Congress
The ‘Medicaid moderates’ are the senators to watch on the megabill
The Senate’s deficit hawks might be raising the loudest hue and cry over the GOP’s “big, beautiful bill.” But another group of Republicans is poised to have a bigger impact on the final legislative product.
Call them the “Medicaid moderates.”
They’re actually an ideologically diverse bunch — ranging from conservative Josh Hawley of Missouri to centrist Susan Collins of Maine. Yet they have found rare alignment over concerns about what the House-passed version of the GOP domestic-policy megabill does to the national safety-net health program, and they have the leverage to force significant changes in the Senate.
“I would hope that we would elect not to do anything that would endanger Medicaid benefits as a conference,” Hawley said in an interview. “I’ve made that clear to my leadership. I think others share that perspective.”
Besides Hawley and Collins, other GOP senators including Lisa Murkowski of Alaska, Jerry Moran of Kansas and Jim Justice of West Virginia have also drawn public red lines over health care — and they have some rhetorical backing from President Donald Trump, who has urged congressional Republicans to spare the program as much as possible.
Based on early estimates from the nonpartisan Congressional Budget Office, 10.3 million people would lose coverage under Medicaid if the House-passed bill were to become law — many, if not most, in red states. That could spell trouble for Majority Leader John Thune’s whip count: He can only lose three GOP senators on the expected party-line vote and still have Vice President JD Vance break a tie.
Republicans already have one all-but-guaranteed opponent in Sen. Rand Paul of Kentucky so long as they stick to their plan to raise the debt limit as part of the bill. They also view Wisconsin Sen. Ron Johnson as increasingly likely to oppose the package after spending weeks blasting the bill on fiscal grounds.
Meeting either senator’s demands could be enormously difficult given the tight fiscal parameters through which House leaders have to squeeze the bill to advance it in their own chamber. That in turn is empowering the senators elsewhere in the GOP conference to make changes — and the Medicaid group is emerging as the key bloc to watch because of its size and its overlapping, relatively workable demands.
Heeding those asks won’t be easy. Republicans are counting on savings from Medicaid changes to offset hundreds of billions of dollars in tax cuts, and rolling that back is likely to create political pain elsewhere for Thune & Co., who already want to cut more than the House to assuage a sizable group of spending hawks. At the same time, Speaker Mike Johnson is insisting the Senate make only minor changes to the bill so as to maintain the delicate balance in his own narrowly divided chamber.
Thune and Finance Committee Chair Mike Crapo (R-Idaho) have already acknowledged that Medicaid, covering nearly 80 million low-income Americans, will be one of the biggest sticking points as they embark this month on a rewrite of the megabill. They are talking with key members in anticipation of difficult negotiations and being careful not to draw red lines publicly.
“We want to do things that are meaningful in terms of reforming programs, strengthening programs, without affecting beneficiaries,” Thune said, echoing language used by some of the concerned senators.
Crapo voiced support in an interview for one pillar of the House bill — broad new work requirements for Medicaid beneficiaries — but rushed to add that he’s “still working with a 53-member caucus to get answers” to how the program can be overhauled: “I can only speak for myself.”
Complicating their task is the fact that some in the group — namely Collins and Murkowski — have a proven history of bucking their party even amid intense public pressure. The pair, in fact, helped tank the GOP’s last party-line effort on health care, in 2017.
Leaders view them as unlikely to be moved by the type of arm-twisting Republicans are planning to deploy to bring enough of the fiscal hawks on board. And then there’s Hawley, who is playing up Trump’s own warnings to congressional Republicans about keeping their hands off Medicaid.
Hawley and Trump spoke shortly before the House passed its bill, with the senator recounting that the president said “absolutely categorically, ‘Do not touch Medicaid. No Medicaid benefit cuts, none.’”
Hawley, like Crapo, has indicated he is comfortable with work requirements, but he is pushing for two major tweaks to the House language: undoing a freeze on provider taxes, which most states use to help finance their share of Medicaid costs, and new co-payment requirements for some beneficiaries that he has been calling a “sick tax.”
The provider tax changes would present an issue with multiple senators, who fear it would exacerbate the bill’s impact on state budgets and slash funding that helps keep rural hospitals afloat. Justice, a former governor, called it a “real issue.”
“They haven’t done anything to really cut into the bone except that one thing,” Justice added. ”That’s gonna put a big burden on the states.”
Moran grabbed the attention of his colleagues when he warned in a pointed April floor speech that making changes to Medicaid would hurt rural hospitals. A “significant portion” of his focus, he said, “is to make sure the hospitals have the capability and the revenues necessary to provide the services the community needs — Medicaid is a component of that.”
Collins, who is up for reelection in 2026, has also left the door open to supporting work requirements, depending on how they are crafted. She has also raised concerns about the provider tax provision, noting that “rural hospitals in my state and across the country are really teetering.”
Murkowski, meanwhile, isn’t as concerned about the provider tax, because Alaska is the only state that doesn’t use it to help cover its share of Medicaid spending. But she has expressed alarm over the House’s approach to work requirements, including a decision to speed up the implementation deadline to appease House hard-liners. She said it would be “very challenging if not impossible” for her state to implement.
As it is, any effort to water down the House’s Medicaid language will face steep resistance in other corners of the GOP-controlled Senate, where lawmakers are pushing to amp up spending cuts, not scale them back. Some senators, in fact, want to further tighten the House’s work requirements or reduce, not just freeze, the provider tax.
“I’d be damned disappointed if a Republican majority with a Republican president didn’t make some reforms,” said Sen. Kevin Cramer (R-N.D.). “The provider tax is a money laundering machine. … If we don’t go after that, we’re not doing our jobs.”
Ron Johnson and a few others are continuing to push to change the cost split for those Medicaid beneficiaries made eligible under the Affordable Care Act. The federal government now picks up 90 percent of the cost, and House centrists nixed an effort by conservatives to reduce it.
One idea under discussion by conservatives is to phase in the change to appease skittish colleagues and state governments, but that is still likely to be a nonstarter for 50 GOP senators. Hawley warned that “there will be no Senate bill if that is on the table.”
Adam Cancryn contributed to this report.
The chair of the House Agriculture Committee said he’s not willing to “accept bad results” as a tradeoff for the benefits of advancements in artificial intelligence — a direct rebuttal to OpenAI CEO Sam Altman.
“As someone who practiced health care for 28 years, I’m never willing to accept bad results. I think we just need to do our best,” Rep. G.T. Thompson, a Pennsylvania Republican, told reporters Monday.
He was responding to Altman’s comments to Decoded by Blue Light News that people “should accept some bad things happening for the benefits of this technology and people having the agency.”
Pressed further on whether he agreed with Altman’s premise, Thompson replied, “No, I think we have to work harder to prevent any bad things from happening.”
Altman’s comments come in the wake of increased panic over the risks of catastrophic destruction from AI, with many industry leaders and experts arguing that guardrails are needed on the technology to prevent it from spinning out of human control.
Pressure is building on Congress to regulate the rapidly-advancing technology, but lawmakers are divided over whether the AI industry needs federal regulation or if it’s capable of governing itself.
The executives of major AI labs and tech companies gathered at the White House last week to discuss solutions with President Donald Trump, who believes overregulating AI will have national security repercussions. The group ended up signing a “morally binding” AI accord that critics say won’t do enough to prevent a worst-case scenario.
Thompson noted Monday he believes that AI will bring “tremendous solutions,” specifically in regards to finding cures for health issues like cancer and Alzheimer’s disease. But he also said AI has to be led with “principle” — comparing it to how he addressed digital assets in a bill to regulate the cryptocurrency industry, which he worked on as chair of the Agriculture Committee.
“The first principle is ‘do no harm.’ So we need to protect consumers, and that means, I think, building some guardrails — some guidelines — to do that,” Thompson said. He added that the second principle is to “foster innovation.”
“I think AI has a lot to do with that,” he added. “I don’t think AI works without RI: Real Intelligence.”
LE SUEUR, Minnesota — Senate Majority Leader John Thune said Monday there is no “consensus” yet on advancing a bill establishing permanent daylight saving time even as President Donald Trump ramps up pressure on Republicans to pass it.
Thune addressed the matter in a Monday interview after Trump used his Truth Social account multiple times over the weekend to rail against the legislation, known as the Sunshine Protection Act — going so far as to post the personal cell phone number of one of its GOP opponents, Sen. Tom Cotton of Arkansas.
“The president feels strongly on it like he does a lot of issues,” he said. “It’s something we’re having conversations about but there’s no clear path forward or consensus on it yet.”
While Trump singled out Cotton for scrutiny, Thune made clear the opposition to the permanent daylight saving time proposal — which would lead to very late winter sunrises in some parts of the country — ran deeper than one senator.
Cotton has publicly voiced opposition to the proposal for year, citing, among other things, the fact that children in his state would be going to school in the dark for part of the year.
Sen. Roger Wicker (R-Miss.) voiced similar objections Monday to reporters in the Capitol, saying he was mindful of “safety concerns in the more northern and rural states where children get on the school bus in very early hours.”
Thune, who spoke during a campaign swing in Minnesota with GOP Senate nominee Michele Tafoya, has himself opposed previous daylight saving bills. He said Monday that “a lot of it depends on where you are in the country” and that “your geography probably has as much to do with your position on that as anything.”
Sen. Rick Scott (R-Fla.), who has aligned himself closely with Trump, is among the lawmakers who have been pushing to get the bill through the Senate. He recently told POLITICO, “I’m going to make sure it gets passed this year.”
Riley Rogerson contributed to this report.
Democrats have pulled back some of their ads in North Carolina’s Senate race, days after the top Senate Republican super PAC paused its future spending in the state.
WinSenate, a group affiliated with the Senate Minority Leader Chuck Schumer-aligned Senate Majority PAC, has removed roughly $1.1 million in North Carolina ad buys this week, according to ad tracking firm AdImpact. The group still has roughly $18.8 million in future reservations through Election Day.
“Senate Majority PAC is committed to seeing this race through to victory, and will continue to make spending decisions based on how to best build a strong Senate majority,” Senate Majority PAC spokesperson Lauren French said in a statement.
The move, combined with the GOP-aligned Senate Leadership Fund’s decision to pause future spending, are a signal that both parties are shifting resources amid an ever-expanding Senate map. Democrats are increasingly confident in their North Carolina Senate nominee, Roy Cooper, as he continues to hold a sizable lead in public polling over Republican Michael Whatley — but some privately say states like Michigan and New Hampshire need more resources.
Meanwhile, multiple Republican groups, not just SLF, have retreated from the state in recent weeks, effectively deciding that it’s no longer worth the money to boost Whatley’s campaign.
The Koch-aligned Americans for Prosperity Action left North Carolina off its $22 million list of future spending across key Senate contests, and Old North Action removed $6.5 million in ad reservations last month.
The Cooper campaign, however, is still treating the race as competitive, pointing to North Carolina’s closely divided electorate and the fact that President Donald Trump won the state in each of the past three presidential elections.
“North Carolina is a truly 50/50 state and Democrats haven’t won a US Senate race in 18 years. We can’t take anything for granted or our eye off the ball,” said Morgan Jackson, a senior adviser to the Cooper campaign. “DC is broken and we’re going to continue to run this race like we’re ten points down to ensure North Carolinians get the change they desperately need.”
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