Senate Republicans are pushing a version of President Donald Trump's sweeping legislative agenda that proposes deeper Medicaid waste cuts than the House-passed bill, prompting internal party tensions and concerns over effects on vulnerable constituents, The Hill reported.
The Senate's version of the One Big Beautiful Bill to implement President Trump's agenda proposes sharper reductions to Medicaid fraud than legislation passed by the House, GOP aides familiar with the plan said.
According to several Republican aides, the Senate draft would tighten eligibility requirements and block states from leveraging health care provider taxes to secure additional federal Medicaid dollars — moves that could further restrict access for low-income Americans. Many of the cuts would come from the waste found by the Department of Government Efficiency, which discovered 8 million people fraudulently enrolled in the program.
"It's still f'd up," said a GOP aide, speaking candidly about the internal frustration over the Medicaid provisions, according to The Hill. The aide noted that the Senate language fails to address concerns raised by multiple Republicans who objected to the House version.
At least four Republican senators have publicly warned that Medicaid spending cuts in the House bill could hurt their states: Susan Collins of Maine, Josh Hawley of Missouri, Jerry Moran of Kansas, and Lisa Murkowski of Alaska. With only a three-vote margin for error, Senate GOP leaders face the challenge of winning over dissenters while maintaining enough support to move the bill forward through reconciliation.
The proposed Senate changes are part of a larger budget reconciliation package expected to allocate roughly $150 billion to border security and immigration enforcement. The bill also includes a $150 billion boost in defense spending, fulfilling major priorities in Trump's budget framework.
Republicans on the Senate Budget Committee, including Chair Lindsey Graham of South Carolina, have urged stronger deficit-reduction measures. Other GOP senators pushing for deeper cuts include Ron Johnson of Wisconsin, Mike Lee of Utah, and Rick Scott of Florida.
The House-passed version of the legislation already introduced sweeping changes to the Medicaid program, centering on cost-cutting and work requirements for recipients. These provisions aim to reduce overall federal health care spending, with Medicaid absorbing much of the burden.
Critics and some Senate Republicans have expressed concern that such aggressive cuts could result in millions of Americans losing coverage or experiencing limited access to care. The current Senate draft appears to expand these cost-cutting measures further, escalating tensions within the party.
While Trump continues to promote the package as a central piece of his domestic policy agenda, the Medicaid debate remains a flashpoint in negotiations. The administration has emphasized the need to trim federal spending while funding national priorities like border security and defense.
As the Senate debates the bill, party leaders must navigate between fiscal hawks pushing for steeper reductions and moderates wary of the political and practical implications of deep cuts to Medicaid, a program that serves more than 71 million Americans.
Jim Thomas ✉
Jim Thomas is a writer based in Indiana. He holds a bachelor's degree in Political Science, a law degree from U.I.C. Law School, and has practiced law for more than 20 years.