Crucial Votes In Favor Came From Former Outspoken Opponents Of Deadly Medicaid Cuts
“Do I like this bill? No.” — GOP Senator Lisa Murkowski, after casting the deciding vote for the bill.
Maine GOP Sen. Susan Collins is famous for voting for things she claims to be against — the entire anti-choice Supreme Court majority, for example. So it was a genuine surprise when she voted against the Senate version of Trump’s murder budget, because it will decimate Maine’s rural hospitals, and her band-aid attempt to save them was rejected.
Nationwide, rural hospitals are slated to lose 21 cents of every Medicaid dollar they now receive — almost $70 billion total, according to a report from the National Rural Health Association. That’s more than 15% greater than the $60 billion cuts in the House version.
But Alaska GOP Senator Lisa Murkowski out-Susan-Collinsed Susan Collins this time, telling NBC News’ reporter Ryan Nobles afterwards that she didn’t like the bill, and expressing the vain, irresponsible wish that the House would fix the mess she helped make.
“I know that in many parts of the country, there are Americans that are not going to be advantaged by this bill. I don’t like that,” she said. “My hope is that the House is going to look at this and recognize that we’re not there yet,” she went on to say. “I would hope that we would be able to actually do what we used to do around here, which is work back and forth between the two bodies to get a measure that’s going to be better.”
“If you really believe that, then why the hell did you vote for this bill?” Massachusetts Rep. Jim McGovern said in response. “It’s a dereliction of your duty as a United States senator and as a representative for the people in Alaska. I mean, when was the last time this current House of Representatives has fixed or solved anything? I mean, where have you been, Sen. Murkowski? This Republican House is dysfunction on steroids.”
Indeed, the back-and-forth so far has only made things worse. Most notably, the Senate’s cuts to Medicaid and the Children’s Health Insurance Program (CHIP) of $1.02 trillion over 10 years are $156.1 billion or 18% larger than the House’s cuts of $863.4 billion. This came after a nationwide poll found there’s not a single congressional district with more than 15% support for such cuts.
“The Senate took the largest health care cuts in history and made them even worse,” said Rep. Nanette Barragán in a press statement. “The Senate’s version of Trump’s Big Ugly Bill would take health care away from nearly 17 million Americans, including nearly 2 million Californians, and raise health care costs for more than 20 million people who rely on the Affordable Care Act marketplace.”
For generations, Republicans have passed bills to cut taxes for the wealthy, claiming that they will “pay for themselves” by producing more growth and generating more tax revenue. However, a recent study of four decades of such tax cuts across the developed world found that such tax cuts have no impact on economic growth. So, when budget deficits naturally soar as a result, Republicans then turn around and say we have to cut social spending to close the budget gap that their tax cuts created.
But this time it’s different: they’re cutting taxes and social spending in the same bill, resulting in a straightforward transfer of money from poor and working-class people to the rich. But even then, tax cuts for the wealthy are so huge that they will increase the deficit by over $3.3 trillion. Healthcare spending cuts are the largest source of money transferred to the rich, followed by food assistance, about $300 billion in cuts, affecting 40 million people.
But the reverse-Robin-Hood core of the bill isn’t the only dramatically bad thing about it. After casting his tie-breaking vote to pass the Senate bill, Vice President JD Vance — who vehemently warned against smaller Medicaid cuts in 2017 as a betrayal of rural Trump voters — said that none of the traditional GOP budget obsessions mattered: “”Everything else—the CBO score [budget deficit], the proper baseline, the minutiae of the Medicaid policy—is immaterial compared to the ICE money and immigration enforcement provisions.” Vance wrote on Twitter.
Apart from dismissing a $1 trillion cut in Medicare spending, and the closing of hundreds of rural hospitals as “minutia,” what’s most notable here is Vance’s complete reversal of his argument during the campaign that immigration mattered because it was a Medicare issue. In September, he said, “We’re bankrupting a lot of hospitals by forcing these hospitals to provide care for people who don’t have the legal right to be in our country.” But now he himself cast the deciding vote to bankrupt rural hospitals in order to deport more immigrants.
His original claim was false, of course, as experts noted at the time.
“When we speak with our rural hospital members, that is not what we hear,” Shannon Wu, director of payment policy at the American Hospital Association, a trade group representing more than 5,000 hospitals, told KFF Health News in response.
But this time, there’s a germ of truth in what Vance is saying. The “immigration enforcement” spending is not only dramatically larger than anything ever seen before, it would go a long way towards turning America into a classic police state — as evidenced by the Trump administration’s willingness to arrest judges and politicians who stand in the way of its lawless immigration agenda.
Aaron Reichlin-Melnick, senior fellow at the American Immigration Council, outlined the scope of immigration-enforcement funding on Bluesky:
– $51.6 billion for border wall ($46.6 billion for wall, $5 billion for U.S. Customs and Border Protection checkpoints and facilities)
– $45 billion for ICE detention
– $29.9 billion for ICE enforcement
Grand total: $170.7 billion.
This would translate into 10,000 new ICE agents and 100,000 new detention beds at a time when ICE currently can’t find enough criminal immigrants to fill its current quotas, and instead is mass-arresting farmworkers, day laborers and other crucial industry-specific workers.
The bill is massively unpopular with the public, as pollster G Elliott Morris noted on Bluesky. “I haven’t seen a single credible poll with support above 40% of adults. And that’s just if you ask people, ‘Do you support the OBBB,’” he wrote. “If you poll them about the individual components, it’s 30+ points underwater” He posted a screenshot showing it was opposed 49-29% according to Pew, 64-35% according to KFF, 53-27% according to Quinnipiac, 42-23% according the Washington Post, and 59-38% according to Fox.
Republicans are in a hurry trying to get it passed, precisely because it’s so unpopular. They’re hoping they can get away with it, if they do it lightning quick. But whether they will remains to be seen. They’re almost certain to lose their House majority as a result — and possibly their Senate majority as well. Enough swing-district House members have voiced opposition in the past, and then folded. But it only passed by a single vote last time. So the outcome is far from assured.