| A few weeks ago, hospitals, health insurers and health advocacy groups decried the House of Representatives’ plans to approve major cuts to Medicaid spending, while hoping that the Senate would soften the blow. Instead, senators made the reductions to the health insurance program for low-income and disabled people even deeper as they passed their version of President Donald Trump’s giant tax measure today. While the Senate, during more than 24 hours of wrangling, shied away from demands by conservatives to vote on a proposal that would have rolled back the Affordable Care Act’s Medicaid expansion, plenty of politically dicey policies remain. Republicans are still planning to implement work requirements for people younger than 65 — set to kick in shortly after the midterm elections — as well as more frequent checks of eligibility for some enrollees. The Senate legislation would hamstring states’ ability to finance their insurance programs by taxing health care providers, blowing holes in budgets across the country. The Senate version also would charge more Medicaid beneficiaries for health care services. Congressional budget analysts expect 11.8 million people would lose insurance over the next 10 years under the Senate bill, and some of them will undoubtedly be Republican voters.  The US Capitol early this morning. Photographer: Kent Nishimura/Bloomberg It’s unclear whether House moderates will find senators’ more restrictive positions politically palatable before next year’s elections, given that Trump promised not to cut Medicaid benefits. Senator Thom Tillis, a North Carolina Republican, who announced earlier this week that he’s not running for reelection, said the Medicaid cuts went further than the president’s promise to eradicate fraud and waste. “What do I tell 663,000 people in two years or three years, when President Trump breaks his promise by pushing them off of Medicaid because the funding’s not there anymore, guys?” Tillis said on Sunday. While Republicans could have achieved savings by changing billing practices used by large insurance companies and large hospital systems, they instead chose to cut spending in Medicaid — a dream scenario for Democratic politicians eager to exploit any political blowback as states rush to implement complicated new policies on an accelerated timeline. — Rachel Cohrs Zhang | 
