WASHINGTON – Representatives of Louisiana’s largest hospitals converged Tuesday on Capitol Hill after a Senate committee released its recommendations to squeeze more spending cuts out of Medicaid than the House did in the One Big Beautiful Bill Act.

Louisiana’s hospitals are still evaluating the suggested Medicaid cuts, but a first read of the 549-page bill released Monday night is not optimistic, said Paul A. Salles, president and chief executive officer of the Louisiana Hospital Association.

“Unlike the House bill, which takes a more balanced approach to controlling Medicaid spending, the new proposal from the Senate Finance Committee includes devastating reductions that could jeopardize rural access, medical education, and essential services such as maternity care, children’s services, behavioral health, and access to specialty care for patients across Louisiana,” Salles said Tuesday.

The legislation, which includes most of President Donald Trump’s domestic agenda, cleared the House by a single vote. It would cut spending over the next 10 years by $1.6 trillion, mostly from Medicaid reductions, but add $2.4 trillion to the national debt, mostly from tax breaks. An estimated 10 million people would no longer be able to enroll in the state-federal program that pays for healthcare services for low-income Americans, according to the Congressional Budget Office.

Senators promised significant changes to the House-passed bill.

Their suggestions go much further on Medicaid than the House by cracking down on strategies states have used to raise more money for their share of Medicaid, which brings in more federal “match” dollars. That would have the effect of transferring the costs from taxpayers around the country to just those in a state.

Officials from Louisiana’s largest health systems gave U.S. Sen. Bill Cassidy an earful Tuesday morning, both Cassidy and hospital administrators in attendance acknowledged.

“I’m very much conscious of the impact that would have on our providers back home, but that’s the setting in which this is occurring,” Cassidy said after meeting with the Louisiana healthcare officials. The Baton Rouge Republican is a member of the Senate Finance Committee and chair of the Senate Health Education Labor and Pensions committee.

“States have gotten incredibly greedy about pulling down money from the federal taxpayer as governors and legislatures have decided to spend their own dollars on things besides Medicaid,” Cassidy said.

Cassidy said the the tax breaks in the bill will energize the U.S. economy and Louisiana workers.

Cassidy and the hospital executives note that the bill as released serves as a base for negotiations and is a long way from the shape it’ll be in when the legislation heads to the floor for Senate passage.

But the language now has worried hospitals in rural areas of the state, whose patients are mostly on Medicaid, said Jeff Reynolds, executive director for the Louisiana Rural Hospital Coalition.

“Right now, the way the bill reads,” Reynolds said, “all my member hospitals would have to see what programs they could reduce and what layoffs they’d have to order to stabilize” their finances.

In particular, wording was changed to require “state directed payments” for Medicaid programs to equal the rate paid for Medicare, which is the federal healthcare program for the elderly. The rules now allow the upper limit of those payments to be calculated from the average commercial rate for hospitals and nursing facilities.

For Louisiana, the rural hospitals are set to receive $245 million in the state’s budget for the fiscal year — the money coming primarily from the “state directed payments” the bill targets — to help offset providing healthcare services that cost more than the amount Medicaid covers.

If the Senate’s proposed legislation becomes law, equalizing those payments with the Medicare rate would immediately drop the amount the state receives to $211 million. Then the federal government would start withholding 10% annually until the calculated rate equals the Medicare rate.

Eventually, payments would drop to about $128 million annually, Reynolds said. State legislators would have to cover the difference — or they could cut Medicaid services.

“Senate Republicans are actively looking at ways to support rural hospitals,” Cassidy said. “As a doctor who worked in the charity hospital system, seeing referrals from rural parishes, I understand the importance of these hospitals and will work to maintain them in Louisiana and elsewhere.”

Additionally, the Senate Finance Committee basically reduced the amount a state can tax hospitals, clinics, and other healthcare providers from 6% to 3.5%. Louisiana and most other states use the taxes to offset the portion they owe for services rendered, which leads the federal government picking more of the costs.

Nobody knows for sure how much this provision would cost the state treasury, but lowering those percentages would shift the burden of raising the state’s match to the state’s taxpayers.

“Frankly, states have backed out their commitment to the Medicaid program and use provider taxes to replace the state commitment with federal taxpayer dollars. When we say federal taxpayer dollars, that’s you and me,” Cassidy said.

Less in the regulatory weeds is the proposed change likely to attract the most attention: Able-bodied adults with children over the age of 14 years are going to have to work or volunteer work at least 80 hours a month to qualify for the health insurance program.

The House’s work requirement was only for childless adults. In the House version, the Congressional Budget Office estimated about five million beneficiaries would lose their Medicaid – mostly from being unable to keep up with the paperwork and confusion over the qualifications. Those estimates likely would grow as the numbers required to work increases dramatically in the Senate version.

House Speaker Mike Johnson, R-Benton, has repeatedly asked senators to take a light hand in the changes they make, pointing out that House leadership crafted the bill’s provisions to win over GOP reps who had opposed the legislation. The measure passed the House in May by a single vote.

Johnson’s staff on Tuesday said the speaker wasn’t ready to comment on the Senate’s ideas for changes.

Senate leadership hopes to get a vote on the bill next week and begin negotiations with the House on final language and deliver to Trump by July 4th.