WASHINGTON — The Senate has set an ambitious timeline for passing President Donald Trump’s sweeping legislation to cut taxes and spending. But getting it on the Republican president’s desk by July 4 will require some big decisions, and soon.
Republican senators are airing concerns about different parts of the legislation, including cuts to Medicaid, changes to food aid and the impact on the deficit. To push the bill to passage, Senate Majority Leader John Thune of South Dakota and other negotiators will need to find a compromise that satisfies both ends of their conference — and that can still satisfy the House, which passed the bill last month by only one vote.
A look at some of the groups and senators who leaders will have to convince as they work to push Trump’s “big, beautiful” bill toward a Senate vote:
Every Republican senator represents a state with a rural constituency — and some of their states are among the most rural in the country. Many in those less-populated areas rely heavily on Medicaid for health care, leading several of them to warn that the changes to the program in the bill could be devastating to communities that are already struggling.
Of particular concern is a freeze on a so-called provider tax that some states use to help pay for large portions of their Medicaid programs. The extra tax often leads to higher payments from the federal government, which critics say is a loophole that allows states to inflate their budgets. Sen. Josh Hawley of Missouri and several others have argued that freezing that tax revenue would hurt rural hospitals, in particular.
“Hospitals will close,” Hawley said last month. “It’s that simple. And that pattern will replicate in states across the country.”
Alabama Sen. Tommy Tuberville said Thursday that provider taxes in his state are “the money we use for Medicaid.”
“You start cutting that out, we’ve got big problems,” Tuberville said. Eliminating those taxes “might lose some folks.”
At the same time, Republican senators have little interest in a House-passed provision that spends more money by raising a cap on state and local tax deductions, known as SALT. The higher cap traditionally benefits more urban areas in states with high taxes, such as New York and California.
The House included the new cap after New York Republicans threatened to oppose the bill, but Senate Republicans uniformly dislike it. “I think there’s going to have to be some adjustment” on the SALT provision, Thune said Wednesday, noting that “senators are just in a very different place” from the House.
The House-passed bill would also shift some Medicaid and food stamp costs to states, a change that has the former governors in the Senate, in particular, worried.
West Virginia Sen. Jim Justice, who was governor of his state for eight years before his election to the Senate last year, said he favors many aspects of the bill. He supports the new work requirements for Medicaid and food stamp recipients, the restrictions on benefits for immigrants who are in the country illegally and the efforts to cut down on fraud. “There’s real savings there,” Justice said. “But then we ought to stop.”
“We’re on our way to cannibalizing ourselves,” Justice said. “We don’t want to hurt kids and hurt our families.”
The provision stirring the most unease would shift 5% of administrative costs to the state for administering food stamps — known as the Supplemental Nutrition Assistance Program, or SNAP. States that have high error rates in the program would have to take on an even higher percentage of federal costs.
North Dakota Sen. John Hoeven, also a former governor, said senators are working to get feedback from current governors and may propose some “incentive-oriented ideas” instead of a penalty for the high error rates.
“We don’t know if the states have really looked at the impacts of some of this yet,” Hoeven said.
Tuberville, who is running for governor of Alabama next year, said the program should be reformed instead of shifting costs.
“I know what our budget is and what we can afford, and we can’t start a federal program and then say, ‘Oh, let’s, let’s send it back to the states and let them take a big hunk of it,’” Tuberville said. “I mean, that’s not the way we do it.”
Thune needs to bring Republican moderates on board with the bill, including Maine Sen. Susan Collins and Alaska Sen. Lisa Murkowski. Both have reservations with the Medicaid cuts, among other things.
Collins said she wants to review how the SNAP changes will affect her state. Murkowski has questioned expiring subsidies for the Affordable Care Act and whether they might be needed if people are kicked off Medicaid.
Last month, Murkowski said she wants to make sure that people are not negatively impacted by the bill, “so we’re looking at it through that lens for both Medicaid and on energy.”
Murkowski and Sens. Thom Tillis of North Carolina, John Curtis of Utah and Jerry Moran of Kansas have also supported energy tax credits that would be phased out quickly under the House bill. The four senators argued that the quick repeal creates uncertainty for businesses and could raise prices for consumers.
Sens. Rand Paul of Kentucky, Ron Johnson of Wisconsin, Mike Lee of Utah and Rick Scott of Florida have argued the legislation does not save enough money and threatened to vote against it.
Paul is considered the least likely to support the measure. He says he won’t vote for it if it raises the debt ceiling — a key priority for GOP leaders in both the House and the Senate. The package would raise the nation’s debt limit by $4 trillion to allow more borrowing to pay the nation’s bills, as the Treasury Department says the limit needs to be raised by the middle of July.
Johnson has been railing against the legislation since it was unveiled in the House, arguing that it does little to reduce government spending over time. He took those arguments to Trump last week at a meeting between the president and members of the Senate Finance Committee.
After the meeting, Johnson said he would continue to argue that the bill needs to do more to cut costs. But he said he came away with the recognition that he needed to be “more positive” as Trump exerts political pressure on Republicans to pass it.
“We’re a long ways from making the deficit curve bend down, but I recognize that’s going to take time,” Johnson said. “The truth is, there are a lot of good things in this bill that I absolutely support. I want it to succeed.”
