Current Actions Sign On

June 2, 2025 - Members of Congress are on their way back to DC to resume work on the "BBB," Trump's Big, Beautiful Bill, which is about to undergo some changes as Senators contemplate how to adjust the language to make it acceptable to their conference. Remember that the GOP continues to be unified around one key point: they want this bill done and on the President's desk by Fourth of July. That's just one month away, so we have our work cut out for us.

Once the Senate does their work, they will send the bill back over to the House and it will have to be approved (again) by the House Members. This gives us two clear shots at stopping this bill, which will wreak historic harm on millions of Americans and change healthcare as we know it today, back to the pre-ACA conditions that we have tried to improve over the last 15 years.

We learned some lessons in Round 1 that are critical to apply moving forward. The GOP is clearly learning and adapting also, as the House moved quickly to pass their bill notwithstanding disagreements that looked like they would topple their narrow majority.  Now the question is whether Democrats and progressives can do the same.

QUICK LEGISLATIVE UPDATES:
Trump is having lunch with VP Vance today to talk about advancing the immigration proposal in the BBB. Meanwhile, Majority Leader Thune is working behind the scenes negotiations to move the overall package. Keep in mind that Thune can only lose 3 votes in the Senate to advance the bill. There's already one GOP Senator who's vowing to oppose it because it will raise the debt ceiling. The debt ceiling increase will raise the borrowing threshold for the US-failure to raise it before around August could cause the US to default and suffer damage to the nation's credit rating. That's a big deal even though the GOP keeps acting like they don't care about credit ratings.

Like in the House, there a few factions to balance in the Senate--these are all opportunities for us:

• Some Republicans have raised concerns about Medicaid cuts (Susan Collins, Lisa Murkowski, Josh Hawley)
• Some are voicing concerns about the clean energy tax credits that have already started to benefit their states (Tom Tillis, John Curtis)
• And then there's Ron Johnson (Wi) and a handful of others who think the bill is too big with too much spending and want it pared down and more focused on deficit reduction.

Read more on the GOP Senators who could make it hard to get to 51 votes.

Is the Parliamentarian going to intervene to enforce the Byrd rule?

As you know, the version of the bill that passes the Senate has to adhere to the Byrd rule, which means that everything will have to have a specific and direct budgetary impact and be germane to the budget (taxes, spending, deficit and debt reduction):  basically, you can't use a reconciliation bill to legislate on other issues that are not relevant to the budget. . .like potentially some immigration or wage issues.

Republicans are worried about getting their “funny math” to work in order to advance the bill. Keep in mind that the GOP is using a new accounting gimmick called "current policy" to represent that the extension of the Trump tax breaks won't cost anything since there's no new policy but rather just a continuation.  Senate Republicans are trying to limit the Parliamentarian's influence to nixt that kind of accounting by insisting that it's up to Senate Budget Committee Chair Lindsey Graham (R-S.C.) to set the budgetary baseline for the bill not the Parliamentarian's.  Under that scenario, making the Trump tax cuts permanent would appear budget neutral even though in real life, it would cost trillions.

Yes, Republican lawmakers lie but sometimes the truth slips out.

Last Friday, Iowa Senator Joni Ernst was confronted at a town hall by voters angry about the GOP plan to take away Medicaid. After one of them raised concerns that people could die if the GOP followed through on this plan, Ernst sparked outrage by replying: “Well, we are all going to die.” This is the kind of in-district confrontation that we need to drive to tarnish the public's view of the Big Beautiful Bill and those who support it.

This follows another Iowa town hall, where GOP Rep. Ashley Hinson (IA) was also booed and confronted by angry constituents. Read more.

TAKE ACTION THREE STEP:

We need to expand our strategy to target both the House and Senate simultaneously because there are a few states where there are overlapping targets in both chambers.

1. House and Senate: Educate the public about what is so terrible in this bill. . . it's not just Medicaid and SNAP--this bill rolls back healthcare access to the pre-ACA days, puts Medicare at risk, shifts trillions to the wealthy and curtails economic opportunity for tens of millions of people. But they won't know unless we tell them because this thing passed in the dead of night with very little debate and extremely limited in-district activity.

2. Hold accountability actions and events targeting MOCs who voted for the bill--there's another vote coming. If you want to discourage the Members from continuing to support a terrible bill, you'll have to do public events to highlight their betrayal and get them to think twice about a do-over. I get it: they won't accept invites. That's okay. Leaflet outside their offices and do some press worthy events with grassroots leaders and impacted people. Try seniors. . . they tend to get a lot of attention.

3. Reach out to your Republican Senators and ask them to reject this bill.

      · Send a Sign On Letter to GOP Senators: See this TEMPLATE Letter that you can customize.

          o Add details that are relevant to your state but keep it short: remember, this is an opportunity to alert your Members that state stakeholders are following what is happening and have an opinion.

          o Use this as a sign on letter: get 20-50 groups in your state signed on--especially helpful if these are groups that represent a broad constituency--before sending or delivering the letter.

          o If you need specific information or data, please send me a note.

       · Reach out to Senate offices for a meeting. See these TEMPLATE outreach messages to reach your Senate offices and request a meeting in state or invite your Senator to an event. Also see this Senate Roster of Health, Tax and other staff that you can reach out to directly via email. If you need help please reach out to us

NEWS CLIPS:

Washington Post: Shhh. Republicans are trying to repeal Obamacare again. Sort of.

Congressional Republicans are pursuing changes to the Affordable Care Act that would mean 10.7 million fewer Americans using its insurance marketplaces and Medicaid, a huge reduction that some view as a way to accomplish part of the health-care coverage cancellation that failed in 2017.

They’re not branding it a repeal of President Barack Obama’s signature health care law this time around, and this year’s effort wouldn’t erase its marketplaces or Medicaid expansion. Congress tried that the last time President Donald Trump was in office but abandoned it amid an outcry from the health care industry, advocates and voters.

But the GOP plan making its way through Congress would sharply increase the number of people without health insurance, largely by narrowing the path for poor Americans to gain coverage and making it easier for them to be booted off it. It would target the twin pillars of Medicaid expansion and federally subsidized insurance marketplaces, with new rules Republicans say will reduce waste, fraud and abuse.

The Hill: Johnson Says 4.8 Million Americans Won’t Lose Medicaid Access ‘Unless They Choose To Do So’

Speaker Mike Johnson (R-La.) doubled down on his claim that there won’t be Medicaid cuts in President Trump’s “big, beautiful bill,” despite projections that millions of low-income individuals would lose health insurance as a result of the bill. Johnson, during an appearance on NBC’s “Meet the Press,” pushed back on independent projections that the bill would lead to 4.8 million people who would lose coverage because of work requirements, saying they won’t lose it “unless they choose to do so.” ... He added that the people who are complaining about losing their coverage are doing so “because they can’t fulfill the paperwork,” noting that the policy follows “common sense.”

New York Times: Trump and Allies Sell Domestic Policy Bill With Falsehoods

The bill passed by the House will reduce federal spending on Medicaid by at least $600 billion over a decade and reduce enrollment by about 10.3 million people, according to a preliminary estimate from the Congressional Budget Office. But most of the changes to Medicaid have little to do with waste, fraud or abuse as defined by the Centers for Medicare and Medicaid Service.

Edwin Park, a professor at Georgetown University whose research focuses on Medicaid and the Children’s Health Insurance Program, said that some provisions could qualify as cutting “waste, fraud and abuse,” like increasing assessments to make sure beneficiaries are not deceased.

But most other provisions fit into several categories of cuts and restrictions, according to Professor Park, targeting Medicaid expansion, limiting states’ ability to finance Medicaid, imposing red tape on beneficiaries, rolling back protections against medical debt, forcing states to drop coverage, and limiting access to care and long-term care.

“These are cuts that will take away coverage and access from many millions of low-income Medicaid beneficiaries,” he said. “One cannot credibly claim that these provisions involve curbing ‘fraud, waste and abuse.’”

The Hill: Trump’s ‘big, beautiful bill’ heads for showdown with Senate parliamentarian

Senate Republicans argue that it’s up to Senate Budget Committee Chair Lindsey Graham (R-S.C.) to set the budgetary baseline for the bill. They say it’s not up to the parliamentarian to determine whether extending the 2017 Trump tax cuts should be scored as adding to the deficit.

If Graham determines that extending Trump’s tax cuts should be judged as an extension of current policy and therefore is budget neutral, it would allow Republicans to make the 2017 Tax Cuts and Jobs Act permanent, which is a top priority of Thune and Senate Finance Committee Chair Mike Crapo (R-Idaho).

Democrats expect Senate Republicans to do just that, most likely by putting the question to a vote in the Senate, which Republicans control with 53 seats.

That’s what Thune did before the Memorial Day recess to set a new Senate precedent to allow Republicans to repeal California’s electric vehicle (EV) mandate under the Congressional Review Act.  

Democrats will attempt to force the parliamentarian to rule that making the Trump tax cuts permanent would add to federal deficits beyond 2034 — beyond the 10-year budget window — and therefore violate the Senate’s Byrd Rule.

Such a ruling, if upheld on the Senate floor, would blow up Thune and Crapo’s plan to make the 2017 tax cuts permanent. They would have to add language to sunset those tax cuts to allow the bill to pass the Senate with a simple-majority vote.

Punchbowl News: The Senate’s reconciliation standouts

The budget hawks. Sen. Ron Johnson (R-Wis.) has been bashing the House-passed reconciliation bill. Johnson has said it doesn’t go far enough to slash federal spending, despite over $1.5 trillion in cuts. Moderates in both chambers will have big problems with deeper cuts.

Johnson isn’t alone among Republicans who want to slash more in federal spending. There’s also Sens. Mike Lee (R-Utah) and Rick Scott (R-Fla.). But Johnson is in his own category here, claiming he doesn’t care about political pressures from Trump.

The spending-cut skeptics. This is the counterpunch to budget hawks’ demands. Just like in the House, the Senate has members wary of cutting safety-net programs like Medicaid and SNAP.

Keep an eye on Sen. Susan Collins (R-Maine), who has expressed concern about Medicaid changes. Collins is up for reelection in 2026. Democrats will hammer the GOP over Medicaid cuts on the campaign trail, so Collins will have to tread especially carefully.

Sen. Josh Hawley (R-Mo.) is another one to watch. Hawley has been loudly opposed to Medicaid benefit cuts.

The clean-energy crew. The House-passed bill claws back more than $550 billion of clean-energy tax credits from the Inflation Reduction Act.

Four Senate Republicans publicly oppose a total repeal of the credits. Sens. Lisa Murkowski (Alaska), Thom Tillis (N.C.), John Curtis (Utah) and Jerry Moran (Kan.) sent a letter asking for a “targeted, pragmatic approach” to IRA cuts. Tillis is up in 2026, too.

This group could try to tweak the clawbacks in the House GOP’s bill, though that’ll cause friction with hardline conservatives.

The committee chairs. There are 10 Senate committees with reconciliation instructions. One in particular has perhaps the best and worst job in Washington right now.

The Senate Finance Committee has jurisdiction over taxes, the debt limit, and Medicaid. That makes Chair Mike Crapo (R-Idaho) critical for where Republicans land on trillions of dollars in tax cuts and reductions to Medicaid spending.

The broker. The House’s thin majority is a problem for the Senate too. Keep an eye on Sen. Markwayne Mullin (R-Okla.), a former House member.

Mullin often acts as an informal liaison with House Republicans. He’s also an ally of House Ways and Means Committee Chair Jason Smith (R-Mo.).

Wall Street Journal: GOP Senator Draws Red Line on Trump Megabill

Sen. Ron Johnson (R., Wis.) is insisting on deeper spending cuts in President Trump’s “big beautiful bill,” saying his party is doing too little to address the country’s debt burden. His hard-line stance threatens to complicate passage of the GOP’s multitrillion dollar measure, which the Senate is turning to now and Trump wants on his desk by July 4.

“I’m saying things that people know need to be said,” said Johnson, 70 years old. “The kid who just exposed that the king is butt-naked may not be real popular, because he kind of made everybody else look like fools, but they all recognize he was right.” In the Senate, Johnson said, he would “like to think at least that my colleagues respect my passion, my genuine desire to do the right thing, to fix these problems.”

He takes issue with GOP colleagues’ claims that economic growth from the new tax cuts will rein in the deficit, instead siding with official scorekeepers who say the deficit will expand. He said he appreciates that Trump’s ideas, such as no tax on overtime, are “directed toward working men and women, but there’s nothing growth-incentivizing about his tax proposals.”

Politico: The ‘Medicaid moderates’ are the senators to watch on the megabill

Call them the “Medicaid moderates.”

They’re actually an ideologically diverse bunch — ranging from conservative Josh Hawley of Missouri to centrist Susan Collins of Maine. Yet they have found rare alignment over concerns about what the House-passed version of the GOP domestic-policy megabill does to the national safety-net health program, and they have the leverage to force significant changes in the Senate…

Besides Hawley and Collins, other GOP senators including Lisa Murkowski of Alaska, Jerry Moran of Kansas and Jim Justice of West Virginia have also drawn public red lines over health care — and they have some rhetorical backing from President Donald Trump, who has urged congressional Republicans to spare the program as much as possible.

Washington Post: Ernst posts snarky reply after telling town hall ‘we all are going to die’

Sen. Joni Ernst, an Iowa Republican facing reelection in 2026, flippantly dismissed voters’ concerns in recent days that people could die if Republicans cut Medicaid as they’ve promised to do in President Donald Trump’s sprawling immigration and tax package.

Speaking at a town hall in Butler County, Iowa, on Friday, Ernst was explaining how the bill would affect Medicaid eligibility when one audience member yelled out that individuals who lost coverage because of the cuts could die.

“Well, we all are going to die,” Ernst replied as the crowd groaned. “So, for heaven’s sakes. For heaven’s sakes, folks.”

While outrage at Ernst’s glib comment was immediate, on Saturday, the senator doubled down with a sarcastic response shared on Instagram.

Roll Call: Checking the math on White House, GOP claims about ‘Big Beautiful Bill’

Multiple independent analyses say the recently passed House reconciliation bill — even with its deep spending cuts in some areas — would add trillions of dollars to the federal deficit over 10 years. Those analyses contradict Republican lawmakers who have downplayed the net cost of the bill and White House claims that it wouldn’t increase the deficit at all.

CBS News: Trump Administration Ending Multiple HIV Vaccine Studies, Scientists And Officials Say

The Trump administration has moved to end funding for a broad swath of HIV vaccine research, saying current approaches are enough to counter the virus, multiple scientists and federal health officials say. ... The cuts will shutter two major HIV vaccine research efforts that were first funded by the NIH in 2012 at the Duke Human Vaccine Institute and the Scripps Research Institute, multiple scientists said. A spokesperson for Moderna said the vaccine manufacturer's clinical trials through the NIH's HIV Vaccine Trials Network have also been put on pause.

New York Times: CDC Issues New Advice On Covid Vaccines For Children That Contradicted RFK Jr.

Days after Health Secretary Robert F. Kennedy Jr. announced that Covid shots would be removed from the federal immunization schedule for children, the Centers for Disease Control and Prevention issued updated advice that largely countered Mr. Kennedy’s new policy. The agency kept Covid shots on the schedule for healthy children 6 months to 17 years old, but added a new condition. Children and their caregivers will be able to get the vaccines in consultation with a doctor or provider, which the agency calls “shared decision-making.”

Politico: ‘They're The Backbone’: Trump’s Targeting Of Legal Immigrants Threatens Health Sector

The Trump administration’s efforts to strip protections from more than half a million legal immigrants could devastate the health sector, endangering care for the elderly and worsening rates of both chronic and infectious diseases. Hundreds of thousands of health care workers, including an estimated 30,000 legal immigrants from Cuba, Haiti, Nicaragua and Venezuela, are at risk of being deported — worrying providers and patients who rely on them for everything from nursing and physical therapy to maintenance, janitorial, foodservice, and housekeeping work.

Margarida Jorge
‍Executive Director
‍Health Care for America Now (HCAN) &
Health Care for American Now Education Fund (HCANEF)
‍mj@healthcareforamericanow.org

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April 3, 2025 - an amicus letter was filed with the United States District Court Eastern District of New York on behalf of New York State Council of Churches in support of the motion for a preliminary injunction filed by the Plaintiffs in Engesser et al v. McDonald, Docket No. 25-cv-01689 (FB) (LKE).

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The Build Back Better Plan will improve healthcare in the United States. Here are background papers on two significant provisions:

Close the Medicaid Coverage Gap  

Significantly Expand Affordable Coverage

Take Action

September 27, 2021: We urge you to call your Congress Member, Senators Schumer and Gillibrand, and the White House and urge them to pass a fully funded Build Back Better Act with all of the health care provisions. Use this contact tool from Citizen Action https://p2a.co/z0RURTG