Hawley suggested he would work with Democrats to cut prescription drug pricing, a priority Trump has said he wants Congress to focus on, to pay for the tax cuts made permanent by the new law.
Ultimately, Hawley — who is seen as a potential future presidential candidate — chose to stay in Trump’s good graces and vote for the bill despite his reservations, while managing to score victories for his constituents.
“Gotta take the wins that you can,” Hawley told NBC News when asked about voting for a bill he admitted he didn’t like.
Defending his vote for the package that the nonpartisan Congressional Budget Office projected will cause nearly 12 million people to lose their health care coverage by 2034, Hawley said the Radiation Exposure Compensation Act (RECA), as well as the rural hospital fund included in the bill at the eleventh hour to appease GOP holdouts in the Senate, would expand health care in Missouri.
But for the hospitals and social safety net administrators in Missouri, the law’s changes — even if not fully implemented until later — bring uncertainty to a community dependent on funding from expanded Medicaid access. The Missouri Hospital Association estimates the state will lose hundreds of millions of dollars in funding from the provider tax changes alone.
Federally qualified health centers, which rely on government funding to function and provide health care to underserved populations, are already facing shortfalls and budget cuts. An administrator at such a health center in the rural Missouri Highlands told NBC News last month that the impacts from Trump’s megabill will lead to death in her community.
The issue is already impacting states across the country. Hundreds of rural hospitals could close and many more will lose billions of dollars in funding over the next decade, according to an analysis from the Kaiser Family Foundation.
From a political standpoint, Republicans will need to defend policy choices that Democrats are already attacking as they seek to hold onto their congressional majorities in 2026.
Hawley joined many GOP lawmakers in gaining private assurances from leadership early on and securing priorities in the sprawling legislation.
He worked with Senate Majority Leader John Thune, R-S.D., “early in the year” to attach RECA to the package. RECA, a federal law that provided financial compensation to individuals who developed certain diseases as a result of exposure to radiation, expired last year.
“For me, it was key to my vote,” Hawley said. The expanded fund will accept new claims from “downwinders” and uranium workers until Dec. 31, 2027 and covers more cities and states, including zip codes in Missouri.
