Missouri Sens. Josh Hawley and Eric Schmitt voted yes on Tuesday morning to pass a massive budgetary package that includes controversial restrictions on medical provider taxes.
Senators labored overnight on more than 45 amendments to the tax cuts, immigration restriction and debt ceiling legislation. The bill ended up passing after Vice President J.D. Vance supplied the tie-breaking vote, which sends the measure to the House.
Schmitt said in a statement he proudly "voted to move forward with President Trump's America First agenda today." He pointed to provisions in the bill he crafted to make college savings accounts known as 529s more attractive – as well as another measure aimed at culling waiting lists for home and community-based services for people with disabilities.
"The One Big Beautiful Bill will prevent the largest tax hike in American history, secure our border, fund deportations, create American jobs, and keep our country safe," Schmitt said. "This is a win for families across Missouri, and I look forward to continuing to work with President Trump to usher in America's Golden Age."
Even though he voted for the so-called 'Big Beautiful Bill," Hawley said he still had misgivings about some provisions around Medicaid.
One of the more controversial provisions in the reconciliation package would force states like Missouri to cap their medical provider taxes on places like hospitals. Under the way the measure is structured, the 49 states like Missouri that have up to a 6% medical provider tax would gradually have to lower them to 3.5% by 2032.
Currently, Missouri's medical provider tax is at 4.2% – but has gone as high as close to 6%. The Missouri Hospital Association said capping the tax at 3.5% would cost Missouri hundreds of millions of dollars, which they add would likely force lawmakers to lower payments to medical providers.
Hawley had spoken out against the medical provider tax plan, but ended up supporting the budgetary package after senators added a $50 billion rural hospital fund. He said in a statement that he "would continue to do everything in my power to reverse future cuts to Medicaid."
"If Republicans want to be the party of the working class, we cannot cut health insurance for working people," Hawley said.
Hawley was able to convince senators to include what's known as the Radiation Exposure Compensation Act in the legislation. That program, which expired last year, would be available to Missourians who became sick because of radioactive waste exposure in the St. Louis area.
"RECA is generational legislation for Missouri and will finally deliver justice for survivors in the St. Louis region," Hawley said. "And when this reconciliation bill is signed into law, Missouri will also see new health care funding and big tax cuts for working families. I call on the House to quickly pass this legislation and send it to President Trump's desk."
Missouri Democrats were especially harsh against Hawley, who had penned an op-ed in the New York Times calling on his colleagues not to make cuts to Medicaid.
At least one Republican who voted against the Big Beautiful Bill, North Carolina Sen. Thom Tillis, said the medical provider tax plan would force states to kick people off of Medicaid.
"Josh Hawley & Eric Schmitt just voted to sell out the people of Missouri," said Missouri Democratic Party Chair Russ Carnahan in a statement. "Despite weeks of pretending to be undecided and voicing concerns about Medicaid cuts, Hawley weakly caved to GOP leadership and cast his vote in favor of the bill."
Turbulence in the House?
The bill now heads to the House, which is slated to take up the measure on Wednesday.
Whether they'll simply pass what the Senate approved is unclear. At least two members of the Missouri delegation, Reps. Bob Onder and Eric Burlison, said they were profoundly unhappy with the Senate's version of the reconciliation package.
"The House gave the Senate a modest blueprint, but the bill they passed blows right past anything resembling an acceptable framework," Burlison said in a post on X.
Onder was especially upset that the Senate parliamentarian excised a number of provisions from the bill. He said on Facebook that the "parliamentarian should stay out of the business of legislating."
Onder and Burlison's misgivings are important, since Republicans can only afford a few defections to send the budget bill to President Donald Trump.
And some House Republicans have a dim view of the Senate version of the medical provider tax plan. The House's proposal would bar states like Missouri from raising or expanding medical provider taxes, which some health care leaders contend would be more manageable than the Senate version.
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