A group of 16 Republican House members sent a June 24 letter (PDF) to Senate Majority Leader John Thune (R-S.D.) expressing concerns with provisions contained in the Senate Finance Committee’s title of the GOP reconciliation bill and urging the Senate to retain Medicaid policies included in the House-passed bill [refer to Washington Highlights, June 20]. In their letter, the members juxtaposed the House-passed One Big Beautiful Bill Act (H.R. 1) against the Senate’s proposal, arguing that the House’s proposed Medicaid policies “reflect a more pragmatic and compassionate standard” [refer to Washington Highlights, May 23]. The letter outlined concerns that the Senate proposal places overly restrictive limits on Medicaid provider taxes and state-directed payments, noting that such policies “do not give hospitals sufficient time to adjust to new budgetary constraints for identify alternative funding sources.” The letter further outlined the members’ concerns with the Senate proposal’s modifications to work and community engagement requirements, new cuts to emergency Medicaid funding, and targeted financial penalties for Medicaid expansion states, arguing that such changes would “place additional burdens on hospitals already stretched thin by legal and moral obligations to provide care.”
Senate Parliamentarian Elizabeth MacDonough ruled Thursday that several Medicaid policies contained in the Senate Finance Committee’s proposal violate the Byrd Rule and cannot proceed in the reconciliation process as written. MacDonough identified the following policies as violating the Byrd Rule: a moratorium on provider taxes and additional restrictions on these taxes in Medicaid expansion states; a reduction in the federal medical assistance percentage for states that use state-only funds to cover certain immigrants; and a prohibition on federal Medicaid funding for certain noncitizens, such as refugees and asylum seekers. MacDonough also struck proposals that would restrict the access to premium tax credits for certain immigrants and prohibit federal Medicaid funding for gender-affirming medical care.