Following House passage of a reconciliation bill, the Senate is now working on its version. Last week, the Senate Finance Committee (in charge of the tax and Medicaid portions) released proposed text.

• The Senate version contains some changes to the House version, some of which would amount to deeper cuts to Medicaid.
• The main point: Either version of the proposed bill would cause millions of people to lose access to insurance coverage and make it harder for people to access needed care.

The details:

• Work requirements: Like the House bill, the Senate version would impose work requirements on Medicaid beneficiaries beginning at age 19. The Senate version applies work requirements to adults with dependent children older than 14, while the House-passed version would exempt all adults with dependent children. An estimated 150,000-380,000 additional people are at risk of losing Medicaid coverage due to this change.
• Eligibility requirements: The House and Senate bills have similar provisions restricting Medicaid eligibility. The Senate version includes a provision that would require states to conduct eligibility redeterminations every 6 months for individuals enrolled in Medicaid under Medicaid expansion. Both bills bar the implementation of Biden-era rules streamlining Medicaid enrollment and eligibility.
• Provider taxes: The Senate version includes harsher restrictions on Medicaid provider taxes than the House-passed version (reminder: provider taxes are a way states increase the federal funding they receive to pay for Medicaid). The House version would ban new or increased provider taxes, maintaining a 6% cap. The Senate bill would also impose that moratorium for states that have not expanded Medicaid, but it would go further in states that have expanded, lowering the 6% cap to 3.5%.
• State-directed payments: The Senate bill also places stricter limits on state-directed payment programs, which allow states to increase how much Medicaid pays to certain providers. The House bill froze state-directed payments at current levels. But the Senate bill would reduce those payments, reducing the payment limit from average commercial rates to Medicare rates in states that expanded Medicaid and to 10% over Medicare rates in states that have not expanded.

The reaction:

• The Senate: Some Republican senators are not happy with the proposed language. Some senators (e.g., Sens. Hawley, Collins, Murkowski) are concerned about the restrictions on Medicaid provider taxes and other Medicaid provisions. But others (e.g., Sen. Rick Scott) still want deeper Medicaid cuts, including a reduction in the federal match rate for Medicaid expansion states. And still others are opposed because the bill would continue to raise the deficit (e.g., Sens. Paul, Johnson) or due to other concerns.
• The House: Some House Republicans are also saying they will not vote for the Senate bill, which upends some key deals that were essential to ensuring House passage the first time around.
• Industry: Hospital groups, a powerful industry and lobbying force, have blasted the changes.
• The public: A KFF poll found that the bill is viewed unfavorably by a majority of adults (64%). The public is particularly concerned that the bill would increase the country’s uninsured rate and decrease funding for local hospitals.

What’s coming: The Senate Finance Committee will not hold a markup of its portion of the bill. Senators will continue to meet and make changes to get enough support to bring the bill to the Senate floor for a vote.

• Senate leadership is still aiming to pass the bill by July 4th recess, but the pushback the bill is still receiving will make that a challenge.
• Then the House would have to vote again on the new Senate version.