Illustration: Lindsey Bailey / Axios
The Senate is heading into a crucial week for reconciliation, with a floor vote and major changes to the health provisions in the GOP megabill looming.
Why it matters: Republicans are trying to stay on track and meet a self-imposed deadline for passing the package by the July 4 recess. But new proposals keep cropping up that are proving divisive or complicating the math.
Driving the news: One new potential change under discussion is Sen. Rick Scott's proposal to lower the 90% federal matching share (FMAP) for new Medicaid enrollees in expansion states.
- Current enrollees would be grandfathered in under the existing 90% match, but over time, churn in the program would steadily reduce the FMAP for more people.
- The idea is setting off major alarm bells among hospitals.
- Scott's plan could draw opposition from moderates, including on the House side, who've objected to FMAP changes throughout the reconciliation debate. Scott's office didn't immediately respond to a request for comment.
Between the lines: On another front, moderates like Sen. Susan Collins are discussing establishing a fund to help rural hospitals, in a bid to assuage concerns about cuts to provider taxes that states levy to help offset their share of Medicaid costs.
- Details on that proposal are not yet clear. Collins told reporters last week that she was "looking at whether there would be receptivity to a provider relief fund for rural hospitals and health centers" and added that she had not "endorsed in any way the provider tax changes."
- Sen. Josh Hawley late last week floated the idea of both a rural hospital fund and undoing the Senate's deeper provider tax limits.
- "We could do both," Hawley told Axios' Stef Kight. "I mean, they're not mutually exclusive."
What we're watching: The Senate parliamentarian is still considering the Finance Committee's health care provisions and whether they meet the Byrd rule.
- Measures that could be thrown out include language that would lower the FMAP for states that opt to cover undocumented immigrants in their Medicaid programs, and restrictions around cost-sharing reductions for Affordable Care Act plans that provide abortions.
What's next: Assuming enough of the divisions are worked out, Senate Majority Leader John Thune has said he wants to take up the reconciliation bill by midweek. But a vote could slip to Friday.
- There would still be a vote-a-rama at which Democratic senators offer numerous amendments to try to take out portions of the bill.
- Depending on when the bill is actually taken up and how long Democrats want to drag out the process, the proceedings could potentially last into the weekend.
