Senate Republicans on Monday unveiled a sweeping set of Medicaid cuts and healthcare changes as part of their version of President Donald Trump’s “big, beautiful bill,” deepening the healthcare rollbacks already passed by the House and drawing sharp criticism from health policy experts and advocates. The proposal, released by the Senate Finance Committee, aims to help offset the cost of extending Trump’s expiring tax cuts, which disproportionately benefit the wealthiest Americans.
The Senate bill includes broader Medicaid work requirements than the House version, targeting more low-income parents and imposing stricter eligibility standards. According to the legislative text, the Senate plan would require work or community service from adults with children over the age of 14, expanding on the House’s proposed mandate, which applied to parents with children over seven or ten years old, depending on the benefit.
The bill would also phase down provider taxes—fees states levy on hospitals to help fund Medicaid programs—which health experts say could undermine state finances and jeopardize care. Edwin Park, a research professor at Georgetown University’s Center for Children and Families, warned the provision would “devastate” state budgets, especially in states that expanded Medicaid under the Affordable Care Act.
“This will create huge budget holes over time, some in as little as two years, forcing states to make severe, highly damaging cuts,” Park wrote in his analysis of the Senate proposal.
The Senate’s draft legislation retains the House’s proposed $35 per service co-pay for certain Medicaid patients who earn more than the poverty line—approximately $32,000 annually for a family of four. Exceptions are included for primary, pediatric, prenatal, and emergency care.
The GOP’s move to deepen Medicaid restrictions follows the Congressional Budget Office’s estimate that the House-passed reconciliation package would cause nearly 11 million Americans to lose healthcare coverage over the next decade. The figure rises to 16 million when including the expiration of ACA tax credits that Republicans have declined to renew.
Sharon Parrott, president of the Center on Budget and Policy Priorities, called the Senate’s additions a shocking escalation. “It shocks the conscience that Senate Republican leaders saw the impacts of the House bill—16 million more people uninsured and millions losing help buying groceries, including families with children—and chose to double down.”
A separate analysis found that the healthcare losses triggered by the proposals could lead to roughly 51,000 additional deaths each year.
Leslie Dach, chair of Protect Our Care, denounced the Senate proposal in a statement Monday. “This bill was already a five-alarm fire for American healthcare, and Senate Republicans have just poured gasoline on it,” Dach said. “Contrary to what they’ve repeatedly promised, Republicans are torching Medicaid, ripping apart the Affordable Care Act, and leaving 16 million people without the critical care they need, all so Trump and the GOP can funnel more money to their billionaire and corporate friends.”
“Seniors will be thrown out of nursing homes, people fighting cancer will be cut off from treatment, and rural hospitals will shutter,” Dach added. “Senate Republicans have made this cruel, heartless bill even worse as they continue on their endless pursuit to destroy our healthcare system.”
The proposal comes as Republican leadership accelerates efforts to pass the reconciliation bill before Trump’s self-imposed July 4 deadline. At the center of the package are extensions to the $4.5 trillion in tax breaks enacted during Trump’s first term in 2017, which are set to expire this year unless Congress acts. According to the CBO, the legislation would increase deficits by $2.4 trillion over the next decade.
The CBO reported that the wealthiest households could receive tax breaks worth $12,000 annually, while the poorest would face a tax hike of approximately $1,600. Middle-income households would receive between $500 and $1,000 in tax cuts.
“This is the largest transfer from the poor to the rich in a single law in history,” wrote Bobby Kogan, senior director of federal budget policy at the Center for American Progress. “Each would kick millions of people off their health insurance and each would rip food assistance away from millions of households. Each would increase deficits by trillions of dollars while making the poorest Americans poorer and making the richest Americans richer.”
Despite GOP unity on tax cuts, the Senate version has triggered resistance within the party over specific provisions, including the Medicaid provider tax phase-out and changes to the state and local tax (SALT) deduction cap. The Senate draft retains the current $10,000 SALT deduction cap, while the House-passed bill raised the cap to $40,000 following negotiations with GOP lawmakers from high-tax states.
“We have been crystal clear that the SALT deal we negotiated in good faith with the Speaker and the White House must remain in the final bill,” Reps. Young Kim (R-Calif.) and Andrew Garbarino (R-N.Y.) said in a joint statement.
Rep. Nicole Malliotakis (R-N.Y.) called the Senate’s retention of the lower cap “a slap in the face to the Republican districts that delivered our majority and trifecta” and posted on social media that the provision was “insulting.”
Other Republicans expressed alarm over the impact of healthcare cuts on rural areas. Senator Josh Hawley (R-Mo.) criticized the proposed provider tax changes, warning they would endanger rural hospitals already struggling to stay afloat. “This needs a lot of work. It’s really concerning and I’m really surprised by it,” Hawley said. “Rural hospitals are going to be in bad shape.”
The Senate’s proposal also preserves the House’s expansion of work requirements for the Supplemental Nutritional Assistance Program (SNAP), requiring work from parents of children older than ten. Previously, the House set the threshold at age seven. These changes coincide with expanded work mandates for Medicaid recipients and other benefit recipients between ages 18 and 64.
The bill includes provisions to fund a $350 billion increase in Department of Homeland Security and Pentagon spending, including $175 billion to expand Immigration and Customs Enforcement. This would cover the hiring of 10,000 new ICE officers to support Trump’s mass deportation agenda, even as protests continue against the administration’s immigration policies.
Senator Rand Paul (R-Ky.) and other fiscal conservatives have voiced concern about the $5 trillion debt ceiling increase included in the bill to accommodate the additional borrowing. “We’ve got a ways to go on this one,” said Senator Ron Johnson (R-Wis.), suggesting that further changes will be necessary to secure enough votes for passage.
Senate Democratic Leader Chuck Schumer warned that the bill’s proposed changes to healthcare would be catastrophic. “Cuts to Medicaid are deeper and more devastating than even the Republican House’s disaster of a bill,” Schumer said.
While Senate Republicans attempt to fast-track the legislation, the changes would require the House to vote again before the bill can reach President Trump’s desk. Resistance from within the GOP and a unified Democratic opposition leave the bill’s fate uncertain, even as public support remains high for programs like Medicaid and food assistance.
COMMENTS