Trump, GOP rush to overcome clashes on Medicaid in tax bill

Modern Healthcare – Monday, June 30, 2025
By Erik Wasson and Jamie Tarabay, Bloomberg

Republican party leaders are rushing to overcome lingering internal fights over President Donald Trump’s massive tax and spending package as Democrats launch attacks to exploit the divisions.

Senate Republicans were still at odds Monday over how much to cut Medicaid and other social safety-net programs and how rapidly to end Biden-era clean energy tax breaks as Democrats gained the chance Monday to force votes on amendments to the package.

Democrats, locked out of power in Washington, are aiming to offer amendments during a marathon voting session to exploit the infighting and make the GOP goal of getting holdouts to back the bill as soon as tonight more difficult.

The minority party believes the $3.3 trillion package, which cuts social safety net programs to partly pay for tax cuts that skew toward the wealthy, will provoke a political backlash against Republicans in the 2026 midterm elections. They will use the amendment votes to highlight the legislation’s most politically problematic provisions and put Republican senators on the record through their votes.

Under Senate rules, Democrats can offer unlimited amendments that can pass with just 51 votes. They say they will aim to strip out Republican cuts to Medicaid health insurance for the poor and disabled, food stamps and college student loans.

Offensive posture

The Democrats are trying to either put swing-state moderates on record supporting those specific provisions or persuade them to take them out — something that would rile the Republicans’ fiscal conservatives. An amendment to stop cuts to rural hospitals, a particularly sensitive topic to some GOP members, is high on their list.

Senate Democratic Leader Chuck Schumer on Sunday was already relishing the retirement announcement of North Carolina Senator Thom Tillis, a casualty of the GOP infighting over the bill’s Medicaid cuts.

“It just shows you that the Republican majority is at risk because their Big Ugly Bill is so unpopular,” he told reporters.

Tillis, unfettered by electoral concerns, warned Republicans were at risk of a backlash by failing to keep Trump’s health care promises.

“What do I tell 663,000 people in two years or three years when President Trump breaks his promise by pushing them off of Medicaid because the funding’s not there anymore?” Tillis said on the Senate floor.

Tillis on Sunday announced he wouldn’t be running for reelection, a decision that gives him more latitude to break with Trump, who had threatened to back a primary challenge to Tillis. The 64-year-old senator has said that he’ll oppose the bill and railed on it in a floor speech for Medicaid cuts.

Vote counting

Senate Republican leader John Thune of South Dakota needs to win over at least five of a group of eight major GOP holdouts on the bill. The amendment votes could make the job harder by fanning the flames of division.

Thune can afford to lose only three of his 53 members in the chamber, with Vice President JD Vance breaking the tie.

Kentucky’s Rand Paul has said he is going to vote “no” on the legislation based on the price tag and the inclusion of a $5 trillion debt ceiling increase. If both Tillis and Paul remain in opposition, Thune can only lose one more.

That means Thune has to satisfy most of a group of conservatives including Ron Johnson of Wisconsin, Cynthia Lummis of Wyoming, Rick Scott of Florida and Mike Lee of Utah. Thune told reporters he will back an amendment they support to roll back the expansion of Medicaid under President Barack Obama’s Affordable Care Act but he said he cannot guarantee that the amendment will pass. If it fails, it remains unclear how this block of conservatives will vote on final passage.

Thune is also trying to convince moderates Susan Collins of Maine and Lisa Murkowski of Alaska to swallow their qualms over cuts to social safety net programs and clean energy tax credits and vote for the bill.

An attempt to steer more Medicaid dollars specifically to Alaska has run afoul of Senate budget rules, making the job of convincing Murkowski even harder.

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