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The Medicaid debate among Senate Republicans continues to rage on, but a new proposal geared toward sating concerns over the survivability of rural hospitals could help to close the lingering fissures within the conference.
Senate Republicans are sprinting to finish their work on President Donald Trump’s “big, beautiful bill,” which is filled with key priorities like making his first-term tax cuts permanent, funding his immigration and border security agenda, and rooting out waste, fraud and abuse across a variety of programs.
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But lawmakers are still at odds over changes made in the Senate’s version of the bill to the Medicaid provider tax rate and the effects that it could have on rural hospitals, threatening to derail the legislation near the finish line.
A proposal making the rounds from the Senate Finance Committee obtained by Fox News Digital would create a separate stabilization fund that would go toward aiding and upgrading rural healthcare.
The committee’s proposal would allocate $3 billion annually to states that apply to the program over the next five fiscal years.
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But that amount is too low for some senators and far too much for others.
Sen. Susan Collins, R-Maine, has been working on a similar proposal but would prefer a much higher fund of $100 billion. That number is unlikely to pass muster with her colleagues and still isn’t high enough for her.
“I don’t think that solves the entire problem,” she said. “The Senate cuts in Medicaid are far deeper than the House cuts and I think that’s problematic as well.”
Collins would prefer a return to the House GOP’s proposed changes to the provider tax rate, rather than the Senate’s harsher crackdown.
The Senate changes to the provider tax rate hit close to home for Collins, whose state’s rural hospitals are already in jeopardy because the state of Maine failed to advance its budget in time, leaving roughly $400 million in Medicaid funding that would have gone to rural hospitals in limbo.
“Obviously any money is helpful. But no, it is not adequate,” she said.
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Indeed, the changes to the Medicaid provider tax rate, which were a stark departure from the House GOP’s version of the bill, angered the Republicans who have warned not to make revisions to the health care program that could shut down rural hospitals and boot working Americans from their benefits.
The Senate Finance Committee went further than the House’s freeze of the provider tax rate, or the amount that state Medicaid programs pay to healthcare providers on behalf of Medicaid beneficiaries, for non-Affordable Care Act expansion states and included a provision that lowers the rate in expansion states annually until it hits 3.5%.
However, Centers for Medicare & Medicaid Services (CMS) Administrator Dr. Mehmet Oz and some Senate Republicans have argued that the provider tax rate is a scam rife with fraud that actually harms rural hospitals more than it helps.
Sen. Rick Scott, R-Fla., was in the same camp, and has argued that the rate should be nixed completely. He has similarly pushed for a separate fund but wasn’t keen on the cost of the current proposal.
“I don’t know that we need $15 billion,” he said. “But this needs to be run by CMS.”
And others wanted to see more money injected into a stabilization fund.
“I think $5 billion a year would more than make them whole,” Sen. Roger Marshall, R-Kan., said.
He contended that, as the only lawmaker who has run a rural hospital, there are only roughly 12 million people on Medicaid in rural America, and that lawmakers should “tighten things up” when it comes to funding the health care program.
He said that being on Medicaid was “not the same as having healthcare,” and added that “at best, two thirds of doctors accept Medicaid, and even many of the specialists, when they say they do, they won’t give you an appointment for six months or a year.”
“Medicaid is not the solution,” he said. “It’s the most broken federal system up here.”
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