Without changes to the GOP's "big, beautiful bill," Sen. Josh Hawley fears "there’s going to be a lot of rural hospitals in Missouri that close."

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.

Senate Republicans on Monday proposed steeper Medicaid cuts than those included in the House-passed version of President Donald Trump’s signature policy bill—making the bill’s passage by the July 4 deadline set by Congressional Republicans even more uncertain as Medicaid cuts have been a major sticking point for some in the GOP.