The Senate Republicans’ tax and spending bill, which is speeding through the chamber, would result in deeper health care cuts and more people without insurance than the version that passed the House, according to a report from the Congressional Budget Office.
The legislation would result in 11.8 million Americans without insurance by 2034, CBO found: nearly 1 million more people without insurance than the House version. That amount includes an estimated 1.4 million people without “verified citizenship, nationality, or satisfactory immigration status” who would lose their state-funded coverage.
The legislation would also cut federal spending on Medicaid, Medicare and Obamacare by $1.1 trillion, with more than $1 trillion coming from Medicaid.
The CBO’s analysis confirms that despite President Trump’s repeated pledges he was only cutting waste, fraud and abuse in Medicaid, the legislation would enact an unprecedented reduction in the program currently used by more than 70 million low-income Americans.
The bill would achieve its savings in various ways, but the bulk of the cuts come from a strict national work requirement and new restrictions on state-levied taxes on health providers.
Under the bill, for the first time in the history of the Medicaid program, beneficiaries would need to prove they are working or in school at least 80 hours a month to keep their health insurance. The Senate version extends the requirement to low-income parents of children older than 14, in addition to childless adults without disabilities. The work requirements are projected to save about $325 billion over a decade.
The provider taxes were the second-largest Medicaid cut in the House bill, after the work requirements. The cuts are even larger under the Senate design. Those changes would reduce spending by nearly $191 billion over a decade, according to the CBO estimate.
The provider tax provisions have been among the most controversial in the Senate. States impose taxes on providers to boost their federal Medicaid contributions, which they then redirect to hospitals in the form of higher reimbursements.
Limiting provider taxes is a long-held conservative goal, as they argue states are gaming the current system and driving up federal Medicaid spending. But senators representing states with poor, rural populations have objected to the scale of the cuts, including Sens. Josh Hawley (R-Mo.), Susan Collins (R-Maine), Lisa Murkowski (R-Alaska), and Thom Tillis (R-N.C.).
The House bill would freeze the tax rate for most states, but the Senate version would require many states to lower their existing rates. As an incentive for senators uncomfortable with the provider tax cuts, the bill includes a $25 billion fund to aid rural hospitals.
But that amount wasn’t enough to sway Tillis, who voted with Democrats against a procedural motion late Saturday night. Hawley voted for the motion and said he would support the bill despite his misgivings over the Medicaid cuts.
Additional details of the bill are in flux as negotiations between Republicans continue and the Senate parliamentarian reviews key pieces of the bill to determine if they follow the legislative rules.
Lawmakers are facing down a White House-pushed July 4th deadline to pass the bill in the Senate, and then again in the House, and put it on President Trump’s desk.
