GOP leaders boost rural hospital fund, rewrite Medicaid provisions to save Trump megabill
Senate Republican leaders substantially increased the size of a rural hospital relief fund and rewrote controversial language freezing health care provider taxes in a late-night bid to keep President Trump's 'big, beautiful bill' on track for a vote Saturday afternoon.
Republican leaders increased the size of the proposed rural hospital relief fund from $15 billion to $25 billion, with the money to be distributed over five years.
But the proposal falls far short of the $100 billion that Sen. Susan Collins (R-Maine), a key swing vote, asked to be allocated to a health care provider relief fund to help rural hospitals, nursing homes and community health centers.
The $25 billion rural hospital fund would allocate $10 billion in funding in 2028, another $10 billion in 2029, then $2 billion in 2030, another $2 billion in 2031 and finally $1 billion in 2032.
Altogether, it would provide only a fraction of the federal Medicaid funding that states are projected to lose over the next decade because of caps on the use of health care provider funds.
For example, Sen. Thom Tillis (R-N.C.) has projected that North Carolina would forfeit $38.9 billion in Medicaid funding from 2026 to 2035 as a result of capping the provider tax rate.
Senate Republican leaders cut language establishing a moratorium on new or increased health care provider taxes in states that did not expand Medicaid under the Affordable Care Act, which the parliamentarian found violated the Byrd Rule because it did not produce a substantial budgetary effect, according to a Republican senator briefed on the parliamentarian's ruling.
And they delayed the phase-in of a 0.5 percentage point annual reduction of the cap on health care provider taxes in states that expanded Medicaid under the ACA by one year.
Instead of states' health care provider taxes being reduced from 6 percent to 5.5 percent in 2027, the half-point reduction in the cap in provider taxes would go into effect in 2028.
Republicans hope the changes in language related to health care provider taxes will pass muster with Senate parliamentarian Elizabeth MacDonough.
MacDonough ruled on Thursday that the section of the bill capping states' use of health care provider taxes violated the Byrd Rule would not be eligible to pass with a simple-majority vote under the budget reconciliation fast track.
Republican senators briefed on the discussions with the parliamentarian said she also objected to the timeline for lowering the cap on health care provider taxes in Medicaid expansion states.
GOP lawmakers said they hope the parliamentarian will accept the cap language if it is delayed by a year.
Senate Budget Committee Chairman Lindsey Graham (R-S.C.) released the revised text of the Senate amendment to the One Big Beautiful Bill Act, which passed the House on May 22.
The Senate amendment is 940 pages long and cuts federal Medicaid spending substantially more than the House package.
Senate Majority Leader John Thune (R-S.D.) told Republican colleagues at lunch Friday that he plans to hold a vote on proceeding to the package midday Saturday.
If the motion to proceed to the bill passes, that would set up 20 hours of debate, equally divided between Republicans and Democrats, on the legislation before a long series of amendment votes known as a vote-a-rama.
Senators would vote on final passage of the bill at the end of the vote-a-rama.
Trump has set a deadline of July 4 for passing the bill.
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