Republican senators are pushing back hard on hundreds of billions of dollars in Medicaid cuts included in the Senate version of President Trump’s budget reconciliation package, endangering Senate Majority Leader John Thune's (R-S.D.) plan for a vote as soon as Friday.
Two Republicans are a hard “no” on the bill — Sens. Rand Paul (Ky.) and Ron Johnson (Wis.) — and a handful of other Republicans won’t say whether they’ll vote to begin debate on the package because they are concerned that deep cuts in Medicaid spending could cause millions of Americans to lose their coverage and push scores of rural hospitals around the country into bankruptcy.
Sens. Susan Collins (R-Maine) and Josh Hawley (R-Mo.) declined to say Wednesday whether they would vote to proceed to the bill if their concerns about Medicaid cuts remain unsolved.
The Senate Finance Committee on Wednesday circulated a proposal to establish a $15 billion health care provider relief fund, but Collins said it wouldn’t be adequate to keep many rural hospitals from going out of business.
A Republican senator familiar with the Finance Committee’s proposal said roughly half of the fund would be available to rural hospitals around the country, and the other half would be targeted to specific hospitals chosen by the Centers for Medicare and Medicaid Services.
Collins said the proposal falls far short of what’s needed.
“I believe we need [a] $100 billion provider-relief fund. I don’t think that solves the entire problem. The Senate cuts in Medicaid are far deeper than the House cuts, and I think that’s problematic as well,” Collins said.
“Obviously any money is helpful but not if it is not adequate. But I do not know for certain that that is where the Finance Committee has landed,” she said of the Finance panel’s concession.
Collins, who faces reelection next year in a state former Vice President Kamala Harris won in 2024, declined to say how she would vote on the motion to proceed but emphasized she has major concerns with the bill.
Hawley said the bill does not have the votes to pass as it now stands, but he said Thune could help fix that by providing more help to rural hospitals.
“Probably not this instant, but presumably we’ll get some text, some actual text and finalized plans on various things, including rural hospitals,” he said. “I don’t think Sen. Thune would put it on the floor with just a, ‘Hey, let’s vote on it. We’ll see text later.’ That’s so against what Republicans have always preached.”
The votes of Sens. Lisa Murkowski (R-Alaska) and Jerry Moran (R-Kan.), who are also concerned about Medicaid cuts, are also in doubt. Both of them have raised alarms about what hundreds of billions of dollars in Medicaid cuts and changes in eligibility and work requirements would mean for their states.
Murkowski is skeptical that the $15 billion relief fund would be enough to offset the Senate bill’s impact on small rural hospitals, according to a Senate GOP source familiar with the internal debate.
Sen. Thom Tillis (R-N.C.), who is considered one of the Senate’s most vulnerable GOP incumbents in 2026, has circulated a chart with colleagues projecting that the Senate Finance Committee’s proposed cap on health care provider taxes would cost North Carolina $38.9 billion in federal funding
His office estimates more than 600,000 North Carolinians would be at risk of losing Medicaid coverage.
Tillis projects other Republican-represented states would also be hard-hit.
Louisiana could lose up to $20 billion in federal funding, while Tennessee could lose $16 billion and Missouri stands to forfeit $6.1 billion in funding, according to the estimate Tillis shared with colleagues.
One GOP senator who requested anonymity to comment on the Senate Finance Committee’s proposed fund said, “$15 billion for everybody doesn’t cut it.”
A Republican source familiar with Thune’s thinking said his plan is to put the bill on the floor and essentially dare his GOP colleagues to block it, betting that all the major Republican policy wins in the package will outweigh what some senators see as major flaws in the bill.
“Honestly, I wish we’d have it up [on the floor] now. I don’t see us moving anybody else more positively,” said the source. “A couple of people have said they’re not for it, but are they going to be the ones to take it down?”
The source said Paul, an outspoken opponent to raising the debt limit, is a hard “no,” but GOP leaders view the other GOP senators who have threatened to vote against the bill as squishy.
Johnson said Wednesday he would not vote to advance the bill because it doesn’t cut enough spending. He has argued to colleagues that there is $419 billion in annual mandatory spending outside of Social Security, Medicare and Medicaid that could be cut.
“We’ve got a lot of work to do,” he said.
He said “it’s going to be difficult” for Thune to marshal the votes to pass the bill anytime soon.
“I can't vote for it,” he said.
The critics may be talking tough now, but Thune is betting that some of them won’t have the gumption to block the bill on the Senate floor and risk having Trump’s anger rain down on them through social media.
The president on Thursday will hold a rally at the White House intended to put greater pressure on GOP senators.
Thune on Wednesday afternoon said he doesn’t have the votes locked down but expressed optimism the bill would have enough support to advance Friday.
“Everybody’s got their own vote. We’re working with all of our members to try and get people comfortable with the bill, and hopefully in the end, they’ll be there,” he said.
Asked whether the legislation is still on track to come to the floor Friday, Thune replied: “We’ll see.”
He dismissed the idea of increasing the size of the rural health care provider relief fund for rural hospitals and nursing homes to $100 billion, the funding target called for by Collins and a few other GOP senators.
“It won’t be that big,” he said.
A Senate Republican source familiar with Thune’s thinking argued it wouldn’t make a lot of sense to make reforms to reduce the cost of Medicaid only to turn around and add significantly more Medicaid spending into the bill.
Sen. Chuck Grassley (R-Iowa) said $15 billion in targeted funding for rural hospitals is an improvement to the bill.
“Anything for rural health is going to help, but there’s no way I can measure how much it’s going to help,” he said. “It’s a step in the right direction, helping out what we’re trying to do to reform Medicaid.”
Iowa stands to lose $4.1 billion in federal funding if the Senate’s language to cap health care provider taxes becomes law.
Al Weaver contributed.
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