The Senate early Tuesday rejected an amendment by Sen. Susan Collins that would have raised taxes on the wealthiest Americans to double funding for rural hospitals facing potential closures under the Republican tax and spending package.
The 78-22 vote against the Maine Republican's proposal came during an overnight session as GOP leaders scrambled to secure support for President Donald Trump's reconciliation bill ahead of his July 4 deadline. Collins' amendment would have created a new 39.6% tax bracket for individuals earning more than $25 million and couples earning over $50 million, using the revenue to boost the rural hospital relief fund from $25 billion to $50 billion.
Collins warned that rural facilities are closing their doors, leaving residents "without access to healthcare"1. Her amendment attracted support from only four Democrats and 18 Republicans, far short of the 60 votes needed to overcome a budget point of order23.
"When these facilities close their doors, the people they serve are often left behind without access to healthcare," Collins said on the Senate floor1. The senator has not indicated whether the amendment's failure will affect her vote on the overall package14.
The broader reconciliation bill includes $930 billion in Medicaid cuts over 10 years, prompting warnings from hospital groups about widespread closures1. According to the Urban Institute, rural hospitals could lose $87 billion in revenue between 2025 and 2034, with the proposed $25 billion relief fund falling far short of covering those losses2.
"To fully cover the likely financial losses, a relief fund closer to $100 billion would be needed for rural hospitals," the Urban Institute found2. The Congressional Budget Office estimates that 11.8 million Americans would become uninsured by 2034 under the Senate plan3.
The vote occurred as Majority Leader John Thune worked to hold together his narrow majority. Sen. Thom Tillis of North Carolina and Sen. Rand Paul of Kentucky have indicated opposition to the package, while Sen. Lisa Murkowski of Alaska remains uncommitted1.
House Speaker Mike Johnson has privately warned that the Senate's deep Medicaid cuts could cost House Republicans their majority in the next election, according to three people familiar with the discussions2.
Hospital advocacy groups have intensified their opposition, with the Federation of American Hospitals calling a separate amendment by Sen. Rick Scott that could end Medicaid expansion "an insult to injury"3.
The Senate continued its marathon voting session Tuesday morning, with Republicans racing to pass the package before Trump's holiday deadline.
