The Senate’s deep cuts to Medicaid in the tax and spending megabill are setting off alarm bells among some Republicans, complicating leadership's effort to get the legislation passed by July 4.

It seeks to clamp down on two tactics states use to boost Medicaid funding to hospitals: state-directed payments and Medicaid provider taxes. The restrictions are a major concern for rural hospitals, a key constituency for senators.

Republicans have set an ambitious July 4 deadline to pass the bill and send it to President Trump to be signed into law.

Sen. Josh Hawley (R-Mo.), who has been warning his colleagues about making cuts to Medicaid for weeks, said the changes took him by surprise.

“I had no idea that they were going to completely scrap the House framework with this. I mean, this totally caught me by surprise. And I've talked to other senators, and that's what I've heard consistently from everybody I've talked to, that no one was expecting this entirely new framework,” Hawley told reporters Tuesday.

States impose taxes on providers to boost their........

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