Medicaid Toast, Americans Suffer As GOP Pushes Trump Bill

Senate Republicans have unveiled late-night revisions to their massive domestic policy bill, making modest changes to key provisions on Medicaid and state and local tax (SALT) deductions. But despite the tweaks, critics warn the updated bill still poses a serious threat to millions of Americans especially those on Medicaid, as well as rural and middle-class communities that depend on critical healthcare support.

In a bid to win over skeptical moderates, GOP leaders added a $25 billion stabilization fund for rural hospitals over five years a $10 billion increase from their earlier offer. While this appears aimed at softening the blow from deep Medicaid cuts, it does little to reverse the core issue: the legislation still significantly reduces funding mechanisms that states rely on to keep Medicaid afloat.

One of the most controversial pieces remains the reduction of provider taxes fees states charge medical facilities to fund their share of Medicaid. Under the new language, the cuts to those taxes would start in 2028 instead of 2027. But the end goal remains unchanged: to shrink the allowable tax rate from 6 percent to 3.5 percent in expansion states. That phased reduction could devastate hospital funding, particularly in rural areas and low-income communities where Medicaid is a lifeline.

Sen. Thom Tillis (R-N.C.) and other Republicans have raised concerns that these cuts could have political blowback in the midterms but the real impact will be felt by Americans who rely on Medicaid for doctor visits, hospital stays, and essential treatments. Slashing provider tax flexibility will force states to either reduce coverage or pull money from other essential services, creating a ripple effect that harms middle-class families, working parents, and elderly citizens.

Meanwhile, changes to the SALT deduction pushed by Republicans from blue states like New York and California would temporarily raise the cap from $10,000 to $40,000 for individuals making less than $500,000. But the increase would expire in 2029, reverting to its original level and stripping away long-term relief for middle-income homeowners in high-tax states. That rollback, combined with reductions in green energy incentives, has already prompted several House Republicans to signal opposition.

Speaker Mike Johnson reportedly told Senate Republicans at a Friday lunch that only one holdout remains on the SALT issue, likely Rep. Nick LaLota (R-N.Y.), who confirmed he wasn’t part of any final deal.

The bill remains a moving target. Key sections particularly those affecting Medicaid and taxes are still under review by Senate Parliamentarian Elizabeth MacDonough, who must determine whether the proposals comply with strict budget rules. Some of the bill’s tax measures rely on a controversial accounting tactic called the “current policy baseline,” which artificially erases trillions in projected tax cut extensions to claim budget neutrality.

Despite these unresolved issues, Senate Republicans are pushing ahead with a Saturday vote. President Trump has made clear he wants the legislation on his desk by July 4. But unless major changes are made, the bill’s current structure would leave many Americans especially Medicaid recipients, rural patients, and middle-class taxpayers bearing the brunt of its consequences.