When Republican leaders weigh which of their members could challenge the party and the defect in important legislation, the name of Senator Jerry Moran rarely appears.
Therefore, it was even more remarkable when Mr. Moran, a third period of Kansas, went to the floor last week to broadcast a warning of how the budget plane that his party was about to approve could affect his state.
By pointing out that the budget plan that the Republicans were considering could lay the foundations for sweeping to Medicaid, Moran warned that such reductions could threaten rural hospitals with difficulties and, by extension, the future of the American rural heart.
“I want to make sure my colleagues know, in my opinion, the value of making sure we do not have harm to those who desperately need medical care in Kansas and throughout the country,” said Moran.
The speaker Mike Johnson was able to reject Thursday and promote that plan to deliver the agenda of expenses and tax cuts of President Trump by the promising conservatives of the House of Representatives that his colleagues in the Senate would join them to reduce $ 1.5 billion in federal expenses during the next decade.
The problem for Republicans is that it is increasingly clear that some Republican senators simply do not have the appetite for the types of deep cuts through which their counterparts in the camera are agitated. In recent days, they have expressed concern about repealing the entire inflation reduction law of President Joseph R. Biden Jr. and restricting access to food coupons.
But no problem has attracted as much resistance as the possibility of cuts to Medicaid.
“I’m not going to vote for Medicaid benefits cuts,” Senator Josh Hawley in Missouri said Thursday, who has been one of the most open Republicans on the subject, to journalists shortly after the Chamber adopted the budget resolution. “Then, if you want my vote here, then it will not contain docks of Medicaid.”
Republican leaders have insisted that they have no plans to reduce Medicaid, and Johnson said Trump would not support cuts to the benefits of Social Security, Medicare or Medicaid.
“We are going to protect the benefits to which everyone is legally entitled,” said Johnson.
But it will be almost impossible for Republicans to reach $ 1.5 billion in expenses of expenses without touching Medicaid. Although Mr. Johnson suggested that the party would consider imposing work requirements and uprooting waste, fraud and abuse, those changes would surely not be enough to achieve their goal.
The leaders of the Republican party in the Senate faced themselves at the open at the end of last week when that camera exceeded a commitment budget that included elements of one that the Chamber approved in February that asks the committee that Supervisa Medicaid to find $ 880 billion in cuts. The Senate Republicans had previously been able to avoid specific discussions about possible cuts to Medicaid, and the scrutiny had focused on their politically vulnerable colleagues in the Chamber.
But when Senator John Thune of South Dakota, the leader of the majority, sought to take the resolution to the floor, the Republican senators initially resisted. A group of Holdouts, including Senator Susan Collins de Maine, curled up privately with Mr. Thune to broadcast his concerns.
When they left the meeting, Mr. Thune had the votes to proceed. But the senators warned that they would not be willing to approve the final legislation that would take a meat ax to a medical care program in which many of their constituents trust.
“The instruction of the house at $ 880 billion worries me a lot,” said Collins, “because I think it would inevitably lead to significant cuts in Medicaid, which would be very harmful to people in Maine and for our rural hospitals and other medical care providers.
Mrs. Collins later added: “I will not support the cuts that affect low -income families, individuals with disabilities, low -income elderly, rural hospitals. I am open to a work requirement for people who do not have children of preschool age.”
The same situation was developed in the camera this week in reverse, when conservatives who demanded deep expense cuts initially refused to support a commitment version of the budget plan that requires the Senate to find only $ 4 billion in reductions for a decade, a small fraction of the cuts described by the camera. Texas Chip Roy representative, one of the Holdouts, said he had ceded only after being insured by Mr. Trump and party leaders in both cameras that the final product would include large cuts to federal rights programs, including Medicaid.
A survey conducted last month by Fabrizio Ward, the signing of the main campaign polls of Mr. Trump, found a wide disapproval of cutting Medicaid, even among the voters who supported the president in 2024 (the survey was conducted in the name of the modern Medicaid alliance, a coalition of organizations that includes insurance and suppliers of medical care).
Senator Lisa Murkowski from Alaska, who has made clear her colleagues in recent weeks that she thinks Cut Medicaid would be particularly disastrous for her state, issued a list of concerns with the resolution. It included “instruction to a camera committee that would require significant cuts to Medicaid.”
“If the final bill falls short on any of those fronts, could not support its approval,” Murkowski said.
Mrs. Murkowski and Mrs. Collins joined the Democrats last week to support a bipartisan amendment led by Mr. Hawley who would have eliminated the medical cuts from the budget. His effort failed after Republican leaders worked to guarantee their defeat. A broader amendment that promises to protect Medicaid and Medicare approved.
Senator Jim Justice of West Virginia, where about 28 percent of the population is registered in Medicaid, has said that the program is “monstrously important” for its state. He told Axios that he was concerned about Medicaid’s proposals for his party, and that although he would support to impose work requirements for beneficiaries, he wanted more information about the limitation of Medicaid’s expansion.
Since then it has taken a more optimistic tone.
“I have said again and again, we all have legitimate reasons to feel worried,” Justice said in a brief interview. “But I don’t really believe at the end of the day that President Trump is going to hurt our elders or our children.”
Federal and state governments share the costs of Medicaid, a public health insurance program for low -income people that covers more than 70 million people. In rural areas, where income tends to be lower and people do not have higher rates insurance, hospitals often face higher levels of uncompromising care, which means that people cannot pay their bills in the hospital.
Medicaid payments can provide a financial buffer that helps rural hospitals fighting that gap. Mr. Moran, the Kansas senator, said in his speech on the floor that the average operational margin for a hospital was negative of 7 percent, and that eight Kansas hospitals had closed in the last 10 years.
“My goal is to make sure that rural communities have a future,” said Moran. “But that future disappears in the absence of accessing medical care.”
