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Republicans Propose Fixing 1.5 Percent of Their Rural Hospital Problem
The desperation from the Republican leadership on the Big Beautiful Bill would be funny if I thought it would stick. The bill is clearly not ready for the Senate floor, with numerous Republicans saying they would not vote to advance it. Yet Majority Leader John Thune (R-SD) is sticking to his original plan of passing the bill this week, a bill that remains invisible, without final text, without CBO scores (which are critical for compliance with budget rules), without fixes to some of the items ruled not germane to a reconciliation bill, and without adjudication on many of the other items, including most of the all-important Senate Finance Committee language that covers taxes and Medicaid.
About Medicaid…
The more severe cuts in the Senate Finance version, especially restrictions on the Medicaid provider tax that would leave many states unable to afford the program, have really set off several Republicans, especially those in rural states who know that their hospitals will not survive the carnage. This is probably now the biggest sticking point in the bill.
There were rumors of a rural hospital fund, to shore up those facilities most at risk of closure. Then yesterday Senate Republicans made their offer: a $15 billion fund.
It’s an unbelievably insulting number. The House Medicaid title cut about $907 billion, and with the added weight of the provider tax the number is more than $1 trillion. So this is less than 1.5 percent of the proposed cut. Sen. Thom Tillis (R-NC) estimated $38 billion in losses in his home state of North Carolina alone; that’s nearly triple the total fund.
Keep in mind that Tillis’s loss figures just come from the provider tax, not the work requirements and increased co-pays and other Medicaid changes in the bill, which will have the effect of 11 million fewer people on the rolls, at least. Republicans have tried to pinpoint just the expanded provider tax as the problem, not the destruction of Medicaid contemplated in the bill that goes well beyond that. And this rural hospital fund doesn’t even come close to dealing with the compartmentalized pain, let alone all of it.
About Medicaid…
The more severe cuts in the Senate Finance version, especially restrictions on the Medicaid provider tax that would leave many states unable to afford the program, have really set off several Republicans, especially those in rural states who know that their hospitals will not survive the carnage. This is probably now the biggest sticking point in the bill.
There were rumors of a rural hospital fund, to shore up those facilities most at risk of closure. Then yesterday Senate Republicans made their offer: a $15 billion fund.
It’s an unbelievably insulting number. The House Medicaid title cut about $907 billion, and with the added weight of the provider tax the number is more than $1 trillion. So this is less than 1.5 percent of the proposed cut. Sen. Thom Tillis (R-NC) estimated $38 billion in losses in his home state of North Carolina alone; that’s nearly triple the total fund.
Keep in mind that Tillis’s loss figures just come from the provider tax, not the work requirements and increased co-pays and other Medicaid changes in the bill, which will have the effect of 11 million fewer people on the rolls, at least. Republicans have tried to pinpoint just the expanded provider tax as the problem, not the destruction of Medicaid contemplated in the bill that goes well beyond that. And this rural hospital fund doesn’t even come close to dealing with the compartmentalized pain, let alone all of it.
https://prospect.org/politics/2025-06-26-trump-big-beautiful-bill-republicans-rural-hospital/