More than a dozen Republicans say they 'cannot support' Trump's bill due to this provision

As the Republican-majority U.S. Senate finalizes its changes to H.R. 1 — President Donald Trump's "One Big Beautiful Bill Act" — its chances of passing through the GOP-controlled House of Representatives appear increasingly slim.

That's according to a Tuesday article in The Hill, which reported that 15 House Republicans led by Rep. David Valadao (R-Calif.) are now railing against the Senate's changes to the Medicaid portion of the bill. The group of Republicans sent a letter to House Speaker Mike Johnson (R-La.) and Senate Majority Leader John Thune (R-S.D.) telling them that the Senate's version of H.R. 1 could prove particularly harmful to their constituents who rely on Medicaid (which provides health insurance to low-income and disabled Americans).

"Protecting Medicaid is essential for the vulnerable constituents we were elected to represent. Therefore, we cannot support a final bill that threatens access to coverage or jeopardizes the stability of our hospitals and providers,” the letter read. “The House’s approach reflects a more pragmatic and compassionate standard, and we urge that it be retained in the final bill."

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"Throughout the budget process, we have consistently affirmed our commitment to ensuring that reductions in federal spending do not come at the expense of our most vulnerable constituents," the letter continued. "We write to reiterate that commitment to those we represent here in Washington."

The group of Republicans are specifically opposing changes to state-directed payments and Medicaid provider taxes, according to the Hill. The state-directed payments section changes what states can pay private companies that provide Medicaid coverage to patients, which can have an outsized impact on red states in particular that chose not to expand Medicaid under the 2010 Affordable Care Act.

As South Carolina Hospital Association chief executive Thornton Kirby told Politico last week, the Senate's version of the One Big Beautiful Bill Act could end up costing the Palmetto State an additional $2.3 billion per year, which would likely force the state to finally expand Medicaid. Both the state-directed payments and lower Medicaid provider taxes (which cuts the amount of money states use to reimburse hospitals that serve Medicaid patients) could also exacerbate the closure of rural hospitals, with hundreds already at risk of closure in many Republican-dominated states should H.R. 1 become law. Democratic Congressional Campaign Committee spokesperson Justin Chermol didn't buy the argument from the Republicans' letter, calling it "performative bulls---" given that they already voted in favor of a bill that cuts Medicaid by hundreds of billions of dollars.

"These so-called moderates already voted for the largest cut to Medicaid in American history – and when the time comes, they’ll cave to their D.C. party bosses once again to give their billionaire donors a massive tax break," Chermol said.

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Click here to read the Hill's full report.