‘There will be no Senate bill if that is on the table’: Josh Hawley leads Medicaid revolt threatening GOP megabill

A group of Republican senators, known informally as the “Medicaid moderates,” has emerged as a significant force in shaping the GOP’s domestic policy megabill. These senators, ranging from conservative Josh Hawley to centrist Susan Collins, have united over concerns about the bill’s impact on Medicaid, the national safety net health program.

According to Politico, the House-passed version of the bill has raised alarms among these senators, particularly regarding its potential effects on healthcare coverage. According to the Congressional Budget Office’s early estimates, approximately 10.3 million people could lose their Medicaid coverage if the bill becomes law, with many losses expected in red states.

“I would hope that we would elect not to do anything that would endanger Medicaid benefits as a conference,” stated Hawley, who has been vocal about his opposition. Speaking about potential changes to the ACA’s Medicaid cost-sharing structure, Hawley warned that “there will be no Senate bill if that is on the table.”

Senators face tough choices as Medicaid changes impact state budgets and rural hospitals

The proposed changes to Medicaid are particularly contentious due to their potential impact on state budgets and rural healthcare facilities. Key concerns include a freeze on provider taxes, which most states use to finance their share of Medicaid costs, and new co-payment requirements that Hawley has termed a “sick tax.”

Senate Majority Leader John Thune faces a challenging situation, as he can only afford to lose three GOP senators for the bill to pass with Vice President JD Vance’s tie-breaking vote. The situation is further complicated by Senator Rand Paul’s already declared opposition and Senator Ron Johnson’s likely dissent over fiscal concerns.

The group of concerned senators includes Lisa Murkowski of Alaska, Jerry Moran of Kansas, and Jim Justice of West Virginia, who have all expressed serious reservations about the healthcare provisions. Justice, drawing from his experience as a former governor, has specifically highlighted the burden the provider tax changes would place on states.

Senator Collins and Murkowski, who previously helped defeat the GOP’s 2017 healthcare effort, remain key figures in the current debate. While some senators have indicated openness to certain aspects like work requirements, they continue to express serious concerns about the overall impact on healthcare access and rural hospitals, making the path forward for the megabill increasingly uncertain.