In a 215-214 party-line vote on May 22, House Republicans passed a mammoth budget bill that includes $9 billion in Medicare physician payments and $700 billion worth of Medicaid cuts. The Medicare provisions would adjust physician payments by 75% of the Medicare Economic Index (MEI) for 2026 and 10% of MEI for every year afterwards. These provisions do not address payment cuts in 2025 but are designed to provide a boost in 2026 and beyond. Furthermore, tying physician pay to inflation provides a more stable footing to advocate for better updates in the years ahead. ASTRO is grateful for Republican physicians in Congress, including ROCR champion John Joyce, MD (R-PA), for pushing to include a physician payment increase in the legislation.

Regarding Medicaid cuts, the bill would reduce the expansion match rate from 90% to 80% for states effective October 1, 2027. No later than December 31, 2026, states would also be required to condition Medicaid eligibility for able-bodied individuals aged 19-64 on them working or participating in qualifying activities for at least 80 hours per month. Lastly, the bill prohibits states from establishing new provider taxes or raising the rates of existing ones in order to finance the non-federal share of Medicaid spending. The non-partisan Congressional Budget Office (CBO) estimates that such changes will save $625 billion but also result in 10.3 million people losing coverage and 7.6 million people going uninsured by 2034. ASTRO has joined patient advocacy groups and the Association for Clinical Oncology in a statement opposing deep cuts to Medicaid.

The bill now heads to the Senate where significant changes are expected to be made. Many Republican Senators are wary of deep cuts to the Medicaid program and have raised concerns about provisions in the bill abolishing renewable energy tax credits. Fiscal hawks like Senators Ron Johnson (R-WI) and Rand Paul (R-KY) are also pushing for steeper spending cuts across the federal government. While the bill is being moved through the budget reconciliation process, which skips the Senate's 60-vote filibuster requirement and therefore allows Republicans to eschew support from Democrats, House and Senate Republicans must find agreement with each other before sending the bill to President Trump's desk.