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Senate rejects Susan Collins amendment to boost rural hospitals, raise taxes on wealthy

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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.

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Congress

House Budget chair eyes more safety-net cuts for second megabill

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DORAL, Florida — “Fraud prevention” in federal and state safety-net programs should be the main target of a new Republican reconciliation bill, House Budget Chair Jodey Arrington said in an interview Tuesday where he also called for reviving Medicaid spending cuts provisions that fell out of last year’s GOP megabill.

“The whole kit and caboodle of welfare is $1.6 trillion in our budget,” Arrington said on the sidelines of the House Republican policy retreat. “But it’s also not just welfare — it’s programs across the federal government that states need to be responsible [for].”

Arrington said Republicans needed to act after federal officials identified potentially billions of dollars of potential benefits fraud in Minnesota. But the suggestion of additional cuts to safety-net programs comes as House Republicans vulnerable in the upcoming midterms deal with the political fallout of the Medicaid and food-aid cuts enacted last year.

“I’m going to listen to everything,” said Rep. Rob Wittman, a Virginia Republican battling to keep a district that could be redrawn in Democrats’ favor. “I think we need to be very thoughtful about what we do and how we go about doing that.”

Arrington said he wanted to revisit several proposals to reduce Medicaid spending that did not end up complying with strict Senate rules for a filibuster-skirting budget package. He suggested Senate Republicans didn’t spend “a lot of time” last year reworking them to pass muster.

Arrington also said he wants to identify Pentagon spending cuts that would offset new investments President Donald Trump wants for the military — something that will likely trigger pushback from GOP defense hawks.

“I think there’s certainly waste at the Pentagon,” he said. “I think the president and his team want to retool it, modernize it, but there’s also going to be a capital investment associated with it. I just want to make sure that whatever we’re spending, we’re offsetting.”

While Speaker Mike Johnson has repeatedly promised GOP hard-liners he will push for a new reconciliation bill, he continues to face serious internal doubts — especially after Trump failed to mention it once in a nearly hourlong address to Republican lawmakers Monday.

A senior House Republican, granted anonymity to candidly discuss internal conversations, said lawmakers shouldn’t “kill themselves” to do one given Trump’s lack of interest. And a key committee chair remains publicly skeptical of the push, noting Tuesday the House GOP majority is even thinner than it was in July, when the megabill passed.

“I’d love to do a second reconciliation bill, but I’d also love to be Brad Pitt,” Ways and Means Chair Jason Smith (R-Mo.) said. “It’s never going to happen.”

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Capitol agenda: Trump’s Doral demands ripple through GOP

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President Donald Trump’s demand that Congress pass an expanded version of the SAVE America Act is creating headaches for both chambers.

The president told House Republicans on Monday the sweeping GOP elections overhaul bill — with several key add-ons — should be their “No. 1 priority.” It’s upending their plans to discuss other premidterms priorities during the retreat Tuesday — and raising eyebrows among some senators back in Washington.

— How it’s playing in Doral: The House has passed two versions of the GOP elections bill already, but now the president wants to tack on limits to mail voting, a ban on transgender surgeries for minors and a prohibition on transgender women participating in women’s sports.

GOP leaders now have to drum up support from members reluctant to dive into the culture war of transgender politics when they’d prefer to focus on affordability. And the mail voting provision was left off the package last time for a reason.

Committee chairs will brief members Tuesday on their legislative priorities, including the possibility of a new reconciliation bill this year. But Trump made no mention of that possibility during his remarks Monday, which does not bode well for those seeking a second megabill.

Elected Republican leaders will then huddle privately at 4 p.m. to discuss paths forward. Expect Trump’s SAVE America demands to be a big part of the conversation.

The GOP leaders will also discuss how to pass a housing affordability package — though that, too, doesn’t appear to be a priority for Trump, who said Monday that Americans are demanding the election bill and “don’t talk about housing.”

— More trouble for Thune: Trump’s ultimatum further complicates matters in the Senate, where there the legislation is on the rocks even without the president’s new demands.

Several Republican senators signaled Monday they aren’t behind the president’s call to significantly limit mail-in ballots, touting the success of the practice in their own states.

“I don’t want the federal government telling me that I can’t have mail-in voting or absentee ballot voting,” Sen. Thom Tillis (R-N.C.) told reporters. “There’s nothing wrong with mail-in voting if you have the right standards in place.”

Trump also kept pressing on the “talking filibuster,” keeping that internal battle front and center for Majority Leader John Thune, who delivered a public reality check on the “complicated and risky” idea Monday.

Sen. John Kennedy (R-La.), in a sign of how desperate some Republicans are to avoid a bruising internal filibuster fight, floated passing the SAVE America Act through reconciliation Monday, despite the lack of a clear budget connection.

“We have some clever wordsmiths,” Kennedy said.

What else we’re watching: 

— Immigration policy hearings: Two Senate hearings Tuesday will put a spotlight on key immigration policy debates — birthright citizenship and so-called “sanctuary cities.”

Senate Budget Committee Chair Lindsey Graham (R-S.C.) will host a 10:30 a.m. hearing on jurisdictions that do not cooperate with federal immigration enforcement; witnesses will include Chad Wolf, Trump’s former acting DHS secretary.

A Senate Judiciary panel will then hold a 2:30 p.m. hearing on “Protecting American Citizenship” as the Supreme Court mulls whether to void Trump’s effort to end automatic birthright citizenship for those born in the U.S.

— Race to replace MTG: It’s Election Day to fill the seat of Marjorie Taylor Greene, whose retirement from Congress in January narrowed an already thin Republican House majority. The bad news for the GOP: The race might drag on another month.

Seventeen candidates are on the ballot, including 12 Republicans. And because so many candidates filed, it’s possible no one emerges with the 50 percent required to win, leaving the seat open until after the potential April 7 runoff.

Hailey Fuchs and Andrew Howard contributed to this report.

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SAVE America Act is ‘No. 1 priority,’ Trump tells Republicans

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DORAL, Florida — President Donald Trump told House Republicans Monday to pass a major partisan elections bill a third time with new provisions, saying it should be the GOP’s “No. 1 priority” ahead of the midterm elections.

“It will guarantee the midterms,” Trump told lawmakers gathered at his golf resort. “If you don’t get it, big trouble, my opinion.”

The president spent 13 minutes at the close of a nearly hourlong address making crystal-clear he expects Speaker Mike Johnson and other top leaders to meet his demands. The House has already two passed versions of what is now called the “SAVE America Act” that would institute tough new citizenship and photo ID requirements for voting.

But Trump asked the gathered lawmakers to add in provisions curbing mail voting and targeting transgender rights — even it means abandoning the remainder of their legislative agenda before the November elections.

“Let’s go for the gold,” he said. “It’s actually a matter in a serious way of national survival. We can’t have these elections going on like this anymore.”

The already passed version of the SAVE America Act is awaiting a Senate vote. Majority Leader John Thune has committed to calling it up, but it is certain to be blocked by Democrats under the chamber’s 60-vote filibuster threshold.

Some conservatives, with Trump’s backing are looking to sidestep that obstacle with a “talking filibuster” that would force Democrats to hold the floor. Thune and other Senate Republicans are skeptical it would work without a rules change, but Trump said Monday failure was not an option.

“They have to get it done,” he said of the Senate. “If it takes you six months — I’m for not approving anything. … I don’t think we should approve anything until this is approved.”

Trump also endorsed a push by some House Republican hard-liners to attach a must-pass spy powers extension to the SAVE America legislation in a bid to pass both together — creating a nightmare for House GOP leaders who already face obstacles passing either bill.

He cast the voting and transgender provisions as proven political winners that Democrats would be hard-pressed to oppose, even though they have so far stayed almost entirely united against the legislation.

“That should be the easiest thing to get passed that you’ve ever had,” Trump said. “Those are best of Trump. This is the No. 1 priority, it should be, for the House.”

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