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The Senate's Tax and Health Care Shake-Up
Washington, DC, USAWednesday, June 18, 2025
The Senate version of the bill also includes a $5 trillion increase in the debt limit, up from the House's $4 trillion figure. This is a contentious issue, as some Republicans, like Kentucky Sen. Rand Paul, oppose it. Congress needs to act by late summer to adjust the debt limit and avoid defaulting on the nation's debt.
The Senate bill also makes various changes to taxes, including permanently extending the 2017 tax cuts and including deductions for tips and overtime pay. It also creates school choice tax credits and establishes savings accounts for newborns. However, neither version of the bill benefits low-income families who don't have a tax liability.
The bill also includes significant rollbacks to clean energy credits, with more flexibility than the House version. It phases out incentives for wind and solar at a slower pace, allowing more projects to access the credits. The House bill includes a provision requiring projects to start construction within 60 days of the bill's enactment, which concerned some Senate Republicans. The Senate language gives projects more time to start construction.
The Senate bill also includes work requirements for Medicaid, which is a joint federal-state health care program for Americans with disabilities, the elderly, and low-income people. The proposal would require nonpregnant, nondisabled, childless adults, aged 19-64, to complete a minimum of 80 hours of work, community service, or other qualifying activities to qualify for Medicaid. There would be several exemptions, including for veterans with a disability rated as total, individuals who are medically frail, and young people in foster care through the age of 26.
Some Republican senators are also raising concerns about a provision that would incrementally lower provider tax in states that expanded Medicaid under the Affordable Care Act. Critics of the provider tax say it's a loophole that drives expenditures, while supporters say it's a critical form of funding for hospitals, particularly rural hospitals. Florida Sen. Rick Scott is optimistic that they can come together and get some fiscal sanity, while Missouri Sen. Josh Hawley is concerned about the changes to provider tax and how it would hurt rural hospitals in his state.
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