'I'm shocked': Senate wants more Medicaid cuts in Trump's bill

Ben Mause, Baltimore Sun on Jun 17, 2025

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WASHINGTON — The Senate released the Medicaid portion of President Donald Trump’s “One Big, Beautiful Bill” this week, proposing steep cuts to the health care program amid pushback from moderate members.

“I’m shocked,” Sen. Josh Hawley, a Missouri Republican, told reporters on Tuesday. “It needs work.”

“It pares down the president’s tax priorities, it boosts up Green New Deal subsidies, and it defunds rural hospitals,” Hawley added. “It’s gonna be interesting to run on in 2026.”

The Senate cuts go beyond the changes to Medicaid in the House version of the bill, which was passed in late May. Foremost among the additional cuts are a lower cap on the provider tax formula, which allows states to receive more federal funding for Medicaid, and additional work requirements for recipients.

“I was told that senators were actually more worried about the cuts to Medicaid, and yet they increased the Medicaid cuts,” Sen. Chris Van Hollen, a Maryland Democrat, told The Baltimore Sun. “This is a really ugly betrayal of people who are living paycheck to paycheck.”

The House bill established a work requirement, but adults with dependent children were exempt. In the Senate version, Medicaid recipients with dependent children over 14 years old would be subject to work requirements.

Hawley said that he’d spoken to Trump about the changes, which seemed to surprise the president. Trump has previously emphasized that Republicans should leave Medicaid alone except for removing “waste, fraud and abuse,” a phrase the administration has adopted to refer to a broad range of federal personnel and spending reductions, from the program.

A handful of Republicans share Hawley’s concerns about the steeper cuts. Sen. Lisa Murkowski of Alaska said she wants changes to the bill, citing the new work requirement. And Sens. Jim Justice of West Virginia, Susan Collins of Maine, and Murkowski share Hawley’s concerns about what the bill could mean for rural hospitals if passed.

“When it comes to Medicaid, it’s getting even worse than the House bill, including the provider cuts,” Van Hollen said. “What we see is the same overall framework, which is a big tax giveaway to billionaires and other very rich people at the expense of everybody else, especially targeting individuals on Medicaid and people who get food nutrition program benefits.”

Should it pass, the spending package is expected to be the prime legislative achievement of Trump’s second tenure in the White House. Encompassing a wide swath of policies, the legislation would approve billions of dollars for defense and border security while extending the tax cuts from Trump’s first administration and adding new “no tax on tips” and “no tax on overtime” provisions. It would also make cuts to the Supplemental Nutrition Assistance Program and phase out clean-energy tax credits implemented under former President Joe Biden.

Vice President JD Vance and Dr. Mehmet Oz, the administrator for the Centers for Medicare and Medicaid Services, visited Republicans during their conference lunch on Tuesday. Vance said they were working through the holdouts’ concerns. He remained optimistic that the spending package would be done in the Senate by July 4, a deadline self-imposed by Republican leadership.

After speaking with the conference, Oz defended the proposed changes to the provider tax.

“We do not believe that addressing the provider tax effort is going to influence the ability of hospitals to stay viable,” Oz told reporters. “The provider tax now — which has dramatically increased, once it became apparent that you could game the system — is now becoming a dominant part of financing our states. It’s not where the money should be going.”

“There are better ways to address these needs,” Oz added.

A second group of fiscally conservative Republicans are frustrated that the bill doesn’t do enough to reduce spending, leaving the conference with a difficult path to pass the legislation. Conversations about the proposed changes will continue until Republican leadership announces the final version of the bill.

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