House GOP Oppose Senate Medicaid Cuts Threatening Rural Hospitals

A significant rift has emerged within the Republican Party over the Medicaid provisions in President Trump's 'One Big Beautiful Bill.' Senator Thom Tillis warned Senate leaders that deep Medicaid cuts, particularly the proposed cap on the health care provider tax rate, could devastate states like North Carolina and risk Republican control of Congress by disenfranchising working-class Trump voters. Meanwhile, a group of 16 House Republicans, led by Rep. David Valadao, threatened to withhold support for the Senate's version of the bill unless Medicaid changes—especially the rollback of the provider tax cap from 6 percent to 3.5 percent—are reversed to protect vulnerable constituents and rural hospitals. Senate Majority Leader John Thune acknowledged concerns about rural hospital funding and is working to develop solutions to mitigate the impact of Medicaid cuts, but some GOP senators remain skeptical. The House Republicans argue their Medicaid approach is more pragmatic and compassionate, emphasizing the importance of maintaining coverage access and hospital stability, while Senate Republicans strive to meet budget reconciliation rules under tight margins. This internal GOP conflict highlights the challenge of balancing fiscal goals with political risks ahead of the 2026 elections.