UPDATE: The Senate passed the "Big Beautiful Bill" Tuesday after a marathon session. Vice President JD Vance broke a 50-50 tie vote. The three Republicans opposing the bill were Sens. Thom Tillis of North Carolina, Susan Collins of Maine and Sen. Rand Paul of Kentucky, according to AP.
The bill needs to go back to the House to approve the Senate's changes to the reconciliation bill before it heads to the president's desk for his signature.
The Senate worked through the weekend and held a vote-a-rama session on Monday.
WHY THIS MATTERS: WHAT'S IN, OUT FOR HEALTHCARE
Medicaid
New analysis from the Congressional Budget Office shows that the bill cuts $930 billion from Medicaid, which is an increase from the $715 billion estimated to be cut from the House version of the bill.
The cuts would come from enrollment losses due to new work requirements, twice yearly eligibility verification for beneficiaries in Medicaid expansion states and cuts to provider taxes, also in Medicaid expansion states.
Provider Taxes
The bill would reduce the maximum allowable provider tax rate from 6% to 3.5% over time.
States tax hospitals and then put the money into their Medicaid programs. This gains more federal dollars. For every dollar that states spend on Medicaid, they get $1 to $3 from the federal government, according to The Wall Street Journal. The money is then returned to hospitals in Medicaid payments, with hospitals getting more than what they paid in provider taxes.
The American Hospital Association has voiced opposition to cuts to provider taxes.
Many hospitals, especially those in rural areas, rely heavily on Medicaid funding. An additional 55 rural hospitals are at risk of closure should Medicaid cuts pass, according to Families USA.
Telehealth
The Senate has included a telehealth provision in its bill to make virtual care services permanent, according to ATA Action, the advocacy arm of the American Telemedicine Association. The provision makes permanent first-dollar coverage for High-Deductible Health Plan-Health Savings Accounts (HDHP-HSAs).
"This is a meaningful demonstration of the Senate's commitment to ensuring millions of American workers have permanent access to critical telehealth services on a pre-deductible basis, without jeopardizing their HSA eligibility," said Kyle Zebley, executive director of ATA Action and senior vice president, public policy at the ATA. "Making this provision permanent would empower more Americans to receive timely, affordable care through virtual services, especially as more workers rely on HDHP-HSA plans."
In 2020, Congress passed Section 3701 of the bipartisan Coronavirus Aid, Relief, and Economic Security (CARES) Act, which temporarily allowed HDHPs to cover telehealth services on a pre-deductible basis without jeopardizing HSA eligibility during the pandemic. Though extended multiple times, the flexibility expired on Dec. 31, 2024, Zebley said.
Sen. Scott Amendment
Sen. Rick Scott, R-Fla., and several Republican allies have unveiled an amendment to reduce Medicaid spending by another $313 billion by limiting the expansion of Medicaid under the Affordable Care Act. The amendment would prevent new enrollees in Medicaid expansion states from receiving the 9-to-1 enhanced Federal Medical Assistance Percentage (FMAP) if they are able-bodied and don't have dependent children, according to The Hill.
The amendment would require, in expansion states, that any Medicaid beneficiary who temporarily loses coverage and reapplies would be enrolled at the traditional Medicaid Federal Medical Assistance Percentage (FMAP) rather than the 90% federal match rate, the AHA said.
The AHA is urging senators to vote no on the amendment.
ORPHAN Cures Act
This is a pharma-backed proposal that would undermine the Medicare drug price negotiation process, according to P4ADNow.
"Patients are infuriated to see the Senate cave to Big Pharma by reviving the ORPHAN Cures Act at the eleventh hour," said Merith Basey, executive director of Patients For Affordable Drugs Now. "This is a blatant giveaway to the pharmaceutical industry that would keep drug prices high for patients while draining $5 billion in taxpayer dollars. We call on lawmakers to remove this unnecessary provision immediately and stand with an overwhelming majority of Americans who want the Medicare Negotiation program to go further."
THE LARGER TREND
The Congressional Budget Office estimated Sunday that the legislation would increase the deficit by nearly $3.3 trillion over the next decade, according to CBS News.
Senate Republicans advanced the legislation late Saturday as the GOP worked to iron out last-minute details and dispel concern among holdouts.
The 940-page bill was released shortly before midnight Friday.
Email the writer: SMorse@himss.org