Senate Republican leaders are running into a series of obstacles as they race to finalize their sweeping package of tax and spending cuts, with multiple GOP lawmakers warning that they still have concerns about the bill.
Sen. Thom Tillis reportedly has pushed for more clarity about proposed Medicaid changes and has sought to impress upon his colleagues how badly his state, North Carolina, would be hurt by the legislation’s cuts to the program — and how badly Republican candidates in 2026 could be hurt with voters. Tillis is reportedly most concerned about a Senate proposal to lower the cap on Medicaid provider taxes from 6% to 3.5%. States use those taxes to boost the federal funding they receive. The senator reportedly passed out a flyer to his colleagues this week that estimated the cost to his state from changing the cap on the provider tax would approach $39 billion over the next decade.
“If you got a $38.9 billion cut estimated in North Carolina over 10 years, you're going to have to repeal [Medicaid] expansion and do a number of other things to get the books in order. I'm just saying, people need to just go in with their eyes open,” Tillis said, according to NPR.
Senate leaders have sought to address concerns about the effects of Medicaid cuts, including fears that rural hospitals would be forced to close, by offering to create a stabilization fund for the hospitals. But Sen. Susan Collins of Maine, who had pushed for the fund, reportedly called a proposal for $15 billion over five years insufficient. She floated a $100 billion fund instead, Politico reports, but said that even that may not fully address the problem. Collins reportedly floated a proposal Wednesday to raise the top income tax rate from 37% to 39.6% on Americans making more than $100 million a year.
“I would prefer that we take more time and try to sort through these extremely complicated issues,” she said this week.
Fiscal hawks, meanwhile, continue to press for additional deficit reduction and spending cuts. Sen. Ron Johnson, who has been vocal about his concerns, told Politico that he’s not yet ready to throw his support behind the bill, but conversations with the White House and President Donald Trump have helped. Johnson is reportedly pushing for the creation of a budget review panel that would address deficit reduction. “I think the main sticking point is … what’s the forcing mechanism to actually realize those savings, to enact them?” Johnson told Politico.
Republican factions in the House have also warned that they may reject changes made by the Senate, with conservatives complaining that the legislation is getting worse, not better, and blue-state moderates insisting that the state and local tax break they negotiated must be preserved.
Senate Republicans can only afford to lose three votes from their conference and time is running short to get everybody on board ahead of a self-imposed July 4 deadline for getting the bill to Trump’s desk. Thune may look to force lawmakers to fall in line by sticking to his timetable and pressing ahead with votes this week, daring holdouts to defy him and, more to the point, Trump. He’ll likely have some help from the president and the White House in waging a pressure campaign to get the bill passed in the coming days.