WASHINGTON — The U.S. Senate began floor debate on Republicans’ “big, beautiful bill” Sunday afternoon, though there are several steps to go before the legislation can become law, and any one of those could lead to additional GOP opposition — potentially dooming the measure.
Senators must wrap up an ongoing review of the bill with the parliamentarian to ensure it meets the strict rules for using the reconciliation process and then run the gauntlet during a marathon amendment voting session.
Additional changes to the sweeping tax and spending cuts package, some of which were being worked on as debate took place, need to garner the support of nearly every Republican in Congress. Otherwise, it will never become law.
Senate Majority Leader John Thune signaled during a brief hallway interview there may be enough votes for a new twist in the Medicaid changes in the bill — an amendment reducing in some way how much the federal government spends on Medicaid in states that expanded the program as a result of Democrats’ 2010 health care law. The federal government currently pays 90% of the costs for enrollees in the expansion.
“We’re going to do what we can to support the effort,” Thune said, referring to an amendment offered by Florida Sen. Rick Scott that was not yet public. “It’s great policy and something that there’s a high level of interest in our conference in getting made part of the bill, and obviously scores a substantial savings.”
But Thune, R-S.D., sidestepped a question about whether making that change would create vote-count issues if Republicans in the House with affected districts object, potentially preventing the bill from reaching President Donald Trump’s desk.
“We have had some of these conversations with (Speaker Mike Johnson) and others over there, and then also with our colleagues for some time,” Thune said. “But I think the way this is designed, and the way that Sen. Scott has written it; it should be something that I don’t know how Republicans couldn’t be in favor of what he’s trying to get done here.
“So, you know, we’ll cross that bridge when we come to it. Obviously, we’ve still got to get into the debate over here and get through the amendment process and we’ll see what the fate of the amendment is on the floor.”
Currently 41 states, including the District of Columbia, have adopted the Medicaid expansion, according to the health care research organization KFF.
A Scott spokesperson told States Newsroom they would share his amendment once it was final.
Still fluid
Typically when a major piece of legislation comes to the Senate floor the text is set and amendment debate is closely controlled to ensure delicately negotiated deals don’t crumble in full public view.
That isn’t the case this time around and much could change before senators take a final passage vote later this week, potentially as soon as Tuesday.
GOP leaders using the complex reconciliation process to move their signature policy bill through Congress means every provision must have an impact on federal spending or revenue that is not “merely incidental.”
That involves Democrats and Republicans going before the Senate parliamentarian, the chamber’s official referee, to argue over dozens of provisions. She then decides if a given policy meets the strict and sometimes murky rules.
That process hadn’t yet wrapped up when debate on the megabill began and is expected to continue as the 20-hour clock ticks down toward a marathon amendment voting session.
Senate bill would add $3.2 trillion to deficits
There are also increasing concerns among Republicans, including those in the House Freedom Caucus, over how the bill will impact the federal government’s balance sheet during the next decade.
The nonpartisan Congressional Budget Office announced Sunday morning the Senate’s revised tax and spending cuts package will add $3.253 trillion to deficits during the next decade compared to current law.
Trump appeared to try to assuage concerns through a social media post.
“For all cost cutting Republicans, of which I am one, REMEMBER, you still have to get reelected,” Trump wrote. “Don’t go too crazy! We will make it all up, times 10, with GROWTH, more than ever before.”
The latest score came just hours before senators officially began floor debate on the sweeping package that will extend the 2017 GOP tax law, rework how much state governments have to contribute to the Supplemental Nutrition Assistance Program, overhaul several aspects of Medicaid and cut its spending, restructure higher education aid programs and much more.
Senators voted mostly along party lines late Saturday to proceed with the legislation, though leaders had to hold the vote open for more than three hours as they worked to get the votes needed.
Even after taking that crucial procedural step, the bill continued to evolve.
The parliamentarian ruled Sunday morning that another six provisions must be revised to comply with the rules or be removed from the 940-page package.
One Alaska sweetener knocked out
GOP senators cannot include, or might need to restructure, language meant to bring Alaska Republican Sen. Lisa Murkowski on board by enhancing the federal matching rate for Medicaid in two states with high poverty guideline levels: Alaska and Hawaii. The program for low-income people and some people with disabilities is run as a state-federal partnership.
Since Hawaii is represented in Congress by a Democratic delegation, the Republican benefit would largely have applied to Alaska’s two GOP senators.
Senate Republicans did receive some good news from the parliamentarian in her latest ruling, which cleared language that will steadily lower the maximum percent states can set for Medicaid provider tax rates from the current 6% to 3.5% in 2032.
The in-the-weeds policy has caused considerable frustration among GOP senators across the political spectrum, who argued a prior version would likely cause financial strain for rural hospitals by beginning the process one year sooner.
Planned Parenthood
The parliamentarian is still reviewing several other policy changes in the bill, including whether Republicans can prevent Medicaid funding from going to Planned Parenthood for one year, effectively blocking beneficiaries from receiving care there at all.
Federal law already bars federal taxpayer dollars from going toward abortions with limited exceptions for rape, incest, or the life of the pregnant patient. So this change would prevent Medicaid patients, who may have few other options, from using Planned Parenthood for other types of health care, like annual physicals, contraception and cancer screenings.
A prior version of the bill blocked federal funding from going to Planned Parenthood for the next decade.
Senate Finance Committee Chairman Mike Crapo, R-Idaho, did not immediately respond to a request from States Newsroom about how the rulings might impact the bill going forward.
Senate Finance Committee ranking member Ron Wyden, D-Ore., wrote in a statement the latest rulings show “that Republican attempts to give away goodies that benefit certain states will not pass muster under Senate rules.”
“Senate Democrats have also successfully challenged a giveaway to Big Pharma, as well as policies that make it harder for seniors and kids to get affordable health care through Medicaid,” Wyden wrote. “Republicans wanted to bring back the health care tactics of yesteryear, like waiting periods, lock-outs and annual limits on care, but Democrats have wrestled these out of the bill. I am disappointed that the Republican rewrite of the provider tax changes will remain in the bill: this policy will force states into devastating cuts to health care that seniors, kids and Americans with disabilities depend on. We will continue to fight any attempt to sneak through harmful health care policies in this morally bankrupt legislation.”
Amendment fights ahead
Republicans hope to pass the entire package before the Fourth of July, though they have several hurdles to jump over before they can meet that goal.
Senate floor debate can last up to 20 hours. After that, senators will begin a marathon amendment voting session where members of each political party can propose changing or removing certain pieces of the legislation.
GOP leaders generally like to avoid public disputes within the party but the rules of reconciliation don’t really allow that and several Republican senators are expected to offer amendments.
There is no time limit or cap on the number of amendments that can be offered during vote-a-rama, so that can last hours or even days in theory.
Whenever Democrats and Republicans decide they’ve debated their last amendment, they’ll move on to voting to approve the Senate’s version of the “big, beautiful bill.”
At least 50 Republicans need to vote to approve the measure, with Vice President JD Vance’s tie-breaking vote. More than four GOP senators objecting to the overall bill means it cannot pass as it’s written.
Thom Tillis, Rand Paul
Republican Sens. Thom Tillis of North Carolina and Rand Paul of Kentucky voted against moving forward with debate so it’s likely they will vote against final passage as well. Two more senators deciding not to back the bill would halt its momentum, at least until GOP leaders could make changes to get their votes.
Tillis on Sunday announced he would not run for reelection, after being attacked by Trump for voting against advancing the legislation.
Senate approval of the bill would send it back to the House for a final vote, though centrist and far-right members of the Republican Conference in that chamber have voiced concerns about changes made in the upper chamber.
Johnson, R-La., will need to keep nearly every one of the 220 House GOP lawmakers supportive if that chamber is to send the legislation to Trump for his signature before Friday.
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