An old James Bond movie features Christopher Walkin as a crazed business mogul trying to complete a wild scheme to flood Silicon Valley and monopolize the business. Roger Moore stops him (of course). While the storyline is laughable, this week’s fallout from President Donald Trump and Elon Musk is deserving of a comparison or at least something we would see in a Cohen Brothers film.
The Musk and Trump social media dunking, which started with Musk calling the bill a “disgusting abomination,” is an unexpected twist in an already high-stakes push in the U.S. Senate to bring the budget reconciliation bill to the president’s desk. While Musk and Trump mostly traded jabs about each other, the massive implications for Medicaid included in the bill make it susceptible to whatever fallout may happen from Musk jumping off the Trump bandwagon.
Thune Keeps Moving
Senate Majority Leader John Thune said the Senate is on schedule to produce a revised text of the budget reconciliation bill by next week as the Senate pushes toward President Trump’s July Fourth deadline for the big, beautiful bill. The deadline would be a feat in itself considering any required review or final decisions about the bill from the House.
According to a Politico exclusive with Thune, he’s approaching the Senate reconciliation bill as “a game of Whac-A-Mole” as President Trump, House Speaker Mike Johnson and conservatives push for more cuts or a variety of priorities.
The House Freedom Caucus is pushing for more reconciliation cuts this week during a meeting with Senators, with one House republican saying the Senate needs to “hold the line and make it better.” Other senators say they are pursuing the overhauling of Centers of Medicare and Medicaid Services (CMS) to combat waste, fraud and abuse.
Senator Roger Marshall (R-Kansas) says the Senate will make more changes in the budget reconciliation bill and pinged to Axios that they could try and get to $2 trillion in cuts.
Speed
Congress is often chided for moving slow. But the speed at which Trump and Congress are pushing the budget reconciliation bill is nothing short of supersonic for the federal government. Health systems may be slow to recognize or even know about Medicaid and health care changes until the bill is passed key Senate committees or even on the President’s desk.
Higher Costs, More Cuts for Health Systems Projected
America’s Essential Hospitals estimates that the one big, beautiful bill could increase uncompensated care costs for hospitals by $42.4 billion in 2034. The estimates point to Medicaid freezes and lower payments, an increase in uninsured Americans that will likely need or use uncompensated care and an unfair burden among health systems and hospitals.
A Congressional Budget Office report from this week also projects 10.9 million more Americans would become uninsured by 2034 due to the major changes to Medicaid and ACA marketplaces. The CBO said uninsured numbers could climb as a high as 16 million with other policy changes. The report laid out specifics for several big policy changes in health care:
- Premium tax credits would count for around 4.2 million uninsured,
- 80-hour a month work requirements would contribute top 4.8 million;
- Provider taxes, used for funding state Medicaid programs, could add around 400,000 uninsured.
What’s Next for Health Systems
Senate Deadlines
Thune expects a Medicaid mark-up next week, with a final update bill draft by Friday, June 13. Health systems can expect any big changes to come out of either of those two markup sessions. Health system leaders and those watching public affairs should keep an eye out for the July Fourth deadline.
Musk vs. Trump
Will the Trump/Musk fallout impact health care? It’s too early to say what could happen as a result of the biggest political bromance blowup, but health systems shouldn’t expect themselves immune from blowback, policy changes or Trump’s ire from the public sparring.
