Senate Democrats have concluded their strategic delay by compelling Senate clerks to read the full 940-page GOP version of President Donald Trump’s ‘big, beautiful bill,’ a process that lasted nearly 16 hours and extended into Sunday. The move, orchestrated by Senate Minority Leader Chuck Schumer, D-N.Y., aimed to exert pressure on Republicans, who have consistently opposed Democratic involvement in shaping Trump’s agenda. With the reading complete, the Senate will now proceed to a 20-hour debate period, with Democrats expecting to maximize their time while Republicans, who are likely to use only a fraction of the allocated time, face internal resistance.
Key GOP senators, including Rand Paul and Thom Tillis, are anticipated to oppose the bill unless substantial Medicaid adjustments are made, further complicating its path to final passage. Rand Paul, a vocal critic of expansive federal policies, has consistently advocated for a limited role of the federal government in healthcare. His potential opposition has been heightened by Trump’s threats of a primary challenge, which could destabilize the GOP primary race in Kentucky. Thom Tillis, who recently announced his retirement from the Senate, has opted against a potentially contentious primary battle, making his vote crucial for the bill’s approval. His decision to retire rather than face a primary underscores the political risks involved in opposing Trump’s agenda.
Sen. Susan Collins, R-Maine, who initially supported the legislation through the first test, has also expressed concerns about the Medicaid provider tax rate. Her stance reflects a broader concern among some Republicans about the financial implications of the bill, particularly the potential for increased costs to states. Meanwhile, fiscal hawks within the Republican Party have been a significant obstacle, using their influence to negotiate amendments that would adjust the federal medical assistance percentage (FMAP), which determines the federal share of Medicaid costs in each state. These amendments, while unpopular with many Republicans, are supported by a faction seeking to reduce federal spending and increase state responsibility.
The debate over the bill highlights the growing tensions within the GOP, as fiscal conservatives push for significant modifications while other members, like Collins, seek more moderate changes. The Senate majority leader, John Thune, R-S.D., faces the challenge of balancing these competing interests while maintaining the bill’s overall structure. The outcome of these negotiations will play a critical role in determining whether the bill can pass with the narrow Republican majority, given the potential for defections and the need for compromise on key provisions. As the Senate moves toward final votes, the political landscape continues to shift, with the potential for significant implications for the healthcare system and federal-state relations in the coming months.