Context:

A House Republican from Southern California, Rep. Young Kim, is prepared to oppose President Donald Trump's tax bill if it returns without the House's original Medicaid provisions, reflecting the concerns of multiple moderate Republicans. The Senate's new version of the bill, released just before midnight, includes changes to Medicaid and green energy credits, specifically affecting provider tax rates and state-directed payments. These changes have sparked alarm among 16 House GOP moderates who argue that the bill's provisions treat expansion and non-expansion states unfairly and impose stricter limits without adequate time for hospitals to adjust. In response to concerns, the Senate Finance Committee included a $25 billion rural hospital fund, which swayed some senators but left House moderates still unconvinced. Despite the narrow majority in the House, a senior GOP aide believes moderates will eventually support the bill due to pressure from Trump and the GOP leadership’s insistence on minimal changes to the Senate's bill version.

Dive Deeper:

• Rep. Young Kim and other moderate Republicans are threatening to oppose Trump's tax bill if Medicaid provisions from the House's original version are excluded, as these provisions are crucial for protecting Medicaid services for vulnerable populations.

• The Senate's revised bill introduces significant modifications, especially regarding Medicaid and green energy credits, causing unease among House moderates due to the proposed reduction in provider tax rates and state-directed payments that states rely on for Medicaid funding.

• Moderate Republicans, expressing their concerns through a letter, argue that the Senate's version of the bill unfairly treats expansion and non-expansion states, fails to preserve existing state programs, and imposes strict budget constraints without adequate transition time for hospitals.

• In an attempt to address these issues, the Senate Finance Committee added a $25 billion rural hospital fund to the legislation, which persuaded some senators like Josh Hawley, but House moderates remain skeptical about the bill's current form.

• Despite the expressed concerns and the House's narrow majority, GOP leadership is confident that the moderates will eventually support the bill, primarily due to the pressure exerted by President Trump and the strategic emphasis on maintaining minimal changes to the Senate's version of the legislation.