Senate Republicans release Trump agenda bill text on Medicaid, Medicare and SALT

WASHINGTON — Republicans on the Senate Finance Committee released their portion of the massive bill for President Donald Trump’s domestic agenda on Monday, with some significant changes compared with the House-passed package.

The 549-page bill extends the expiring Trump tax cuts and includes provisions to slash taxes on tips and overtime pay.

It contains a slew of Medicaid spending cuts and new rules, including work requirements that would kick in at the end of 2026, like the House bill. It also contains policies to force more frequent checks on eligibility and tougher screenings to prove lawful immigration status, in order for people to keep their coverage.

Another Medicaid change is more aggressive than the House bill.

“The House bill placed a moratorium on taxes on providers that help states fund their Medicaid programs and increase payments to providers for services they provide. The Senate bill goes further, limiting the provider taxes that many states already have in place, but only in states that have expanded Medicaid under the ACA,” said Larry Levitt, executive vice president for health policy at KFF, a research group. “There were expectations that the Senate might moderate the Medicaid cuts passed by the House, but if anything they’re doubling down.”

Sen. Josh Hawley, R-Mo., has been critical of that idea, saying it could hurt rural hospitals in his state. “That’s not good,” he said when asked about the Senate provision. “It sounds to me like this needs some work.”

In a major challenge to House Republicans, the Senate bill caps federal deductions for state and local taxes at $10,000 per tax filer, preserving the status quo on “SALT.”

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That’s much lower than the $40,000 limit per filers with annual incomes under $500,000 that a key group of blue-state Republicans secured in the House version, after making clear it is essential to winning their vote in the narrowly divided chamber.

“Evidently, we’re just putting down a marker for negotiation,” said Sen. Kevin Cramer, R-N.D., who added that he hopes the House-Senate SALT compromise will be a $20,000 cap.

Rep. Mike Lawler, R-N.Y., slammed the $10,000 cap on X, calling it “DEAD ON ARRIVAL.”

The Senate’s bill also includes changes to Medicare including new eligibility rules, including verification of citizenship or lawful permanent residency for older adults to keep getting benefits.

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Another provision that's also in the House bill would adjust cost-sharing rules for “dual eligibles” on both Medicare and Medicaid. Loren Adler, a health policy expert at the Brookings Institution, said that provision “means 1.3 million low-income Medicare beneficiaries see higher premiums and/or cost-sharing, no longer receiving financial assistance they’re eligible for,” citing an analysis by the nonpartisan Congressional Budget Office.

Cramer said the Medicare changes are “low-hanging fruit.”

The Senate bill also swiftly repeals clean energy funding passed by a Democratic-led Congress in 2022, including an electric vehicle tax credit, while tilting the playing field back toward fossil fuels.

And the legislation would raise the debt ceiling by $5 trillion, more than the $4 trillion in the House bill.

“I look forward to continued coordination with our colleagues in the House and the Administration to deliver President Trump’s bold economic agenda for the American people as quickly as possible,” Sen. Mike Crapo, R-Idaho, the chairman of the Finance Committee, said in a statement.

Senate Republicans are hoping to pass the broader domestic policy package by July 4, with the goal of sending it to Trump’s desk by the end of next month.

Sen. Ron Wyden, D-Ore., the ranking member of the Finance Committee, vowed that “Senate Democrats are going to fight this with everything we’ve got.”

“The House Republican version of this bill was already a class war, but Senate Republicans decided to inflict even more devastation on the lives of working Americans to give even larger handouts to the top,” Wyden said in a statement.