Senate Finance releases health text with provider tax crackdown

The Senate Finance Committee on Monday released its long-awaited health and tax provisions, with some controversial moves to get more savings from Medicaid.

Why it matters: The new provisions could pose a problem for more moderate members in both the House and Senate.

What's inside:

• The provider tax is limited more than in the House bill, with the safe harbor reduced from 6% of a provider's net patient revenues to 3.5% in states that have expanded Medicaid.
• State-directed payments are also limited more, with existing arrangements no longer grandfathered in. Instead, they'd be reduced over time to be no more than the rate Medicare pays in expansion states, and 110% of the rate Medicare pays in non-expansion states.
• Work requirements largely remain intact from the House bill.
• A ban on PBM spread pricing in Medicaid also remains in the bill, though further measures to crack down on PBMs via the Medicare program were dropped.

One provision not in the bill is a Medicare physician payment fix. There's also no Medicare Advantage upcoding overhaul, as we reported earlier today.

• A provision to require Medicaid enrollees to pay cost-sharing when they visit a doctor remains in the text, despite earlier objections from Sen. Josh Hawley.

• A measure to ban larger organizations that provide abortions from receiving Medicaid funding was kept in the bill, though it could face a Byrd Rule challenge.
• Another provision that could face Byrd Rule issues is one that would ban Medicaid and CHIP from paying for gender-affirming care. It's included in the Senate bill as well as the House bill.