In a significant development that could stall legislative efforts, Senator Josh Hawley (R-MO) is leading a push against the Senate Finance Committee’s proposed changes to Medicaid financing. Hawley warns that the Senate's language on state provider taxes—a critical revenue source for Medicaid—faces severe opposition in the House, signaling potential roadblocks ahead.

“I don't know why we would pass something that the House can't pass and will force us into [a] conference,” Hawley stated, expressing his concerns about the Senate's aggressive approach to reforming the provider tax system. Unlike the Senate's proposal, which seeks to curtail the tax, the House had earlier opted for a mere freeze, a measure less drastic and more palatable to some lawmakers.

The discord has emerged as a focal point as Senate Majority Leader John Thune (R-SD) races against time to pass what has been described as President Donald Trump’s “big, beautiful bill” before the GOP’s July 4 deadline. Thune is eager to bring the bill to the Senate floor, possibly as early as Wednesday next week.

Hawley, voicing the frustrations of House Republicans, remarked, “We cannot pass this. We were not consulted.” This sentiment underscores a broader dissatisfaction among House moderates and key figures within Speaker Mike Johnson’s circle, who have also expressed being caught off guard by the Senate’s proposal.

In an attempt to bridge differences, Hawley has shown willingness to support the House's version of the provider tax freeze with minor adjustments requested by hospital associations in 13 states, including Missouri. “I think that would be fine,” said Hawley, noting that these changes would satisfy concerns from rural hospitals in his state.

Senate Finance Chair Mike Crapo (R-ID) and other GOP leaders are reportedly considering a rural hospital fund to mitigate the impact of the provider tax changes and win over holdouts like Hawley. However, Hawley remains firm that the Senate’s current stance on provider taxes is untenable.

Amid these legislative negotiations, Hawley has also engaged directly with President Trump, who was reportedly surprised by the Senate's provider tax proposal. The White House, through spokesperson Karoline Leavitt, has signaled flexibility, stating, “the bill hasn’t been sent to the president’s desk yet, there’s more room for change.”

As the Senate pushes forward, the outcome remains uncertain, with internal GOP tensions threatening to derail a key component of their legislative agenda. The coming days will be crucial as leaders attempt to unify the party’s stance and navigate the complex dynamics of healthcare financing reform.