Senate Finance Committee Chair Crapo unveiled the GOP's changes to Trump's “Big, Beautiful bill”, calling for deeper cuts to Medicaid. The Senate bill would match some elements of the House version by implementing work requirements for the popular joint federal-state health care program for Americans with disabilities, the elderly, and low-income people. In addition the Senate is proposing a provision that would incrementally lower provider tax in states that expanded Medicaid under the Affordable Care Act to 3.5% by 2031, down from the current 6%. The cap would be phased in by lowering it 0.5 % annually starting in 2027. Critics of the provider tax say it's a loophole that drives expenditures — supporters say it's a critical form of funding for hospitals, particularly rural hospitals. , followed by 45 states that taxed hospitals. States devote the proceeds of those taxes to Medicaid spending and, in turn, earn a higher matching payment from the federal government. The nonpartisan Congressional Budget Office has not yet rated the Senate bill, but it previously estimated capping all provider taxes at 2.5% would save the federal government $248 billion over 10 years.

The Senate proposal faces an uphill battle for passage. Senate Democrats blasted the proposal, but their criticism is essentially moot, since Republicans are using a budget tool called reconciliation that would enable them to pass the bill along party lines. With a 53-47 Senate majority and a 220-212 edge in the House, Republicans can afford to lose a few votes to pass a bill that faces united Democratic opposition. Some Senators have raised concerns over numerous provisions included in the proposal. Missouri Sen. Josh Hawley, who remains on the fence on the bill, said the changes to the provider tax took him aback. He argued it would hurt rural hospitals in his state. "It just baffles me. I'd invite them to come explain that to the people of Missouri," he said after a Senate Republican meeting over the plan's latest changes.