WASHINGTON (States Newsroom) – The big, beautiful bill on Wednesday seemed to split U.S. Senate Republicans on how to create a fund for rural hospitals to counter the budget impacts of Medicaid cuts.
Medicaid, a state-federal collaboration that offers health insurance to low-income households and some individuals with disabilities, is a major source of funding for the hospitals, which are typically already struggling financially.
Although leaders intend to start voting as early as Friday, GOP senators have yet to agree on the fund’s form or on dozens of other outstanding items in the comprehensive package. Agreements on key aspects of the plan, such as the proposed sale of some public lands and the U.S. Department of Agriculture’s food assistance program for low-income individuals, were still up in the air.
Republican leaders maintained their optimistic stance. As he continues to move toward a self-imposed Fourth of July deadline, Senate Majority Leader John Thune, R-S.D., stated on the floor that “we’re well on our way to getting this bill passed this week.”
Others had a different perspective. Sen. Ron Johnson, a Republican from Wisconsin, questioned the leaders’ tight timeline for reaching a final agreement and passing the package through both chambers.
“We’re still talking about some pretty basic things,” Johnson stated. I’m merely outlining the situation as it is. We have a lot of work ahead of us.
The only person up here that s ever ran a rural hospital
As senators worked to finish the major tax and expenditure cut legislation, competing suggestions to create the rural hospital fund to mitigate the prospect of Medicaid cuts circulated, but by late afternoon, no agreement had emerged.
According to several sources, Senate Republicans are considering including a $15 billion fund that would provide $3 billion year between fiscal 2027 and fiscal 2031 to support rural hospitals.
However, Senate Finance Committee member Sen. Roger Marshall stated that he would like to see that fund increased to $5 billion a year, with half of that amount going to rural hospitals, and the other half going to primary care, prescription medications, physical therapy, occupational therapy, and all the rest.
According to the physician and Kansas Republican, we should probably only continue for four or five years before regrouping and assessing our progress.
The only person up here who has ever managed a rural hospital is me, so I do know a little bit about them, he said.
Marshall claimed that not nearly enough is being reduced, even though he loves 90% of the larger bill.
Though it will be difficult for the House to vote against it, he stated, “I can’t get the votes to do that, so it would still be the largest cut in spending in my lifetime anyway.”
Fund size criticized
The Missouri Budget Project’s Traci Gleason told reporters during a midday call that the stability fund being floated by lawmakers would not adequately address these issues.
According to Gleason, who was speaking at a virtual press briefing hosted by the left-leaning Center for Budget and Policy Priorities, 43% of Missouri’s rural hospitals are in danger of closing, and 17% are in urgent danger.
Not all of the other healthcare providers in rural areas, such as federally designated health centers and others that work on extremely narrow margins, are included in those numbers. According to her, the problem is being caused by the significant Medicaid cuts, and the only effective solution is for Congress to refrain from making these cuts.
Problematic Medicaid cuts
Sen. Susan Collins pushed for a $100 billion rural hospital stabilization fund, which is far larger.
The Senate Appropriations Committee head, a Republican from Maine, stated, “I don’t think that solves the entire problem.”
Another issue, in my opinion, is that the Senate’s Medicaid cuts are much more extensive than the House’s.
The $15 billion is better than nothing, according to West Virginia Senator Jim Justice.
He added that rural hospitals are the backbone of his state and that, of course, he would want it to be as high as possible.
Sen. Josh Hawley of Missouri, a vocal opponent of Medicaid coverage changes, stated that while a stabilization fund is a good idea, the longer-term impacts of this will still need to be addressed.
Hawley responded that it depended on its structure when asked for a monetary estimate.
Sen. John Cornyn, a Republican from Texas, stated that he has heard that the Senate would hold a procedural vote on Friday, but that is not confirmed.
We should all have a good time this weekend, Cornyn added. I’m eager.
The Senate must start its protracted amendment voting process and ultimately a passage vote once it votes on what is known as a motion to proceed, which is followed by up to 20 hours of floor discussion.
SNAP provisions
The lawmaker has not yet examined a revised version of his committee’s measure, according to Senate Agriculture Chairman John Boozman, a Republican from Arkansas.
A portion of the Supplemental Nutrition Assistance Program’s (SNAP) cost-share, a crucial food assistance program for those with low incomes, has been restructured in the amended wording.
For the first time, the clause would mandate that states pay a portion of the program’s benefits. A state’s error payment rate would decide how much it owes; higher error rates would necessitate a larger state share.
What can and cannot be included in the measure is governed by intricate rules. The Senate lawmaker determined that the original proposal’s wording did not adhere to the chamber’s reconciliation regulations.
The revised proposal would provide states additional freedom to select the error rate in fiscal 2025 or fiscal 2026 when the program is phased in in fiscal 2028.
Boozman informed reporters that the goal of the adjustment was to address the parliamentarian’s decision.
According to Boozman, the lawmaker requested that we provide them (the states) an alternative time frame, which essentially gave them more time to estimate their error rate and make plans for it. We made the necessary adjustments, and I believe we were satisfied.
Lee and public lands
According to reports, Mike Lee of Utah, the Senate’s chairman of the Energy and Natural Resources committee, limited a provision that would require the sale of properties owned by the Bureau of Land Management. He has not stated in public where he stands with the lawmaker.
On Tuesday and Wednesday, a committee spokesperson did not respond to queries asking for clarity; nevertheless, a version of the revisions received by news media indicates that they are in line with Lee’s Monday proposal.
These modifications include reducing the percentage of the agency’s lands that must be sold to between.25% and.5% and restricting the required sales to only the BLM and not U.S. Forest Service properties, as Lee had originally suggested. The original proposal called for.5% to.75%.
According to a copy of the amendments acquired by the hunting and fishing publication Outdoor Life, the revised clause would also only require the sale of lands that are within five miles of a population center and would exempt lands that are currently used for grazing or another legitimate existing right that is incompatible with the development of housing.
Some conservative parliamentarians and some Western MPs have opposed the measure.
However, it has its share of proponents. Although he had not seen the revised text, Alaska Republican Dan Sullivan told reporters he still supported the concept.
“I have supported Sen. Lee’s efforts,” he stated. The federal government misuses a large number of Alaska’s public lands. However, we’re having a nice conversation about that, so I need to see the latest information.
By Jennifer Shutt, Jacob Fischler, Shauneen Miranda, and Ashley Murray
