Welp. Senate version of the #MAGAMurderBill would slash Medicaid even MORE.

via Politico:

Senate GOP tax bill would hit politically explosive Medicaid provision

The Finance Committee is due to brief members on its megabill draft text Monday night.

Senate Republicans are seeking to ratchet up savings from a politically explosive policy within Medicaid to pay for their megabill, and it’s already setting off shockwaves through Capitol Hill.

The Senate Finance Committee’s forthcoming portion of the party-line tax and spending package would lower the Medicaid provider tax to 3.5 percent, according to three people with direct knowledge of the legislation who were granted anonymity to discuss it.

That would be a huge departure from the House-passed bill, which would put a moratorium on states’ ability to raise their provider tax beyond the current 6 percent. It’s also likely to spark fierce pushback from a coalition of GOP senators who were already worried that the freeze would negatively impact rural hospitals in their states. Republicans are expecting the forthcoming Medicaid language will have to be further negotiated.

“Hell no,” said one moderate House Republican who was granted anonymity to react candidly to the Senate proposal. That lawmaker is part of a group warning that deeper changes to the provider tax would be viewed as cuts to the program and are a red line for them.

Still, Senate Republicans are scrambling to notch deeper spending cuts in the filibuster-skirting legislation, and the provider tax is one of the few areas lawmakers can increase savings while not touching Medicare — another entitlement program GOP lawmakers were briefly flirting with overhauling to find offsets.

OK, first of all, I'm rolling my eyes at the anonymous "moderate" House Republican who supposedly is solidly opposed to the change. I'll believe it when I see it.

There's also this, according to David Dayen of The American Prospect:

BIG UPDATE: The new changes in the Senate version of BBB that will cut funding for Medicaid do not apply to Medicaid non-expansion states, per sources familiar. In those 10 states (WI, WY, KS, TX, TN, MS, AL, GA, SC, FL), provider taxes and state-directed payments will be frozen at current levels.

ADDITIONAL UPDATE: All PBM reforms have been stripped out of the bill. This included a ban on spread pricing in Medicaid, which allows PBMs to play on information advantages and pocket the spread between what they pay drug companies and what they charge pharmacies.

The upshot: states are rewarded under the bill for not expanding Medicaid; their finances will be easier to manage. PBMs will continue to rip people off. (Including the government; that provision saved money!) The Senate version is worse for Medicaid patients and hospitals than the House's.

I've attached the full legislative text (all 500+ pages of it) below and am digging through it now.

Edwin Park, Research Professor at the Center for Children & Families (CCF) at Georgetown University’s McCourt School of Public Policy, has posted a thread on Bluesky which goes over the ways the Senate version of the bill is even worse than the House version:

Thread: Senate Republicans released initial bill language for their #Medicaid cuts. I am reading the bill now and will highlight key changes from House-passed bill. Topline is provider tax restrictions are worse, will devastate expansion state finances,

On top of House restrictions on any new #Medicaid provider taxes or increased taxes and prohibition on certain existing taxes, starting in 2027, the maximum tax JUST for expansion states will be cut from 6% by 0.5 % pts each year and then permanently limited to 3.5% in 2031.

About 31 expansion states currently have a #Medicaid provider tax on nursing homes above 3.5% (17 above 5.5%). 18 have hospital taxes above 3.5% (7 above 5.5%). So this will create huge budget holes over time, some in as little as two years, forcing states to make severe, highly damaging cuts

These cuts would likely include dropping #Medicaid expansion as many states increased their provider taxes to finance expansion costs (which may now be prohibited). And if states drop expansion the cap on provider taxes goes up to 6% immediately relieving fiscal pressure on rest of the program

As a result this can be viewed as another major attack on #Medicaid expansion forcing states to drop it or face huge penalties that do not apply to the 10 remaining non-expansion states. It is a consistent theme throughout the list of draconian Medicaid cuts.

Clarification on #Medicaid provider taxes and the phase down of 6% safe harbor cap, there is a special protection for existing taxes for nursing homes and intermediate care facilities so long as taxes are changed. But the 18 expansion states with hospital taxes above 3.5% are not protected

There is a new harsh provision (section 71110) not in the House-passed bill that appears to completely take away current #Medicaid eligibility from many lawfully present immigrants including refugees, asylees and others

Only some parents of dependent kids are exempt from #Medicaid work requirements. Parents of children above age 14 are no longer exempt. While states are now sort of required to automatically exclude exempt people like parents of younger kids, they can still require onerous verification

Secretary may but is not required to grant good faith waivers to states to allow them to delay #Medicaid work requirement implementation. But only for up to one year to 12/31/28 and can’t be further extended

The penalty cutting #Medicaid expansion funding for many states covering undocumented kids with their own $ and some lawful immigrants with federal $ is mostly same. It does have a technical fix so it won’t affect states covering immigrant kids and pregnant women under “ICHIA” option in CHIP

In new provision #Medicaid expansion states again get targeted. Federal gov’t will pay only regular matching rate for payments to hospitals for emergency care for undocumented immigrants. Now states can get 90% for those who otherwise meet expansion criteria but for immigration status

Limit on #Medicaid “state directed payments” to hospitals and other providers in House bill ostensibly grandfathered existing and pending SDPs on permanent basis. Payments under that grandfather now get phased down each year by 10% starting in 2027

Limit on #Medicaid retroactive eligibility is now 2 months before application (still down from 3 months but more than 1 month in House bill). Therefore still raises serious risk of more medical debt for families

There were two tiny bipartisan #Medicaid improvements in House bill to ease enrollment of out-of-state providers for kids with complex medical needs and temporarily delay scheduled DSH cuts to hospitals. Both are omitted from Senate bil

Mandatory penalty on states for #Medicaid eligibility errors now clarified to include cases where there’s insufficient info to confirm eligibility on review (even if no indication individual was ineligible). Likely done to include PERM errors even though specific reference to PERM is dropped

While there are a few tiny improvements, overall take of Senate bill is its #Medicaid cuts are harsher than the House bill’s draconian cuts driven by new restrictions of existing provider tax cuts in expansion states and elimination of eligibility for lawfully present immigrants like refugees