Trump’s signature policy bill is facing trouble on multiple fronts in the Senate : NPR

The head of the majority of the Senate, John Thune, Rs.d., Center, speaks to journalists after the GOP legislators met on Treasy Secretary on Tuesday to discuss the radical taxation and the expenses that the Republicans hope to have for President Trump by July 4.

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J. Scott Applewhite / AP

The Senate Republicans run the stopwatch, trying to respond to President Trump’s request to adopt his bill on the national agenda by July 4 while working to resolve the main collage points within the GOP conference.

While the leaders of the Senate Committee have made several major changes to the bill in recent days, the question of the financing of rural hospitals has become a major obstacle.

The leaders of the GOP Senate also await whether the main tax provisions of the bill respect the strict Senate rules for what can be included in the bill and always adopts with a simple majority vote. The Senate parliamentarian – A member who is not a supporter of the body’s professional staff – always examines these elements to ensure that everyone has a direct impact on the budget, among other regulations. Several provisions in the version of the Chamber, such as a ban on legal injunctions nationwide, have already been reduced in this exam.

The leaders of the Senate initially hoped to publish their bill at the beginning of this week. But the debate on hospitals, taxes and other questions threatens to undermine the leader of the majority of the Senate, John Thune, the objective of the bill before the week.

Thune cannot afford to lose three GOP votes in order to adopt the bill.

The fight against MEDICAID and RURALS hospitals

Medicaid – which offers health coverage for low -income people and is one of the largest payers for health care in the United States – has been among the most difficult provisions of the bill. The cause is a directive that states have reduced the tax they impose on medicid suppliers from 6% to 3%. Critics say that the tax is an important part of the financing equation in many states. They say that the change will lead to major challenges for rural hospitals based on this money. It is part of a complex formula which determines the quantity of federal financing received within the framework of the joint program managed with the States.

Mehmet Oz, director of the Trump agency, supervising the Medicaid program, met the Republicans of the Senate last week and defended the need to repress the way the statements finance Medicaid. He described the bill “The most ambitious health reform bill in our history”.

He argued that changes will limit program growth and add new work requirements that will preserve the most vulnerable program.

But Senator Josh Hawley, R-MO., Argued that President Trump had negotiated the House bill and that the changes would force the Senate to conclude negotiations written with the Chamber.

Hawley noted that its legislation aimed at providing health care to those affected by exposure to radiation from atomic weapons tests has been included in the package. “But they must have a hospital where to go,” he added. “So it’s a problem.”

In an effort to win Republicans like Hawley, the Senate finance committee published a new compromise on Wednesday to create a stabilization fund to help rural hospitals. The plan would run $ 15 billion over a period of 5 years in the States in need. However, this does not respond to what other senators say they are necessary.

The Republican Senator of Maine Susan Collins said that the fund must be closer to $ 100 billion. She told journalists from the Capitol on Wednesday that the arrangements that “were much more draconian than the room are problematic” and that leaders should solve this problem rather than rushing to a vote this week.

“Well, I would prefer that we take longer and try to solve these extremely complicated problems,” she said.

Senator Thom Tillis, RN.C. Also warned that the adequate resolution of the problem would be very expensive.

“I think if you examine it more, you will probably have to go much more than people plan if you really want to preserve rural access,” Tillis told journalists earlier this week.

Tillis, who presents himself for a re -election in 2026, served at the State House in his country of origin before coming to Congress and warned that the States would not be able to fill the financing gap due to reductions in the bill. “If you have obtained a reduction of 38.9 billion dollars estimated in North Carolina over 10 years, you will have to repeal the expansion and do a number of other things to put the books in order. I just say that people simply have to go open eyes.”

The head of majority, Thune, acknowledged that the Republicans should find a way to respond to the concerns of several senators. He said discussions have been underway for several days to “ensure that the impact on rural hospitals is reduced – to be attenuated”.

Other divisions remain

Other Republicans are concerned about the overall impact of the changes made to Medicaid, resulting in major discounts in the rollers of their states – which would mean costs of transfer to states to cover these low -income, old and disabled patients on the program.

Senator Rick Scott, R-Fla., Is one of the preservatives who put pressure on more in-depth expenditure in the bill and told journalists that he had recently met the president. He said he wanted to adopt a bill, but “we must have tax mental health”.

Senator Ron Johnson, R-WISC., Continues to say that Congress must reduce expenditure levels to pre-countryic levels, and that legislation adds to the deficit.

Fiscal hawks in the Senate also raised concerns about the fate of energy tax credits. The Republicans have chosen to step back or end many of the credits included in the law on the reduction of inflation which was adopted under President Biden in order to find more cost savings. But this plan has even frustrated some in their own party who say that voters and companies already use these credits and would be negatively affected if they are eliminated.

Even if Thune is able to solve all the problems of her room, several different factions of the Republicans of the Chamber warn that they will oppose the last bill that emerges from the Senate.

The tax debate also includes parallel negotiations with the GOP legislators who represent districts in New York and California who insist that the Senate must preserve a state and local tax relief, known as SAL, which was negotiated with the president of the Chamber Mike Johnson, R-La., For their voters who pay high-level taxes.

They threatened to vote against the bill if he erases the Senate without the intact rupture.

Most of the Senate Republicans have ignored their threats, and the question is not a priority without a republican of the Senate representing the blue states that are affected. “”

Referring to the so-called “Salt Caucus” in the House, Senator Jon Hoeven, RN.D., told journalists that the Senate would propose the bill they believe to be the best deal.

“They will always decide whether they agree or not. I think there will be a lot of pressure because, look, will produce a good product to go. But they can make this call.”

Tuesday afternoon, Senator Markwayne Mullin, R-Okla., Said that he had spoken to almost all of the Caucus Salt, and that even if they were getting closer to an agreement, he supposed that “we will arrive at a place that everyone loves … But we will get a place that could be for people”.

He added that once the legislators reached an agreement on salt and changes to Medicaid, they will be “good to leave”.

“We all have concerns with the bill,” said Mullin. “But that’s what happens when you negotiate the bill here and get 535 opinions.”

Thune has repeatedly called the president “closest” with regard to support for mass legislation, and by advancing with the calendar that Trump has established, he thinks that political pressure will ultimately force the Republicans on both sides of the Capitol to support the package.