The Senate is in the final stages of negotiations to pass the House-passed ‘big, beautiful’ megabill, which includes sweeping reforms to tax and Medicaid programs, with a deadline of July 4. A major hurdle is securing support from Senate ‘Medicaid moderates’—key GOP senators including Sens. Josh Hawley, Lisa Murkowski, and Susan Collins—who oppose the House’s cuts to Medicaid benefits. Senate Majority Leader John Thune and Finance Chair Mike Crapo are working closely with these senators to find common ground and avoid losing the necessary votes to pass the bill.
One of the most contentious issues is the House’s proposal to freeze provider taxes, which most states use to fund Medicaid. While some senators, like Sens. Jim Justice and Hawley, have raised concerns about the decision, others, including Kevin Cramer (N.D.), are pushing for further reductions. Meanwhile, the political fallout from comments by Iowa Senator Joni Ernst, who responded to town hall pushback with controversial remarks, has added to the scrutiny on the Republican side of the aisle.
The debate over the bill has also drawn the attention of deficit hawks like former President Donald Trump, who warned Sen. Rand Paul to back the megabill, despite the inclusion of a debt-limit hike. However, Paul has already stated he will vote against the bill, as have other hardliners like Sen. Ron Johnson, who is calling for a line-by-line budget review. Democrats are also preparing to challenge the bill’s provisions, particularly those that critics argue threaten judicial power to enforce contempt orders.
As the Senate gears up for the final push, the outcome of these negotiations will have significant implications for the future of Medicaid and federal spending policies. The House Appropriations Committee is also set to begin reviewing Trump’s fiscal 2026 budget request, which includes sweeping non-defense spending cuts and faces potential opposition from Democrats, with the government shutdown deadline looming in September.