Breakdown of Health Concerns in Reconciliation Bill July 1, 2025

The following analysis is provided by our friends at the California Medical Association. Upset by these changes? Contact your member of Congress (if you live outside DC) or contact colleagues in other states to tell them to contact their members of Congress.

SUMMARY OF THE HOUSE AND SENATE BILLS

Linked here is an excellent side by side of the House and Senate health care provisions from the Kaiser Family Foundation.

https://www.kff.org/tracking-the-medicaid-provisions-in-the-2025-budget-bill/.

KFF has not yet completed the update to include all of today’s Senate amendments.  Keep checking for final updates.

Additional Highlights
Medicare Physician Payment

The final Senate bill provided a Medicare physician payment update of 2.5% for 2026 higher than the 2.25% rate increase for 2026 included in the House bill.  

Medical Student Loans

The Senate also increased the cap on student loan borrowing for medical school up to a $200,000 lifetime cap in addition to the $50,000 undergraduate borrowing cap. The provision that eliminated Public Service Loan Forgiveness for hours worked during a medical residency or internship was ruled in violation of the Byrd rule and was not reinstated.  

KEY AMENDMENTS ADOPTED IN THE SENATE TODAY

• Increased the Rural Health Fund from $25 billion to $50 billion and included other providers. The funding will be directed to the states to distribute to hospitals, community clinics, mental health centers, opioid programs, and nursing homes. It is important to note that the national hospital associations and other provider groups opposed this new fund and instead supported reinstatement of the provider tax cuts which fund rural providers.
• Clarified that the provider tax section (Section 71115) applies to provider taxes set by both states and local governments.  (Important for TX, FL, OH and LA)
• Clarified the grandfathering provision in the State Directed Payment Section 71116 to allow states that completed preprint submissions to the Secretary prior to the date of enactment would be grandfathered in.  
• Dropped the 10% reduction in the federal matching funding for 15 Medicaid expansion states that use their own state-only dollars to provide coverage to certain immigrants, including undocumented immigrants which was in violation of the Byrd rule.
• Dropped Federal matching funding for certain “high poverty” states.
• Dropped prohibition on federal funding for gender affirming care to comply with the Byrd rule.
• Instead of a 10- year funding cut to Planned Parenthood clinics, it cut funding for one year to comply with the Byrd rule.