluctant to embrace the changes.

Now that all Senate committees have released reconciliation text, the Budget Committee will compile all of the individual committee pieces into a full package for a floor vote. No specific time frame for floor consideration has been announced at this time, but Senators will have up to 20 hours to debate the measure, followed by a “vote-a-rama” on amendments, and only a simple majority (51 votes) is needed for final Senate passage.  

Both chambers will need to reconcile their differences if there are substantial differences between the House and Senate versions of the bill. Once this happens the bill will be sent to the President to be signed.

(Legal Action Center email just in):

Families USA and partners have numerous other ways for you to get involved and make your voice heard this week, including:

• Call to Action
  • Join Families USA and other health advocates in telling your Senator – Hands Off Medicaid and the ACA!
• Updated FUSA Analyses
  • Senate Finance committee section-by-section breakdown
  • One Big Beautiful Bill summary: Harmful Impacts of Proposed House Budget Bill the “One Big Beautiful Bill Act” on Medicaid, Affordable Care Act, and Medicare
• Health Action Resource List
  • As a reminder, Families USA’s Health Action Resources List can be found on our website, where we compile resources from our partners for all of you to access in one place. You can find that page here.
• Defending Medicaid Landing Page
  • Families USA has a Defending Medicaid landing page! You can find district fact sheets, state-specific resources, and any other resources you may need for your advocacy in protecting and defending Medicaid.
  • See our letter opposing the “One Big Beautiful Bill Act” here!

• Email Writing Campaign: Tell Your Senator – No Cuts to Medicaid or the ACA!  Families USA.  
• Contact Your Legislators about the “One Big Beautiful Bill Act: “Take Action with YES! Access.
• Email Writing Campaign: Tell Congress: Reject Medicaid cuts that will pay for more tax cuts for the rich. Coalition on Human Needs.
• State Legislator Sign-On Letter to the Senate: Reject the Reconciliation Bill. Deadline is Friday, June 20th COB. Americans for Tax Fairness.

How to think about Senate Republicans’ goals 

Senate GOP leaders have two priorities as they fine-tune their proposals and pitch the revamped megabill to their colleagues: 

• Make it sound as though the bill has changed enough to satisfy Senate Republicans who had qualms with the House bill.
• Make it sound as though the bill remains mostly the same to placate House Republicans, who will have to approve the Senate’s changes.

Is this a tricky balance to strike? Absolutely, and it won’t be made easier if/when the Senate’s parliamentarian rules that some provisions don’t mass muster under reconciliation’s rules—again, see The Basics of Budget Reconciliation for more on that issue. 

Ultimately, though, Republican leaders are probably going to fall back on the same argument for GOP naysayers, no matter their position: “are you really going to be the person who holds up the President’s agenda when we’re so close to the finish line?” If last month’s House vote is any indication, this could be an effective tactic. Its effectiveness may hinge on:

• Whether and how the Senate’s initial proposals evolve in the coming weeks.
• The extent to which the President engages personally to cajole resistant Republicans, as he did in the House.  

New bill, same winners & losers

Despite these dynamics and the rhetoric you might hear as a result, the Senate’s bill is by no means a “more moderate” version of the House’s. This bill would still: 

• Give more to the very richest Americans and take from those who have the least. 
• Pay for tax giveaways to the rich and corporations by taking health care and food assistance from families.
• Funnel billions to the already-bloated Pentagon budget. 
• Create a slush fund to tear apart immigrant families in violation of the law.

Below are highlights from some of the latest analyses of the GOP megabill:

• The ultra-rich gain while the rest of us lose. The poorest 10 percent of households would lose an estimated $1,600 a year, while the richest 10 percent would gain about $12,000 a year, according to the Congressional Budget Office. Another analysis from Yale’s Budget Lab found that the House-passed bill would reduce incomes for the vast majority of U.S. households—specifically, the bottom 80 percent—when coupled with the President’s ineffective approach to tariffs. 
• Giveaways to the wealthy and corporations come from taking health care and food assistance from millions. An estimated 16 million people would lose their health insurance, while 8 million would be at-risk of losing food assistance under the Republican megabill. 

What to watch next 

Last week, we covered what an ambitious timeline to get the bill through Congress by July 4 could look like. We’ll continue to keep you updated on how this path forward may change in the coming weeks. 

In addition, the Congressional Progressive Caucus Center invites you to join The DOGE Double Standard: Billions for Bombs, Pennies for the People on Wednesday, June 25 at 3PM ET! Experts will debunk DOGE’s promises of government “efficiency” as Congress continues to abet wasteful spending at the Pentagon through legislation like the GOP megabill. Register here!   

(Source:  Congressional Progressive Policy Caucus Center)