Graphic: Quino Al via Unsplash (mod by Rayne)

Making America Gross Again: Big Fugly Bill Hits the Senate Floor

[NB: check the byline, thanks. Updates will be added at the bottom of this post. /~Rayne]

Trump’s big ugly bill will be up for a vote in the Senate this morning.

It takes money from hungry children and gives it to the already rich as Marcy has previously said, and the Center for Budget Policy and Priorities has quantified.

But this bill is a mortal menace to many Americans because of the bill’s cuts to Medicaid.

ER doctor McNadoMD spelled out the revolting death threats this bill poses:


EMTALA: Emergency Medical Treatment and Active Labor Act of 1986. They want to ditch 39-year-old legislation which assures Americans obtain

— a medical screening examination (MSE);
— are stabilized with an emergency medical condition;
— are transferred or accepted as a patient as appropriate and needed.

What are we left with if the GOP Senate knocks off EMTALA?

We already lost so many health care professionals because of COVID and have yet to replace them. COVID also cost this nation hospitals, thanks in no small part to right-wing refuseniks who rejected vaccines and masks. Rural hospitals were at risk of closure before COVID; 19 were closed in 2019. A net 50 rural hospitals were closed between 2017 and 2023.

We simply don’t have enough health care professionals or hospitals BEFORE the damage this bill’s cuts could wreak.

My 94-year-old father-in-law, a veteran, died last August. He ended up in the ER more than three times inside his last 18 months because his nursing home couldn’t handle his needs — basically a soft form of eviction until he was stabilized and returned to the home. This happened in a small town where the resources for his care were limited. If the local hospital closed, he’d have simply been evicted and died.

But I suspect the GOP doesn’t give a shit about lifelong GOP voters once they’re as elderly as my FIL was, without the kind of money to burn on political donations. They certainly don’t care about veterans. The GOP congressional caucus has become the death panels they warned us about.

And who pays for the unpaid ER visits — before the hospital goes bankrupt? We who have private insurance do, through increases to our premiums as hospitals increase overall charges to absorb the losses. This is an invisible tax on us, where Medicaid is fully visible.

In other words this is a definite death sentence for a group of Americans and legal residents who have kidney failure.


I don’t have words for this, but this is reality.

This is a real massacre being staged in the Senate, Kellyanne.

Across America especially in smaller cities and towns, Americans are going to face increasing poverty, illness, and death if this big fugly bill passes.

~ ~ ~

I need to get this post up so that you can see the problem and start working the phones and emails. I’ll continue to add to this post for a bit because you need to read what this ER doctor says about the bill’s likely impact if it passes.

Contact your senators and tell them this bill, H.R. 1 “One Big Beautiful Bill Act” is simply not acceptable. Contact your family and friends, explain quickly how bad this bill is and tell them to contact their senators, too.

Congressional switchboard: (202) 224-3121

or use Resist.bot or 5Calls.

Call even if your senator(s) are Democrats or Independents, because they need to know how you feel, they need to know backsliding isn’t acceptable. Don’t trust they will do the right thing without hearing from you (I’m looking at Pennsylvanians especially given Sen. Fetterman’s increasing unreliability).

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28 replies
  1. PeteT0323 says:

    I dunno if this is the final – or best – read out on those last second giveaways to draw Murkowski, etc into voting to proceed the other night. These are the ones the Senate Parliamentarian nixed in the din of the hoopla over the Big Ugly passing that hurdle 51-49 the other night.

    “…
    The revision helps Republicans shore up the spending cuts they need to fund the bill, but it could also alienate three crucial senators — Susan Collins of Maine, Lisa Murkowski of Alaska and Thom Tillis of North Carolina — who have been pushing to scale back the Medicaid cuts.


    https://finance.yahoo.com/news/senate-republicans-restore-medicaid-cuts-161131357.html

    I am of the stomach turning opinion all of this is going to pass in a one bad enough form or another because until MAGA America feels the pain nothing really can change much.

    Unrelated side note. Canada did a version of Trump’s TACO dance this AM by walking back their digital services tax. WTF – they are way too nice.

    Reply
    • Rayne says:

      Cut Canada some slack, or haven’t you realized with a nearly-global monopoly on certain tech services that Canada can be easily extorted.

      The US is also holding a number of Canadians grabbed by ICE (one died this week in custody). They may be hostages.

      Reply
      • PeteT0323 says:

        OK – I agree. But I still think Canadians are way too nice – and I know and like a lot of Canadians.

        My mom once worked – going way back to the late 1960s – at a Surfside Beach, (Miami) FL winter destination for Canadians. She was always trying to set me up on dates with the female vacationing high school family members. I suppose I should have been more appreciative, but my girlfriend at the time was not.

        Fun fact. The building she worked at was next door to the 2021 Champlain Towers South building collapse, But that was ay before that death trap was built.

        I’ll stop digressing.

        Reply
        • Rayne says:

          Yes, please get back on topic. Especially since that story you shared at that Yahoo link says the Senate’s current iteration is still going to damage Medicaid and our health care system:

          It wasn’t immediately clear how much budget savings the new version would produce.

          The Congressional Budget Office has estimated that the legislation could lead to millions of people losing health coverage. The scorekeeper found that an earlier iteration of the Senate bill would lead to 11.8 million people losing health benefits by the end of the decade.

          The revised provision is likely bad news for HCA Healthcare Inc. and Tenet Healthcare Corp., as hospitals are again facing potential cuts to Medicaid funding.

          States often use the provider taxes, within some already existing rules, to draw down federal funding and increase payments to facilities like hospitals.

        • SteveinMA says:

          My wife and I were once accused (er., mistaken) for being Canadian because we were so nice…
          I another comment, some facts from a couple of Kaiser Family Foundation articles on who gets Medicaid.

    • Rugger_9 says:

      The bill also guts ACA support for the exchanges, making ACA useless. However, in typical GOP fashion, these changes don’t kick in until after the midterm elections so the MAGAs can go on the trail and claim nothing was cut. It also sets the Ds up for blame if they regain Congress in 2026, because there is no way Convict-1 / Krasnov / TACO signs a repeal of this dreck bill.

      Reply
  2. Canine Whisperer says:

    Of course little is said in corporate media about the congressional perk-“Office of the Attending Physician” – Provided to congress members, staff and families at little or no cost. $56 per month additional premium give full range of medical services with ZERO co-pays or deductables. Additionally congress critters are able to use military hospitals and clinics at no charge.

    [Welcome back to emptywheel. Please use the same username AND EMAIL ADDRESS each time you comment. The last comment by user Canine Whisperer used a different email address than the one on this comment, triggering auto-moderation. We don’t even ask for a valid/working email address, only that you use the same one each time you comment. /~Rayne]

    Reply
  3. FL Resister says:

    Was listening to a podcast interview with an economist who has worked in both Democratic and Republican administrations who said he has never seen legislators so oblivious to the wants, needs, and opinions of their constituents.
    My personal belief is that the Republicans in office feel they can ignore majority disapproval because after Trump got away with lying about the Jan 6 attack on the Capitol and was re-elected, that elections simply won’t matter anymore.
    Besides that, many incumbent Democrats in Congress are not using their power sufficiently to stop them (see Chuck Schumer and Dick Durban). Strongly worded letters and reading bills out loud are not gonna do it.

    Reply
    • Rugger_9 says:

      One has to define ‘constituent’ for these guys. Remember the GOP pols exist to get elected, and nothing else. MAGA is 30 – 35% of the voting public, but that proportion doubles for GOP primaries and the MAGA tribe will support whatever Rupert and Convict-1 / Krasnov / TACO tells them to. That’s why Tillis pulled the plug on his Senate career.

      Do we have a D to run against Collins this time, or Murkowski?

      Reply
    • Twaspawarednot says:

      “…Besides that, many incumbent Democrats in Congress are not using their power sufficiently to stop them (see Chuck Schumer and Dick Durban)…” without a suggestion of some action this is an empty statement. Perhaps you can explain.

      Reply
    • Twaspawarednot says:

      “…Besides that, many incumbent Democrats in Congress are not using their power sufficiently to stop them (see Chuck Schumer and Dick Durban)…” Without an explanation of what you think they should be doing, this is an empty criticism.

      Reply
  4. Matt Foley says:

    Rayne, thanks for this kick in the butt. Anger without action helps nobody.

    Yup, MAGA is a death cult. I had some of them tell me via comments that elderly covid deaths were no big deal since they had lived past life expectancy (78).

    Reply
      • gnokgnoh says:

        So did I. McCormick’s mailbox is full. He’s going to vote for the bill, but I wanted to let him know I am his constituent, forcefully opposed to HR1.

        Reply
  5. thesmokies says:

    David Dayen wrote an article about a month ago in which he described one strategy the Democrats could use to block this bill. I sent the article to my senators.

    “Georgia State University assistant professor and former House Oversight Committee staffer Todd Phillips laid this out in a Prospect piece earlier this month. Any 30 senators can force a CRA resolution onto the floor, with a required ten hours of debate time. These resolutions would need the president’s signature, and nearly all of them wouldn’t even get the Republican votes necessary to pass the Senate. But according to Senate procedure, they have to be dealt with if enough senators force them onto the floor. They must be debated and voted upon ahead of other Senate business if brought up for consideration. This means that Democrats can tie up the Senate floor for upwards of ten hours with any single CRA resolution.”

    He says it could eat up the entire session and would have prevented any consideration of the bill this session. Is that a viable tactic?

    Reply
  6. Super Nintendo Chalmers says:

    I predict the Republicans will ignore the parliamentarian and “pass” the bill anyway. They expect that the Extreme Court will rubber stamp this. AFAIK the only legal-ish way to get around the parliamentarian is to either carve out or eliminate the cloture vote AKA the faux filibuster.

    Reply
    • harpie says:

      Senate Press Gallery June 30, 2025 at 10:11 AM

      By a vote of 53-46, the decision of the Chair stands that the Graham Amendment #2360 does not violate section 313(b)(1)(E) of the Congressional Budget Act. Party line vote.

      J Bendery responds to ^^^:
      https://bsky.app/profile/jbendery.bsky.social/post/3lstelz6mik2m
      June 30, 2025 at 10:14 AM

      Translated: In a party-line vote, Republicans just voted to weaken the Senate filibuster by using a gimmick to hide the cost of Trump’s ~$4 trillion tax-and-spending bill.

      More on this from @igorbobic.bsky.social [Link]

      Links to HuffPo:
      Senate Republicans Wound Filibuster To Pass Debt Bomb Republicans used a new budget gimmick to obscure the cost of President Trump’s $4 trillion tax and spending bill in a new attack on the Senate’s filibuster rules.
      Igor Bobic June 30, 2025 10:08 AM ET

      Reply
      • harpie says:

        BB Kogan:
        https://bsky.app/profile/bbkogan.bsky.social/post/3lstf6wm2os2p
        June 30, 2025 at 10:24 AM

        POO to stop deficits fails

        For the 1st time, reconciliation’ll be used to enact huge permanent deficits, in violation of the Byrd rule

        The method was the presiding officer asserting there was no point of order, w/out consulting the parl[imentarian]s,
        to pretend Rs weren’t ignoring her

        No going back from this

        This was a partly-line vote, meaning every single GOP senator felt good about GOP staffers effectively hiding from the parl[imentarian]s, refusing to debate 312 usage, because they knew she’d say they couldn’t do this – so when they did it anyway w/out asking her, they could pretend they weren’t ignoring her

        Reply
  7. UKStephen says:

    The Digital Services Tax is new and hadn’t been implemented. I think it’s fairly minor in the grand scheme of things.

    It will be interesting to see if Trump uses it as a big win he can gloat about and settles with Canada or if he finds some other lame excuse to muck up trade between Canada and the United States to continue with his 51st state crap.

    I like my health care thank you very much.

    Reply
    • Rayne says:

      Going to point out for comment readers that while your username may suggest you’re in the UK, you published your comment from Canada.

      Americans might assume, then, you mean you like your Canadian health care which is definitely not like US health care.

      Reply
    • rosalind says:

      just listened to 1/2 hour of CBC call in radio where the UBC Political Economist agreed with your assessment re. the Digital Services Tax. the callers ran the gamut from agreeing with Carney to being outraged. many voiced vows to not step foot in the U.S. any time soon. while Trump’s name came up, the callers were clear the fight is with the United States. The U.S.

      Us.

      Reply
  8. rosalind says:

    David Dayen’s articles at prospect (dot) org are a very good source as the bill works its way through. [He is also “ddayen.bsky.social”]

    He is able to game out the stakes in a clear way, i.e. Lisa Murkowski’s “Gold Rush” getting whittled down putting her in a much harder public position. Re. the Vote-A-Rama, he says: “There are only a few that could have meaning for the bill contents: 1) Blackburn/Hawley to strip out the state AI regulatory ban; 2) Collins on increasing rural hospital funds or adding a millionaire’s tax; 3) Scott/Lee/Lummis/Johnson on phasing out the ACA Medicaid expansion.

    Reply
  9. SteveinMA says:

    Stats from the Kaiser Family Foundation (one link below states most ARE working) show that only ca. 33% of Medicaid recipients are 20-65 YO. Two thirds work full or part time, another 11% are disabled, about the same are full time caregivers, and ca. 7% are in education programs. Only ca. 8% are possibly capable of working who are not, and many of these can’t find work or retired before age 65. This small number is whom some of the RW call “deadbeats”, but they are few in number, with potential savings being insignificant.

    Of course the real purpose is to force those deserving of Medicaid benefits off of the program if they fail arcane hard to follow rules the RW wants to enforce. Not surprisingly Republican claims are are completely fraudulent.

    https://www.healthcarefinancenews.com/news/most-medicaid-adults-are-working-kff-analysis-finds#:~:text=Four%20years%20ago%2C%20the%20Biden,or%20disability%2C%20or%20school%20attendance.

    Reply
    • P J Evans says:

      The people who want work requirements have never had to look for a job after about the age of 40. After 50, it’s much harder, and after 60, fuhgeddaboudit.

      Reply
      • Matt Foley says:

        PJ Evans, that’s a really good point. Which is why the MAGAs aren’t mentioning it.

        Reply
  10. FunnyDiva says:

    The senate has a live-feed from the floor.
    https://www.senate.gov/legislative/floor_activity_pail.htm

    “motion to commit on HR1” failed 48-52. The Great Googly Moogly isn’t being particularly helpful about defining a motion to commit, but it looks like it would have sent the bill back to committee. Anyway, with that split, I doubt this tally is good news as far as slowing or mitigating this impending catastrophe.

    Reply

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