This is a rush transcript. Copy may not be in its final form.
AMY GOODMAN: Yes, I am in Geneva, Switzerland, broadcasting from the U.N. Human Rights Council. We’re going to go to the council at the end of the broadcast, but we’re going to begin now in the United States.
Yes, right here, in an all-night session that will stretch until today, senators have begun debate on President Trump’s 940-page so-called big, beautiful bill — that’s the budget bill — as Republicans race to meet a Trump-imposed July 4th deadline and are set to vote on key amendments. This comes after a procedural vote this weekend was delayed for hours as Republicans hashed out details before a 51-to-49 vote that saw two Republicans join all the Democrats in opposition: Rand Paul of Kentucky and Senator Thom Tillis of North Carolina. Also announced — Thom Tillis announced he does not plan to seek reelection. Tillis spoke on the Senate floor.
SEN. THOM TILLIS: It’s inescapable that this bill in its current form will betray the very promise that Donald J. Trump made.
AMY GOODMAN: The Senate Republicans’ version of the bill makes deeper cuts to Medicaid and healthcare even after Trump vowed not to touch Medicaid. The nonpartisan Congressional Budget Office estimates nearly 12 million people will lose care under the current version of the bill, especially children, people with disabilities and senior citizens. Meanwhile, the CBO says the bill will add at least $3.3 trillion to the already bulging national debt over a decade.
Speaking from the Senate floor, independent Senator Bernie Sanders called it the most dangerous piece of legislation in modern U.S. history,
SEN. BERNIE SANDERS: Actually, though, Mr. President, I’m wrong. This is not a gift to the billionaire class. They paid for it. This bill is an absolute reflection of a corrupt campaign finance system which allows billionaires to buy elections. And when billionaires spend hundreds and hundreds of millions of dollars trying to elect a president or a senator or a member of Congress, they’re not making that investment just for the fun of it. They want something in return. And this legislation, big time, is what they are getting in return.
NERMEEN SHAIKH: Ahead of today’s vote-a-rama on amendments in the bill, which include some $4 trillion in tax cuts, Senator Bernie Sanders spoke out again in a post on social media Sunday evening.
SEN. BERNIE SANDERS: It is really quite disgusting that you give tax breaks to people who don’t need it, you throw 16 million people off the healthcare that they have, you cut nutrition programs for hungry kids, you make it harder for working-class young people to afford to go to college. This is really an obscene piece of legislation.
NERMEEN SHAIKH: Meanwhile, on Sunday, the Senate parliamentarian ruled against two key carve-outs on Medicaid spending for senators in Alaska and Hawaii, and it’s now unclear how Alaska Republican Lisa Murkowski will vote.
For more, we’re joined by two guests. David Dayen is executive editor of The American Prospect, where his latest piece is headlined “Murkowski’s Alaska Gold Rush Loses Some Gold Plating.” And in Boston, we’re joined by Dr. Adam Gaffney, a critical care physician and professor at Harvard Medical School. He just published an analysis in the Annals of Internal Medicine that showed how provisions in the House version of the bill passed last month, including Medicaid work requirements, would lead to the loss of coverage for millions. Gaffney is also the immediate past president of Physicians for a National Health Program.
Welcome back to Democracy Now! to both of you. David Dayen, let’s begin with you. If you could elaborate on what the key provisions in this bill are and what the implications might be in the event that it’s passed?
DAVID DAYEN: Well, it’s going to affect every American, pretty much. What you have here is an extension of the Trump tax cuts from 2017. They were primarily targeted to the wealthy. Then you add in new tax cuts that were pitched by Donald Trump during the campaign — no tax on tips, no tax on overtime — along with a lot of business tax cuts that the Senate wanted to make permanent. And that is — that massive tax cuts is what creates this huge gap in terms of the deficit.
But on top of that, you have the largest-ever cut of Medicaid in American history. You have the largest-ever cut to the Supplemental Nutrition Assistance Program in American history. You have a change to higher education, particularly student loans, that will make getting an education become more expensive. And then you’ll see not only the loss of most clean energy tax credits, but new taxes that have been described as a kill shot for solar and wind, and we should expect much higher electricity costs and rolling blackouts. You know, meanwhile, there are the tax credits for the kind of coal that is used in steel, and there’s a big tax break for Big Oil that would allow domestic oil drillers to not pay any taxes at all. So, you put that all together, and it’s almost hard to take in and describe, but, basically, you have Republicans taking food and medicine and other things away from vulnerable people in order to finance tax cuts for the rich. And that’s really the bottom line.
AMY GOODMAN: David Dayen, before we go to Dr. Adam Gaffney to talk about the stunning, horrifying tax cuts to Medicaid, I wanted to ask you about this point you made. It’s not only about cutting tax breaks to encourage — you know, tax incentives to encourage renewables. It’s actually increasing taxes on them? Explain the poison pill here.
DAVID DAYEN: That’s correct. So, you know, the tax credits that are being cut are all from the Inflation Reduction Act of 2022, and those gave incentives to produce and install renewable energy. Those are all going away. But there is this new tax on solar and wind, you know, that they can only get out of if they show they are not using any materials that are produced by a so-called foreign entity of concern. This really means China. It only gives two years. Basically, these taxes would start in 2027. And right now supply chains for solar and wind energy at least have some component that is Chinese. And so, there’s very little time to create a domestic supply chain, especially because the production tax credits for domestic solar manufacturers are going away, so it makes it harder to build those factories.
So, you know, people in the industry have said that this is going to make it really ineffective, cost-ineffective, to build solar and wind products, and those projects are probably going to go away. You’re talking about multiple gigawatts of products — projects that are going to go out of business. They aren’t going to be built. And this is at a time when, because of data centers and because of increased electricity demand, we need those products — projects that can be spun up quickly. And so, that is why the expectation is for much higher electricity costs and possibly rolling blackouts, because the grid simply can’t handle the demand that we have right now, and if we can’t quickly build new energy sources, we’re going to face a shortfall.
AMY GOODMAN: So, let’s bring Dr. Adam Gaffney into this conversation, a professor at Harvard Medical School, a critical care physician, a past president of Physicians for a National Health Program and author of To Heal Humankind — hardly what this bill is about. But if you can talk about — well, you just came out with a new study in the Annals of Internal Medicine. And talk about Medicaid. How is it that people were thinking that the Senate wasn’t going to move forward on massive Medicaid cuts? But what this means in terms of lives and who exactly is targeted as trillions of dollars in tax breaks are being offered to America’s wealthiest?
DR. ADAM GAFFNEY: Well, look, these tax — these cuts to Medicaid would be absolutely devastating to the American healthcare safety net. And the implications of that are exactly what you’d expect. As you said, nearly 12 million people would lose health coverage as a result of the Senate bill, even more than the House bill. In our study, we estimate this translates to 1.9 million Americans losing their doctor, 1.3 million Americans going without needed medications, 1.2 million Americans being saddled with medical debt, 380,000 women going without their needed mammograms. And biggest of all, we estimate more than 16,500 deaths annually as a result of the coverage losses that would be inflicted by the so-called Big, Beautiful Bill Act. These are not surprising results. We know that modern medical care saves lives. But they are very disturbing results, and they speak to the fact that the lives of working-class Americans are being weighed as less important than tax cuts for billionaires. It’s quite disturbing.
NERMEEN SHAIKH: And, Dr. Gaffney, indeed, these are the largest reductions in Medicaid since it was created in 1965. So, if you could just explain, you know, who are the principal beneficiaries of Medicaid, and who will become ineligible if this bill were to pass?
DR. ADAM GAFFNEY: Medicaid covers low-income Americans across demographic groups — chronically ill; disabled; people who require long-term care, including the elderly; children; pregnant people; and many, many working-age adults. Probably the biggest impact would fall on that last group. The Medicaid work requirements — the so-called Medicaid work requirements would impose a giant bundle of red tape between Americans and their healthcare, probably causing around 5 million to become uninsured. These are the casualties of red tape, because most of these individuals are either working or have a very good reason not to work, like they’re too sick or they’re taking care of a child. So, you will see coverage losses in multiple groups, but many of them will fall on working-age folks. But again, there are, for instance, elderly individuals who rely on Medicaid to keep down the cost of their medications. They would be impacted, and really, a very wide variety.
Don’t forget, too, it’s not only Medicaid cuts. There’s also changes to the Affordable Care Act Marketplace plans, so-called Obamacare plans, that would make millions more lose coverage, on top of what we looked at, which was just Medicaid. So you’re looking at a lot of people.
NERMEEN SHAIKH: And, Dr. Gaffney, you’ve also pointed out that this will have not only massively injurious effects to the people who are on Medicaid, but also on hospital providers, rural hospitals, doctors, nurses. If you could explain how?
DR. ADAM GAFFNEY: Sure. Well, listen, I mean, many hospitals in this country focus on the care of disadvantaged groups — poor people, people in rural areas, as you said. And as a result, these hospitals rely on Medicaid for their revenues, for their operating revenues. So, what happens when you take a sledgehammer to that foundation? We know what happens. They have to make cuts. They have to cut staff. They have to cut services, or, in a worst-case scenario, even close. And this is compounding an already existing problem where there isn’t the healthcare infrastructure that we need in more disadvantaged areas. So, this means that people will be affected even who don’t lose coverage. Even those of us who don’t rely on Medicaid or the Affordable Care Act could be impacted if the hospital in our area closes and where we have no access to care.
So, this bill would really devastate, again, the American healthcare safety net, such as it is. I would only add it’s important to recognize this is on top of existing problems in our healthcare system. You know, I’m a critical care doctor. I work in the ICU. I see patients with life-threatening complications of untreated illness because they didn’t get care because they couldn’t afford it. What happens when we add to that number massively? You’ll have many more of those sorts of patients winding up in the ICUs of doctors like me, and it was not necessary.
AMY GOODMAN: David Dayen, we just have about 30 seconds, but what happens next? It’s really hard to follow the meanderings of this bill. Do you see it going down? You have Thom Tillis saying he’s retiring under tremendous pressure from President Trump. What’s going to happen here?
DAVID DAYEN: Well, the Senate is going to vote all day on amendments, perhaps even into tonight and tomorrow morning. There are some key senators to watch: Susan Collins, Lisa Murkowski. Murkowski from Alaska got a number of perks in the bill, including a special tax break for whaling captains in Alaska. We’re going to see if — because some of those perks were stripped away, including all of the Medicaid boosts that were put in for Alaska, so we’re going to see if she holds to that deal. Collins has said she’s leaning no, but pending amendments, so we’ll see if she gets amendments.
And in the House, both the Freedom Caucus, the hard-right hard-liners who want to see less deficits and debt, and also some of the moderates, who don’t want to see these Medicaid cuts, have also spoken out against it. So there’s still a needle to thread here for Republicans. But you have to expect that a bill that extends a bunch of tax cuts and cuts a bunch of spending on the poor is going to be somewhat acceptable to Republicans. So, I fear that the differences, especially after Donald Trump sort of bears down on everybody, will go away, and we will see some version of this pass.
NERMEEN SHAIKH: David Dayen, thank you so much for joining us, The American Prospect, and Dr. Adam Gaffney, Harvard Medical School, former president of Physicians for a National Health Program.
Up next, the Supreme Court’s term has ended with more blockbuster 6-to-3 decisions. Stay with us.
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NERMEEN SHAIKH: “I Think of You” by Amadou and Mariam, performing in our Democracy Now! studio.
