Why a GOP senator says the budget bill breaks Trump's promise

Summary

Podcast Summary: Consider This from NPR
Episode: "Why a GOP Senator Says the Budget Bill Breaks Trump's Promise"
Release Date: June 30, 2025
Host: Juana Summers

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Overview of the Republican Budget Bill and Trump’s Promises

In this episode of NPR’s Consider This, host Juana Summers delves into the contentious debate surrounding the massive budget bill currently being deliberated by Senate Republicans. Central to the discussion is whether the bill upholds or violates former President Donald Trump's campaign promises. The bill notably aims to make permanent the tax cuts enacted during Trump's first term and introduces additional tax reductions.

Trump, in his advocacy for the bill, emphasizes the permanence and scale of the tax cuts:

Donald Trump: "My plan is to make the Trump tax cuts permanent. They are massive tax cuts, biggest ever permanent, and to cut taxes even more." [00:14]

However, a critical point of contention arises regarding Trump's assurances about not cutting crucial social programs.

Contradictions Between Promises and the Budget Bill’s Provisions

Despite Trump’s repeated assurances that programs like Medicaid, Medicare, and Social Security would remain untouched, the Republican budget bill proposes significant cuts to Medicaid spending. These cuts are intended to fund the tax reductions, contradicting Trump's statements:

Donald Trump: "We're not cutting Medicaid, we're not cutting Medicare, and we're not cutting Social Security. None of that stuff is going to be touched." [00:29]

Juana Summers highlights this discrepancy, noting that the Congressional Budget Office (CBO) estimates that nearly 12 million people could lose health insurance if the Senate version of the bill is enacted.

Juana Summers: "The latest report from the nonpartisan Congressional Budget Office estimates nearly 12 million people will lose health insurance if the Senate version of the bill becomes law." [00:46]

Democrats and some Republicans argue that these Medicaid cuts directly violate Trump's promises, positioning the bill as a betrayal of his campaign pledges.

Senator Thom Tillis’s Opposition

Adding to the criticism, Republican Senator Thom Tillis of North Carolina voiced strong opposition to the budget bill, especially concerning its impact on rural communities and local hospitals. Speaking after announcing he would not seek re-election, Tillis expressed concern over the bill's rushed passage without adequately addressing its consequences:

Donald Trump: "What do I tell 663,000 people in two years or three years when President Trump breaks his promise by pushing them off of Medicaid because the funding's not there?" [01:15]

Senator Thom Tillis (paraphrased): "One of Tillis's big concerns was what the bill would mean for rural areas of his state and the hospitals that serve them. He urged his colleagues not to rush it through." [01:28]

Tillis's opposition underscores a growing intra-party divide, highlighting the real-world implications of the proposed Medicaid cuts.

Impact on Rural Healthcare: Insights from Sarah Jane Tribble

To shed light on the bill's effects on rural America, Juana Summers interviews Sarah Jane Tribble, the chief rural correspondent for KFF Health News. Tribble outlines the dire consequences the budget bill could have on rural hospitals and healthcare services:

Sarah Jane Tribble: "I'm not hearing good things. They're very concerned because Medicaid rates are so high in rural America that these cuts will be very detrimental. They'll cause more hospitals to close. They'll tax rural health clinics." [04:04]

She provides specific examples, such as a rural hospital in Colorado facing closure due to financial strains exacerbated by the budget cuts. Additionally, Tribble cites statistics from UNC Sheps indicating that over 150 hospitals have closed entirely or reduced services since 2010, with another 267 rural hospitals shutting down obstetrics units from 2011 to 2021.

Sarah Jane Tribble: "These hospitals are already... showing signs of duress underneath the current health system economics." [05:36]

The Senate's proposal includes a $25 billion fund aimed at supporting rural hospitals. However, experts like Tribble argue that this is insufficient:

Sarah Jane Tribble: "The National Rural Health association estimates that it's only 43% of what is needed for rural hospitals to offset the cuts coming in the Senate proposal." [05:47]

Moreover, the fund is expected to be distributed across various healthcare facilities, not exclusively to rural hospitals, further diluting its effectiveness.

White House Claims vs. Expert Analysis

In response to criticisms, the White House issued a fact sheet asserting that the budget bill would not cut Medicaid, labeling such claims as myths. However, Sarah Jane Tribble counters these assertions by referencing analyses from experts and organizations like Georgetown:

Sarah Jane Tribble: "If you decrease the number of people receiving Medicaid in rural areas, then you're going to decrease the amount of revenue the hospitals and clinics get because they just have less paying patients." [06:46]

Further, provisions like work requirements and provider taxes are identified as additional factors that could negatively impact rural healthcare systems, especially in states that have expanded Medicaid.

Consequences for Patients and Rural Communities

The potential shutdown of rural hospitals carries significant repercussions for patients, including limited access to essential services such as trauma care and cancer treatment. Tribble shares anecdotes of patients who already face long travel distances for medical care due to previous hospital closures:

Sarah Jane Tribble: "There's a lot of places where there's just not enough providers in general. And when a rural hospital closes, you know, providers tend to leave the area." [07:56]

This ongoing decline in rural healthcare infrastructure threatens to exacerbate health disparities and strain overburdened medical facilities in remaining hospitals.

Conclusion: The Future of Rural Healthcare Under the Budget Bill

The episode concludes with a stark portrayal of the precarious state of rural healthcare in the United States. While the Republican budget bill aims to deliver on Trump's promise of permanent tax cuts, it inadvertently—or perhaps deliberately—undermines the stability of Medicaid funding, thereby jeopardizing the very social safety nets Trump vowed to protect. The opposition from within the GOP, exemplified by Senator Tillis, and the detailed analysis from experts like Sarah Jane Tribble, paint a concerning picture of the bill's long-term impact on rural communities and their access to healthcare.

As the Senate continues to debate the bill, the tension between fulfilling campaign promises and addressing the tangible needs of vulnerable populations remains at the forefront of the conversation.

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Notable Quotes:

• Donald Trump: "We're not cutting Medicaid, we're not cutting Medicare, and we're not cutting Social Security. None of that stuff is going to be touched." [00:29]

• Sarah Jane Tribble: "The National Rural Health association estimates that it's only 43% of what is needed for rural hospitals to offset the cuts coming in the Senate proposal." [05:47]

• Juana Summers: "Consider this. In rural parts of the country, Medicaid covers 1 in 4 adults. What would Republicans Medicaid cuts mean for them?" [02:05]

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This comprehensive summary captures the critical discussions and insights presented in the episode, highlighting the potential ramifications of the Republican budget bill on Medicaid and rural healthcare, while juxtaposing political promises with legislative actions.

Transcript

[Juana Summers]

Does the massive budget bill that Senate Republicans are currently debating keep a promise or break one? It makes permanent tax cuts passed during President Trump's first term and add some new cuts, which is something Trump ran on.

[Donald Trump]

My plan is to make the Trump tax cuts permanent. They are massive tax cuts, biggest ever permanent, and to cut taxes even more.

[Juana Summers]

But Trump has repeatedly made another promise since he entered.

[Donald Trump]

We're not cutting Medicaid, we're not cutting Medicare, and we're not cutting Social Security. None of that stuff is going to be touched. Nothing I want to. We're going to love and cherish Social Security, Medicare, Medicaid. We're not going to do anything with that. I mean, I have said it so many times. You shouldn't be asking me that question.

[Juana Summers]

Well, the Republican bill pays for some of its tax cuts through hundreds of billions of dollars in cuts to Medicaid spending. The latest report from the nonpartisan Congressional Budget Office estimates nearly 12 million people will lose health insurance if the Senate version of the bill becomes. Trump insists the cuts come from eliminating waste, fraud and abuse. Democrats have said they break Trump's promise not to touch Medicaid. Over the weekend, a Republican senator agreed.

[Donald Trump]

What do I tell 663,000 people in two years or three years when President Trump breaks his promise by pushing them off of Medicaid because the funding's not there?

[Juana Summers]

In a blunt floor speech, Senator Thom Tillis of North Carolina attacked the bill hours after he announced he would not seek reelection. One of Tillis big concerns was what the bill would mean for rural areas of his state and the hospitals that serve them. He urged his colleagues not to rush it through.

[Donald Trump]

How hard is it to sit down and ask the Medicaid office, ask the legislative staff, ask the Independent Hospital association what the impact is if there's no negative impact, what's wrong with daylight? What's wrong with actually understanding what this bill does?

[Juana Summers]

Consider this. In rural parts of the country, Medicaid covers 1 in 4 adults. What would Republicans Medicaid cuts mean for them? From npr, I'm Juana Summers. The House of Representatives has approved a White House request to claw back two years of previously approved funding for public media. The rescissions package now moves on to the Senate. This move poses a serious threat to local stations and public media as we know it. Please take a stand for public media [e-mail] thank you. Decades ago, Brazilian women made a discovery they could have an abortion without a doctor thanks to a tiny pill.

[Sarah Jane Tribble]

That pill spawned a global movement, helping.

[Juana Summers]

Millions of women have safe abortions regardless of the law.

[Sarah Jane Tribble]

Hear that story on the network from.

[Juana Summers]

NPR's Embedded and Futuro Media.

[Sarah Jane Tribble]

Wherever you get your podcasts.

[Donald Trump]

You know those things you shout at the radio or maybe even at this very NPR podcast. On NPR's Wait, Wait, don't tell me. We actually say those things on the radio and on the podcast. We're rude across all media. We think the news can take it. Listen to NPR's Wait, Wait, don't tell me. Wherever you get your podcasts.

[Juana Summers]

It'S consider this from NPR. Roughly 20% of the US population lives in rural areas. That's the population that Sarah Jane Tribble's reporting focuses on. She's the chief rural correspondent for KFF Health News, and I sat down with her to talk about what the Republican budget bill could mean for health care for people who live in rural areas. Sarah, just start, if you can, by telling us a bit about what you have been hearing from people in rural communities across this country about these proposed cuts.

[Sarah Jane Tribble]

Yeah, I'm not hearing good things. They're very concerned because Medicaid rates are so high in rural America that these cuts will be very detrimental. They'll cause more hospitals to close. They'll tax rural health clinics. I was sitting next to a CEO of a rural hospital from Colorado. He has a 25 bed critical access hospital, the only hospital between the Kansas border and Denver on the Colorado I 70 corridor. And he'd been talking about the cuts and not happy about them. And then we heard about the rural transformation fund that the Senate has been working on to sort of help offset the cuts. And he leaned over and he just scoffed. He just said, that's just not going to be enough. So I think that there's a lot of concern out there in rural America.

[Juana Summers]

Give us some details about some of the types of ways in which rural hospitals could be impacted. Like, I guess I'm trying to figure out how these cuts would work and what they would mean for patients.

[Sarah Jane Tribble]

Well, for rural hospitals, they're specifically already on the line. We've had more than 150 hospitals that have either closed completely or shut down their inpatient beds since 2010. According to UNC Sheps in North Carolina, another 267 rural hospitals have closed their obstetrics units from 2011 to 2021. So these hospitals are already, you know, showing signs of duress underneath the current health system economics. If you and really Congress has acknowledged this over the years, passing a new rural emergency hospital Act a couple of years ago, trying to help Shore up these hospitals.

[Juana Summers]

Now, Senate Republicans have proposed adding a $25 billion fund for rural hospitals specifically. But Sarah, is that enough money to actually bridge the gap in funding that we're seeing here?

[Sarah Jane Tribble]

I'm hearing from the experts and organizations that it is absolutely not. The National Rural Health association estimates that it's only 43% of what is needed for rural hospitals to offset the cuts coming in the Senate proposal. And even worse, that that World Transformation Fund won't just go to rural hospitals. It'll go to, you know, health clinics and federally qualified healthcare centers, community mental health and opioid treatment centers, too, by their estimates. So they really don't think it's enough to offset it. I should note that I was talking to the chief lobbyist at the National Rural Health association this morning. You know, they like the idea of a rural transformation fund because rural America needs that. They need new ways of thinking about how to provide care in rural America, what kind of providers there should be. But it definitely doesn't offset the cuts coming to the program.

[Juana Summers]

The White House put out a fact sheet yesterday making the point that the bill will not cut Medicaid. This fact sheet calls it a myth that the bill will close rural hospitals. How do you parse those claims?

[Sarah Jane Tribble]

Yeah. So when you talk to anybody from, say, Georgetown or some of the other experts out there, they have analyzed the numbers of who's using Medicaid in rural America. Say moms, working age adults. These are patients of these hospitals. And if you decrease the number of people receiving Medicaid in rural areas, then you're going to decrease the amount of revenue the hospitals and clinics get because they just have less paying patients. But also, there are some other provisions in the bill that experts have analyzed as far as work requirements and the provider taxes and state directed payments. Those all do hit rural America in different ways, especially the expansion states. So, you know, when I as a reporter, when I'm parsing it, I call the experts and I ask them questions and they tell me that it's going to hurt these hospitals in these rural communities.

[Juana Summers]

Sarah, as you pointed out, rural hospitals have been on the decline for years, with many having closed in the last few decades, even more facing risk of immediate closure. I wonder, what does all of this mean for patients? I've heard about how these closures are particularly problematic, for example, for trauma care, cancer treatment.

[Sarah Jane Tribble]

Yeah. So I've done a lot of reporting over the years where I talk to patients who travel long distances for their care. Right. I did a story out of New Mexico where they were setting up telehealth services after a hospital had closed its obstetrics units so patients wouldn't have to drive for every single prenatal visit. Right. So those are situations that are already sort of on the brink, if you will, where patients are having to drive long distances when they're delivering babies or even for trauma care, where helicopters have to show up and go significant distances to get people to care. And that's because rural hospitals have been closing and rural care in general has been declining over the past couple of decades. There's a lot of places where there's just not enough providers in general. And when a rural hospital closes, you know, providers tend to leave the area.

[Juana Summers]

Sarah Jane Tribble is the chief rural correspondent for KFF Health News. Thank you so much.

[Sarah Jane Tribble]

Thank you for having me.

[Juana Summers]

This episode was produced by Katherine Fink and Connor Donovan, with audio engineering by Tiffany Veracastro. It was edited by Christopher Intagliotta. Our executive producer is Sammy Yenigun. It's Consider this from npr. I'm Juana Summers. On the plus side, you get sponsor free listening to over 25 NPR podcasts. On the minus side, you get fewer chances to t fast forward on your podcast player. On the plus side, you get to support something you care about. On the minus side, you like challenges and think this makes it too easy. So why don't you join us on the plus side of things with NPR? Learn more and sign up at plus.npr.org on NPR's Throughline. Schoolteachers are going to be the ones that rebuild our society in a way that is more cohesive. Basically where soldiers set down their arms, Schoolteachers need to pick up their books. How the U.S. department of Education Tried to Fix a Divided Nation. Listen to Throughline wherever you get your podcasts. Want to hear this podcast without sponsor breaks? Amazon prime members can listen to Consider this sponsor free through Amazon Music. Or you can also support NPR's vital journalism and get consider this [e-mail] that's plus.NPR.org.