Congress
Medicare is a target as Senate GOP faces megabill math issues
Senate Republicans are eyeing possible Medicare provisions to help offset the cost of their megabill as they try to appease budget hawks who want more spending cuts embedded in the legislation.
Making changes to Medicare, the federal health insurance program primarily serving seniors, would be a political longshot: It would face fierce backlash from some corners of the Senate GOP, not to mention across the Capitol, where Medicare proposals were floated but didn’t gain traction.
But Senate Republicans are now seriously considering it as they race to pass their party-line tax and spending package before a self-imposed July 4 deadline. The idea came up in closed-door meetings this week and, crucially, some Republicans believe President Donald Trump is on board with touching the program as long as it’s limited to “waste, fraud and abuse.”
“I think anything that is waste, fraud and abuse are obviously open to discussions,” Senate Majority Leader John Thune (R-S.D.) said Thursday when asked about Medicare.
Cracking down on some smaller areas of the vast program could net significant savings for Senate Republicans. The other main area they’re planning to tap is ratcheting down the House-negotiated state-and-local-tax-deduction cap – as Thune first acknowledged to POLITICO Tuesday. Both are politically explosive areas that will trigger serious blowback in the House.
“I think the focus, as you know, has been on addressing waste, fraud and abuse in Medicaid,” Thune added when pressed on Medicare. “But right now we’re open to suggestions if people have them about other areas where there is clearly waste, fraud and abuse that can be rooted out in any government program.”
Sen. Ron Johnson (R-Wis.), who was among the Republicans on the Senate Finance Committee who went to the White House Wednesday to meet with Trump about the tax portion of their megabill, told reporters he believed the president was more amenable to making Medicare changes than he might have previously let on.
“I think the president is actually open to any elimination of any waste, fraud and abuse … wherever,” he said, though added that Trump “doesn’t want to cut benefits.”
Finance Committee Republicans wanted to use their audience with Trump to press their case for making certain business tax incentives permanent, but a significant chunk of the conversation instead focused on senators pitching their individual ideas for how to inject more savings into their version of the House-passed bill.
A band of House moderates is deeply uncomfortable with the idea of touching Medicare in the megabill, even if it is in the name of “waste, fraud and abuse.” Speaker Mike Johnson said in a brief interview Thursday that he wouldn’t “address hypotheticals.”
But he reiterated he doesn’t want to inject any more major political fights into the already fractious talks. Johnson said the House GOP’s “work reflects more than a year of very careful and deliberate discussion and ideas and so, you know, we’re very satisfied with the product we’ve sent over there, and I hope they’ll change it as little as possible.”
Some House lawmakers briefly floated the idea of overhauling Medicare Advantage — which enables older Americans to buy private plans offering health coverage — to garner savings. Critics have accused Medicare Advantage plans of using financial gamesmanship to increase federal payments, but targeting the program would likely draw the ire of the insurance industry.
The search for more cuts comes as GOP senators look for areas where they can go beyond the House’s $1.6 trillion in cuts. But the push is being complicated because some Senate committees, including the Agriculture panel, are likely to scale back the savings found by their House counterparts.
Leadership is pushing the Agriculture Committee to net $150 billion in cuts as they work to scale down a controversial House plan to shift billions in food aid costs to states, according to four Republicans with direct knowledge of the matter. That’s half of the $300 billion in agriculture cuts from the House bill, and GOP senators are still trying to fit in a $70 billion farm bill package.
As part of an effort to generate more savings, Republicans have floated several ideas related to Medicaid, including tightening the House’s work requirements and trying to roll back — not just freeze — the use of state provider taxes. Both of those ideas would face their own block of opposition within the Senate GOP.
But they also raised Medicare as part of a lengthy debate Senate Republicans had among themselves Wednesday, when they met first with CMS Administrator Mehmet Oz and subsequently got briefed by the chairs of the Armed Services, Banking and Commerce Committees on their pieces of the megabill.
“There was legitimate debate about: Can we do more with Medicaid? Are we doing too much with Medicaid? How much waste, fraud, abuse is there in Medicare — why don’t we go after that? I think we should,” Sen. Kevin Cramer (R-N.D.) said about the discussion Wednesday.
Asked if there was any consideration of including Medicare as part of the megabill, Sen. Roger Marshall (R-Kansas) said, “There is on the Senate Republican side.”
Congress
Trump & Co. launch final megabill pressure campaign
President Donald Trump and his top deputies have started their final public push to get the “big, beautiful bill” over the finish line as the Senate struggles to finish up the legislation.
Stephen Miller, Trump’s top policy aide, appeared on Fox News Channel’s “Hannity” Monday night, about 12 hours into the Senate “vote-a-rama,” to angrily rebut criticisms of the bill and fiercely defend its contents.
“I am sick and tired of the lies about this bill that have been perpetrated by the opportunists who are trying to make a name for themselves. This is the most conservative bill of my lifetime.”
Around that time, White House budget director Russ Vought took apparent aim at deficit hawks concerned about the expanding costs of the Senate version of the megabill in an X post. He embraced the Senate’s “current policy baseline” accounting, zeroing out the cost of extending the 2017 Trump tax cuts.
“Remember, those saying that the Senate bill increases deficits are comparing it to a projection where spending is eternal, and tax relief sunsets,” he said. “That is a Leftist presupposition, and thankfully the Senate refused to let the bill be scored that way.”
Shortly before midnight, Vice President JD Vance also weighed in on X, arguing that the megabill’s border security and immigration provisions alone made it worthwhile.
“Everything else — the CBO score, the proper baseline, the minutiae of the Medicaid policy — is immaterial compared to the ICE money and immigration enforcement provisions,” he wrote.
Then, at 12:01 a.m., Trump himself posted to Truth Social: “Republicans, the One Big Beautiful Bill, perhaps the greatest and most important of its kind in history, gives the largest Tax Cuts and Border Security ever, Jobs by the Millions, Military/Vets increases, and so much more. The failure to pass means a whopping 68% Tax increase, the largest in history!!!”
Meanwhile, the Senate kept voting, with no final deal yet in sight.
Congress
Senate rejects Susan Collins amendment to boost rural hospitals, raise taxes on wealthy
The Senate rejected a bid by Sen. Susan Collins (R-Maine) to raise taxes on the ultra-wealthy and boost money for rural medical providers in the GOP’s megabill.
The chamber voted 78-22 against a procedural motion related to her amendment, which would have increased a rural hospital fund from $25 billion over five years to $50 billion and allowed a wider range of health providers to tap it. The amendment also would have raised the top tax rates for individuals who earn more than $25 million a year and couples earning more than $50 million starting next year.
It remains unclear whether the failure of the amendment could cost GOP leaders Collins’ vote. She had been concerned about the impact on rural hospitals from the bill, and even questioned if any amount in a rural hospital fund would help offset the losses.
“Rural providers, especially our rural hospitals and nursing homes, are under great financial strain right now, with many having recently closed and others being at risk of closing,” Collins said before the vote. “This amendment would help keep them open and caring for those who live in rural communities.”
Most Democrats joined the majority of Republicans in opposing consideration of the amendment. Sen. Ron Wyden (D-Ore.) called it a “Band-Aid on an amputation” that would barely offset the other health care cuts in the bill: “It would be much more logical to simply not cut $1 trillion from Medicaid in the first place,” he said. Georgia Sens. Jon Ossoff and Raphael Warnock and Virginia Sen. Mark Warner were the only Democrats to vote with Collins, along with independent Sen. Angus King of Maine.
Several GOP senators have aired concerns that the bill’s cuts to Medicaid in the bill would force rural hospitals to close. The bill lowers the amount a state can tax a hospital and then use the funding to qualify for more federal Medicaid dollars without having to dip into their own general funds. Hospitals don’t mind the tax because they can get higher payments from their state.
Conservatives have claimed these provider taxes amount to a “money laundering” scheme that enables states to use the extra federal dollars for other things. But the hospital industry has fought this claim, arguing that the provider taxes are needed to help rural hospitals that operate on thin margins.
Congress
The Senate megabill is on a collision course with House fiscal hawks
House fiscal hawks are looking at the math underlying Senate Republicans’ sprawling domestic policy legislation, and they don’t like what they see.
As Senate Republicans try to muscle President Donald Trump’s “big, beautiful bill” for final passage, they’re on track to violate a budget framework brokered between House fiscal hawks and Speaker Mike Johnson. Under that framework, if the GOP piles on tax cuts over $4 trillion, they’d need to match them dollar-for-dollar with additional spending cuts beyond the $1.5 trillion in the House-passed bill.
“The Senate version adds $651 billion to the deficit — and that’s before interest costs, which nearly double the total,” said the House Freedom Caucus in a Monday afternoon post on X. “The Senate must make major changes and should at least be in the ballpark of compliance with the agreed upon House budget framework.”
It’s a wonky hill to die on, but dozens of House conservatives insisted on the deal before smoothing the megabill’s path through their chamber. Johnson at one point told the conservatives they could go after his gavel if he didn’t hold up the deal — what some of the holdouts considered a “blood oath.”
If the House hawks stand by the deal and the Senate bill doesn’t change appreciably during the final amendment vote marathon that got underway Monday, it could force GOP leaders to “conference” the legislation between the two chambers — likely delaying the bill’s passage beyond Trump’s deadline of July 4.
Now compounding concerns for House GOP leaders, who have ordered members back to Washington to start voting on the bill Wednesday morning, billionaire Elon Musk sent new volleys of criticism at Trump’s marquee legislation Monday over the bill’s deficit impact.
“Every member of Congress who campaigned on reducing government spending and then immediately voted for the biggest debt increase in history should hang their head in shame!” said Musk on X on Monday. “And they will lose their primary next year if it is the last thing I do on this Earth.”
The House fiscal hawks have been crystal-clear about their fiscal red lines, though many now privately worry that they could end up getting jammed by Senate Republicans — and by Trump — with a far spendier bill. Johnson on Monday would not address whether the pending Senate bill could pass the House but told reporters he’s long advised Senate GOP leaders to hew as close to the House version as possible.
There’s “a lot of game left to play,” he added.
Notably, a group of 38 House Republicans led by Rep. Lloyd Smucker (R-Pa.) wrote Senate Majority Leader John Thune in early June warning that any changes to the GOP megabill needed to adhere to the fiscal framework laid out by the House. Under that plan, if the GOP includes $4.5 trillion in tax cuts in their bill, then they would need to scrounge up at least $2 trillion in spending cuts.
It’s already looking to be a far cry from what Senate Republicans hope to pass in the coming hours.
According to the Joint Committee on Taxation, the Senate’s plan includes around $4.45 trillion of tax cuts versus the $3.8 trillion in tax cuts passed by the House. But the spending cuts contemplated by the Senate GOP wouldn’t come close to making up the difference, according to the Congressional Budget Office, the other official budget scorer on Capitol Hill.
CBO estimates the Senate plan includes around $1.5 trillion in mandatory spending cuts, but that amount is reduced by around $300 billion in one-time investments in border funding and national security policy.
“The Senate bill is currently out of compliance with the budget framework by $651 billion, which is adjusted for dynamic revenue from higher economic growth,” said Paul Winfree, CEO of the Economic Policy Innovation Center and a top economic official during Trump’s first administration, in a text. “I think it will be very important to get that number closer to $0 to avoid conference.”
Senate Republicans in many ways made steeper cuts to Medicaid than the House, which would have otherwise helped rectify the difference.
But between $200 and $300 billion in spending cuts included in the House-passed bill were knocked out because they didn’t comply with Senate budget rules. The chamber’s parliamentarian, Elizabeth MacDonough, has been in constant talks with Senate Republican and Democratic staff about whether provisions in the legislation are fit for the filibuster-skirting reconciliation process.
“What we’ve been told is somewhere around $250 billion, because I’ve heard $300 and I’ve heard [$200], so I’m gonna split the difference,” said Sen. Markwayne Mullin (R-Okla.) of the sidelined spending cuts.
Mullin added that House Republicans should look at the score of tax cuts under the so-called current policy baseline, which assumes that trillions of dollars of expiring tax cuts would be extended.
“I think it’s up to the House how they want to look at this, because they can go in two different directions,” said Mullin. “If you go underneath current law, then you have a deficit. If you go into current policy, you actually have a surplus of $507 billion.”
Still, prominent Republicans such as Budget Chair Jodey Arrington (R-Texas) and conservative firebrand Rep. Chip Roy (R-Texas) have argued that Senate Republicans still need to do the math as laid out in the House budget, regardless of which baseline they use.
Rep. Keith Self, another Texas Republican, wrote Monday on X that senators are “completely ignoring” the House budget framework. “This isn’t just reckless,” he wrote, “it’s fiscally criminal.”
Meredith Lee Hill contributed to this report.
-
The Josh Fourrier Show8 months ago
DOOMSDAY: Trump won, now what?
-
Uncategorized8 months ago
Bob Good to step down as Freedom Caucus chair this week
-
Politics8 months ago
What 7 political experts will be watching at Tuesday’s debate
-
Politics8 months ago
How Republicans could foil Harris’ Supreme Court plans if she’s elected
-
Economy8 months ago
Fed moves to protect weakening job market with bold rate cut
-
Economy8 months ago
It’s still the economy: What TV ads tell us about each campaign’s closing message
-
Politics8 months ago
RFK Jr.’s bid to take himself off swing state ballots may scramble mail-in voting
-
Uncategorized8 months ago
Johnson plans to bring House GOP short-term spending measure to House floor Wednesday