Senate Republicans on Monday proposed cutting Medicaid even more aggressively than their House colleagues to help offset the cost of trillions of dollars in tax breaks that would disproportionately benefit the wealthiest Americans.
The legislative text unveiled by the GOP-controlled Senate Finance Committee is a central component of the sprawling reconciliation package that Republicans are hoping to send to President Donald Trump's desk by next month.
The bill contains broader Medicaid work requirements than the House-passed legislation, expanding the ineffective and punitive mandates to low-income adults with children over the age of 14.
The Senate version would also sharply limit provider taxes that states use to fund their Medicaid programs. Edwin Park, a research professor at Georgetown University's Center for Children and Families, warned the provision would "devastate" state finances, particularly where lawmakers have expanded Medicaid under the Affordable Care Act (ACA).
"This will create huge budget holes over time, some in as little as two years, forcing states to make severe, highly damaging cuts," Park wrote in an analysis of the new legislation.
"Senate Republicans have made this cruel, heartless bill even worse as they continue on their endless pursuit to destroy our healthcare system."
Senate Republicans released the bill text less than two weeks after the nonpartisan Congressional Budget Office estimated that the House-passed reconciliation package would strip healthcare from nearly 11 million Americans over the next decade—a number that rises to 16 million when accounting for the GOP's refusal to renew ACA tax credits set to expire at the end of the year.
Even more people would lose healthcare if Republicans adopt the Senate plan, analysts and advocates warned. One recent study estimated that around 51,000 additional people across the U.S. would die unnecessarily each year due to large-scale health insurance losses caused by the GOP's proposals.
"It shocks the conscience that Senate Republican leaders saw the impacts of the House bill—16 million more people uninsured and millions losing help buying groceries, including families with children—and chose to double down," said Sharon Parrott, president of the Center on Budget and Policy Priorities.
Leslie Dach, chair of the advocacy group Protect Our Care, said in a statement that "this bill was already a five-alarm fire for American healthcare, and Senate Republicans have just poured gasoline on it."
"Contrary to what they've repeatedly promised, Republicans are torching Medicaid, ripping apart the Affordable Care Act, and leaving 16 million people without the critical care they need, all so Trump and the GOP can funnel more money to their billionaire and corporate friends," said Dach. "Seniors will be thrown out of nursing homes, people fighting cancer will be cut off from treatment, and rural hospitals will shutter. Senate Republicans have made this cruel, heartless bill even worse as they continue on their endless pursuit to destroy our healthcare system."
If Senate Republicans adopt the proposed changes, the House would have to pass the reconciliation bill again before it can reach Trump's desk. One House Republican, granted anonymity by Politico, said "hell no" in response to the Senate language pertaining to Medicaid provider taxes, a signal that the proposal is likely to face intraparty opposition.
But experts stressed that both the House and Senate versions of the reconciliation bill would be disastrous for low-income Americans and a boon for the rich.
"Now that we've seen Senate text, we can say for certain: Either the House or the Senate version would be the largest transfer from the poor to the rich in a single law in history," wrote Bobby Kogan, senior director of federal budget policy at the Center for American Progress.
"Each would kick millions of people off their health insurance and each would rip food assistance away from millions of households," Kogan noted. "Each would increase deficits by trillions of dollars while making the poorest Americans poorer and making the richest Americans richer."