Republicans on the Senate Finance Committee have unveiled that chamber’s version of the “big, beautiful” reconciliation package, which includes notable changes from the House’s proposal.
The bill will be the subject of intense scrutiny in the Senate, where more moderate Republicans have balked at significant cuts to Medicaid while the party’s more conservative wing has pushed for spending reductions to go further. GOP leaders want to push the bill through to the president’s desk by July 4, according to The Wall Street Journal.
Sen. Mike Crapo, R-Idaho, the finance committee’s chairman, said in a statement that the package is designed to take on “fraud, waste and abuse” in key federal spending programs like Medicaid “while preserving and protecting them for the most vulnerable.”
“I look forward to continued coordination with our colleagues in the House and the Administration to deliver President Trump’s bold economic agenda for the American people as quickly as possible,” Crapo said.
Here’s a look at some of the key policies in the bill that impact healthcare:
Medicaid is still set for steep cuts
The Medicaid program was a key target in Republicans’ efforts to cut spending, with the House version of the reconciliation bill instituting work requirements. The Senate’s version of the bill preserves the work requirements.
Under the bill, able-bodied, childless individuals between the ages of 19 and 64 will be required to complete at least 80 hours of certain activities per month, including work, community service or education programs. The Senate bill frames these changes under the topic of “increasing personal accountability.”
The Senate bill exempts adults with dependent children from the work requirements, but only those adults with children under the age of 14.
Experts have warned that most able-bodied people enrolled in Medicaid are already working, and the requirements add a potentially onerous administrative burden that leads people to fall through the cracks. Work requirements have been a longtime policy proposal from Republicans.
The Senate’s bill also takes a more aggressive stance on provider taxes in Medicaid, capping them at 3.5% for expansion states, down from the current 6% rate. The House bill would have instead frozen the taxes at current rates.
The bill would also reduce state-directed payments to providers in expansion states.
The proposed changes to the tax and state-directed payments immediately drew ire from hospital groups following the bill’s release on Monday.
“These harmful proposals will impact access to all patients who are served by our nation’s hospitals and health systems,” said Rick Pollack, president of the American Hospital Association, in a statement. “These cuts will strain emergency departments as they become the family doctor to millions of newly uninsured people. Finally, the proposal will force hospitals to reconsider services or potentially close, particularly in rural areas.”
The reconciliation bill would also prevent federal Medicaid and Children’s Health Insurance Program dollars from being used to cover “specified items and services for gender transition purposes,” per a fact sheet from Crapo’s office.
Medicare spared from major changes despite rumors
As legislators prepared the bill, sources close to the discussions said that significant changes or cuts to Medicare were also on the table, likely through reforms to Medicare Advantage.
The bill would require Medicare beneficiaries to prove their citizenship or legal residency status to continue to receive their benefits.
The proposed package would also bar the Department of Health and Human Services from enforcing regulations that set staffing minimums at long-term care facilities. A federal judge vacated the Biden-era regulation in April following an outcry from the nursing home industry.
NBC News also reported that the reconciliation package would make changes to cost-sharing for dual eligibles.
Other highlights
Senators scrapped provisions in the House bill that would have significantly expanded health savings accounts.
Similar to Medicare, the bill proposal would limit access to premium tax credits under the Affordable Care Act (ACA) to certain immigrant groups and would require individuals who qualify for tax credits to recertify their eligibility, similar to Medicaid eligibility determinations.
Enhanced premium tax credits for ACA plans are set to expire at the end of this year, and the Senate bill does not include measures to extend them. The enhanced subsidies were put in place following the COVID-19 pandemic and have played a key role in a boom in enrollment for marketplace coverage.
Should those tax credits indeed be rolled back, policy experts have said it will likely lead millions to become uninsured.
Republicans in the House were also planning to allow the enhanced subsidies to expire.
Pharmacy benefit managers escaped from the bill largely unscathed despite significant bipartisan interest on the Hill in reforming that sector. The bill would institute a ban on spread pricing in Medicaid, which has largely been criticized by the PBM industry as preventing managed care organizations from selecting the pricing model that best works for them.