Doctors, hospitals and health insurers issued strict warnings to Republican MPs for weeks that millions of people would lose health coverage and the hospital would be closed if they cut the medicine funding to help President Donald Trump pay for large taxes and expenses bills.

But the Republican ignored the arguments, even deeply cut, and sent a law to the White House on 3 July, where Trump signed it The next day.

The path of law marked a rare political loss for some of the biggest players in the health industry. When integrated, doctors, hospitals, and insurers are one of the most powerful lobbying forces in Washington and there is a long track record of blocking or forcing changes in law that can hurt them financially.

But the health industry lobists are breathing their breath and are assessing the loss of Trump on a large scale after running through the Congress in less than two months with Republican votes.

Many lobists offered various reasons to be unable to make the Medicade unable to make a big cut, included a $ 900 billion state-throat health insurance program Low income and disabled people And accounts for 19% All hospital spent Care. , But almost everyone agreed that the GOP MPs were more concerned about annoying Trump than coming back home from local hospitals and components.

Bob Kochhar, a partner with a partner Bob Kochhar, with Venture Capital firm Venrock, who served in the Obama administration, said, “Member Trump was more afraid of releasing a primary challenge compared to the disappointing local voters, who could close their hospitals or increase their insurance premium,” said a partner Bob Kochraro, a partner Bob Kochraro, a partner Bob Kochrock, a partner in the Obama administration. Referring to primary.

Consider what happened to Sen Thom Tilis (RN.C.). After going to the Senate floor to declare the opposition to the bill due to the deduction of the medicid, Trump threatened to support a challenge to run against Tilis the following year. Soon after, Tilis declared his retirement from politics.

Sour feelings on ACA

But other factors were at work.

MPs may have been dismissed by the health industry warning as hospitals, health centers and other health care provider groups are seen as strong supporters of the cheap care act by Republican, law is known as ObamaCare which is considered to be the biggest domestic achievement of Democrats in decades.

ACA first expanded government health insurance coverage for millions of people. And no Republican voted for this.

Kochhar said, “The support of ACA hospitals has disappointed the Republican, and as a result, the reservoir of goodwill for hospitals is less than the past.”

The Chief Executive of the Alliance of Community Health Plan, Seasi Konoli said that his lobbying team along with MPs and their employees spent extra time on Capital Hill, expressed concern about how the law would affect health care coverage.

“There was almost an overriding spirit from Republican in the Congress to give a big win for President Trump,” he said. Its group represents health plans that provide coverage in about 40 states. “This ended some of his concerns, reluctance and hesitation.”

Konoli said that he repeatedly heard GOP MPs that the focus was on focusing on Trump’s promise.

He said that the concerns of some liberal members helped lead a concession: $ 50 billion funds to help rural hospitals and other health providers.

He said that money has made it easier for some MPs to support a bill that cuts more than $ 1 trillion from Medicid in a decade.

Lobbying succeeded in some ways

Another turn: Many new legalists were clearly learning about the Medicade, he said.

He said that Republican was also eager to reduce the scope of coverage of the Medicade and Cheap Care Act, after enrollment in both programs during the epidemic and Biden administration. Trump’s law requires states to verify the eligibility for medicade at at least every six months and the auto-neralment ends in the marketplace plan-Steps say health policy experts. Opposite some of those benefits.

Charles “Chip” Kahn, a long -time health lobist and CEO of the Federation of American Hospitals, who represented hospitals of profit, said the message of the industry was heard on Capital Hill. But because the bill dealt with many other issues including tax deduction, border security and energy, MPs had to decide whether possible health coverage losses were more important.

This was very different compared to 2017, when Republican tried to cancel Obamcare, but failed. 2025 measures of Trump, Kahan said, there is no health reform bill nor a health bill.

It “left us with a result that was unfortunate.”

However, there were some successes, Kahan said.

The advocate of the industry stopped the federal government from reducing its share of spending for states expanding the Medicade under ACA. Advocates of hospitals and other Medicade also persuaded to persuade the Congress not to stop openly federal funding of the program for the states. Both measures may have longed the billions longer in additional medicine funding cuts.

The new law does not change the eligibility rules for Medicade nor changes its benefits. But it determines that States require most Medicade Enroll The WHO has obtained coverage through ACA expansion that they work for documents or they work 80 hours a month, a provision, a provision will lose the coverage by 2034, a provision from predicting the Congress budget office.

Provider tax deduction is delayed

This law also limits the use of a decades -old system of taxing on health providers to take advantage of additional federal medicine funding. The hospital was another disadvantage to the industry, which supported the practice as it made high payment from the Medicade.

Medicade usually pays low fees for care for private insurance and medicare, programs for people disabled along with programs for 65 and older people. But due to provider taxes, some hospitals are paid more under Medicade than Medicare, According to the Commonwealth FundA health research non -profitable.

Kahan credited the Paragon Health Institute, a conservative think tank, and its CEO Brian Blaze to pursue the argument that the provider taxes legalized the “money laundering”. Blase advised Trump on health policy in his first term.

A hospital executive, who had asked to withdraw his name to avoid professional vengeance, said – some features used the play to increase their profits – resonant with GP MPs. “They thought that some hospitals were fixing financially and did not want to reward them,” he said.

Nevertheless, Kahn, who is retiring at the end of the year, said that by 2028 he was pleased to delay the implementation of provider tax deduction in the Senate. This will give the health industry a chance to push to change the law, he estimated, after the mid -of -2026 election and a possible change in the balance of power in the Congress.

In Rural Eastern Louisiana, CEO of Desoto Regional Medical Center Todd Applers had expected that the Congress would pass the early house version of the bill, which did not include a cut in provider-tax funding. But he said that House Speaker Mike Johnson has no effect on his hospital in Mainfield located in the district, will be offset by $ 50 billion Rural Health Fund.

“I am happy where we finished,” said Appler. “I think they heard rural hospitals.”

Millions were spent in advertisements against the bill

Hospitals have argued for decades that any deduction in federal funds to Medicid or Medicare will damage patients and will cause lack of service. Because hospitals are usually one of the largest employers in a Congress district, industry leaders often warned of potential job loss. Such arguments usually stop MPs.

But this time, there was very little traction in that message.

A health industry advocate, who asked not to be identified to speak openly without risking professional results, stated that there was an understanding on Capital Hill that hospitals could face the funding cuts.

But it is also a belief that trade groups could be more effective, including the Lobming Organization of the American Hospital Association, the largest hospital industry. “There is a lot of concern that the AHA statement was very soft, very little and too late,” he said.

AHA helped lead to the alliance of hospital organizations, who spent millions of dollars on television advertisements against the GOP bill. Its chairman and CEO, Rik Pool said that the House said in a statement before voting on the law that Medicade would be cut. “The destructive shock for the health and welfare of our country’s most weak citizens and communities.”

Pool said in a statement to KFF Health News that the appeal for tax deduction motivated Republican MPs to pass the law.

“Hospitals and health systems have tirelessly advocated for millions to protect coverage and access,” he said. “We will continue to raise these important issues to reduce the effects of these proposals.”

The country’s largest trade group for doctors, the American Medical Association, also opposed funding cuts for Medicade and other federal health programs. Its chairman, Bobby Mukkamala, said in a July 1 statement that the change “will transfer costs to states and especially physicians and hospitals to provide unrelated care at a time when rural hospitals and doctors are struggling to keep their doors open.”

But AMA was also focused on acquiring high medicare fees for doctors. The law eventually included a 2.5% Medicare Pay collision for doctors in 2026. It was not a win because it had abandoned the permanent payment fix of the house version, which tied the doctor’s payment at a medical inflation rate. Mukkamala mentioned the temporary lift, but it is “necessary to preserve access to the care of the US seniors.”

The Chief Policy Officer of the National Association of Community Health Centers Joe Dun said that his organization worked continuously to prevent deep medicid cuts this year that would financially hurt non -profit clinics. Health Center administrators visited Washington in February, made thousands of phone calls, and sent emails to Congress members.

One payment was that health centers were exempted from the requirement of law that providers were charged with some medicid enrolls up to $ 35 to $ 35 for services.

But at the end of the day, Dunn said, many GOP House and Senate members just wanted to finish the bill. He said, “He went in a direction that satisfied the President’s deadline and goals,” he said.

KFF chief Washington correspondent Julie Rover contributed to the report.

KFF Health News There is a national news room that produces intensive journalism about health issues and is one of the main operating programs Malevolent,