And the Interesting Thing is on June 29

One Big Beautiful Bill Passes Senate Procedural Vote, Clerks Reading Full Text of Bill on Senate Floor

The Republican-controlled U.S. Senate narrowly advanced the president’s sweeping tax-cut and spending bill on Saturday, during a marathon weekend session that is expected to continue through at least Monday. If you’re looking for some compelling television, go to CSPAN2 where you can watch clerks read the bill in its entirely, a process that will likely take approximately 15 hours to complete.

Here's a rundown and the current state of play:

· The Senate voted 51-49 at 11:00 last night to open debate on the 940-page One Big Beautiful Bill Ac (now referred to as the “megabill” in DC shorthand), after holding the vote open for a remarkable 4 hours to get the votes necessary to pass the resolution. Sen. Ron Johnson (R-WI), who had been one of the most vocal critics of the bill, initially voted against advancing the bill, but after a trip to the White House, switched his vote and joined the others in voting “yes” at about 11 p.m. ET.

· In a statement of administration policy, the White House signaled the obvious, that the president would sign the bill and restated that he wants it on his desk by July 4. And in an attempt to get some of the Senate Republican holdouts on board, the White House used the exact same language it had last month when the House bill was hanging on a thread, “failure to pass this bill would be the ultimate betrayal.” Very soap operatic!

· Two Republicans—Sens. Rand Paul (R-KY) and Thom Tillis (R-NC)—joined all 47 Democrats to oppose the legislation that would fund the president's domestic priorities. Not surprisingly, the president, who had to work over the weekend, took to Truth Social to vent his frustration and attack Senator Tillis. In an unhinged initial post, he wrote, in part: "Looks like Senator Thom Tillis, as usual, wants to tell the Nation that he’s giving them a 68% Tax Increase, as he is opposed to the Biggest Tax Cut in American History!," Trump wrote, adding, "Thom Tillis is making a BIG MISTAKE for America, and the Wonderful People of North Carolina!" Then, by comparison to his first rant, he posted a second, more temperate, threat: “Numerous people have come forward wanting to run in the Primary against “Senator Thom” Tillis. I will be meeting with them over the coming weeks, looking for someone who will properly represent the Great People of North Carolina and, so importantly, the United States of America.” Sen. Rand Paul fared better, the president posted what felt like a pro forma attack: “Did Rand Paul Vote “NO” again tonight? What’s wrong with this guy??? DJT

· According to an updated analysis by the congressional forecasters at the Joint Committee on Taxation (JCT), the cost of the tax cut provisions has grown to $4.45 trillion—up more than $200 billion from the previous provision, reflecting the numerous last-minute changes to get the necessary 51 votes. But the GOP is trying to maneuver for only $693 billion of those tax reductions to count in the official bill cost by using a budget gimmick referred to as “a current policy baseline” that would not count the extension of Trump’s 2017 tax cuts in the price tag. The JCT analysis only measured the tax provisions, it did not address spending.

· The Congressional Budget Office (CBO) issued revised cost projections last night, estimating that the amended Senate bill would likely increase deficits by about $3.3 trillion over 10 years, up from $2.4 trillion for the House version. Specifically, the bill includes roughly $4.5 trillion of net tax cuts and nearly $300 billion of gross spending increase, partially offset by nearly $1.5 trillion of gross spending cuts. The Senate bill would borrow almost $1 trillion more than the House bill (that could grow to $5 trillion if temporary provisions were made permanent), and the higher price tag violates the House reconciliation instructions requiring $2 trillion of gross spending cuts or offsetting tax cuts, falling nearly $500 billion short. That higher deficit figure is more than many House Republicans said they could stomach, raising further questions about potential House passage. Remember, the bill passed the House by a single vote and Senate changes could cause some of the coalitions who voted for the House bill to reconsider.

· The amended version of the Senate bill offers a more generous deduction for state and local taxes (SALT) through 2029 than the previous iteration, a move clearly designed to appease some House Republicans who threatened to vote against the bill without the more generous SALT deduction. It gives states more time before lowering the ceiling on the so-called provider taxes used to enhance state Medicaid budgets and in turn attract federal matching funds, pushing the implementation to 2029, plenty of time for some potentially vulnerable Republicans to run for reelection without having to confront these changes. The revised bill would also cut off tax credits for electric vehicles, solar and wind projects more quickly than the initial Senate version.

· Once the bill reading continues, 20 hours of “debate” have been scheduled. It’s likely that the GOP will yield the bulk of its allotted 10 hours, and the Senate will move on the “vote-a-rama,” where unlimited amendments can be offered and debate, and must be voted on, which can grind the process to a halt. There’s no word yet how many amendments Senate Democrats may offer at this point.

And the interesting thing is, Senate Democrats received some criticism for moving to have the full bill text read on the floor. Yes, it’s grandstanding and designed to slow down passage to give Democrats more time to raise awareness of provisions that don’t poll well. But it’s also not that uncommon. In 2021, Sen. Ron Johnson (R-WI) forced the reading of Democrats’ 628-page American Rescue Act, which took 10 hours and 44 minutes. The reading of bills by Senate clerks is allowed under the chamber’s rules but is almost always waived by unanimous consent. Shockingly, the outrage is misplaced and just performative.

U.S. Healthcare Spending to Reach $8.6 Trillion by 2033

Actuaries from the Centers for Medicare and Medicaid Services (CMS) have updated their projections for national health expenditures from 2024 to 2033, estimating healthcare spending in the U.S. to reach nearly $8.6 trillion in less than a decade.

Here are some of the key findings:

National health expenditures surpassed $5 trillion in 2024, an 8.2% increase from 2023, and nearly 3 percentage points faster than GDP growth (5.3 percent). As a result, health care represented 18% of GDP in 2024, up from 17.6% in 2023. In other words, almost 1 in 5 dollars spent through the entire U.S. economy is for health care.

During 2024–33, as the population continues to age and as demand for health care grows more rapidly than income (consistent with history), annual growth in national health spending (5.8%) is expected to be faster than average growth in GDP (4.3%). By 2033, the health share of the economy is projected to reach 20.3 percent.

Medicare would see the most significant increase in health spending, with a projected annual growth rate of 7.8%. The growth rate reflects strong average enrollment growth compared to other payers, including Medicaid and private insurers as the last group of Baby Boomers will age into Medicare by 2029-2030.

Medicaid would still experience substantial growth, with average spending expected to increase by 6.4% annually through 2033. However, CMS actuaries estimate volatility in the program because of upcoming enrollment changes under the Big, Beautiful Bill," which contains billions in possible Medicaid cuts.

CMS predicts a higher uninsured rate during the period after reaching an all-time high of 92.5% insured rate in 2023. The insured rate is projected to drop—to 92.1% in 2025 and 91.3% in 2033. Meanwhile, private health insurance spending is slated to increase in 2025, although at a slower rate than in 2024. Private payers will likely see slower enrollment growth (1% in 2025 compared with 2.5% in 2024) and per-enrollee growth (6.5% in 2025 compared with 7.7% in 2024). Out-of-pocket spending is expected to experience the slowest rate of growth from 2024 to 2033, at 4.5%.

Total U.S. spending on employer-sponsored health insurance is projected to rise 5.2% between 2025-2026, to $1.6 trillion, the number of people covered by employer plans is expected to fall 0.1%, to 177.7 million. Average spending per enrollee is projected to rise 5.3%, to $8,974, an enormous burden for employers and the majority of Americans presently enrolled in high-deductible plans. By 2033, CMS predicts that employer plan enrollment will slip to 175.4 million (representing the last of the Baby Boomers having aged into Medicare and retiring in larger numbers) and the per-enrollee cost will grow to $12,132

And the interesting thing is, Healthcare spending totaled $74.1 billion in 1970. By 2000, that number had grown to $1.4 trillion, and in 2023 the amount spent on health more than tripled to $4.9 trillion. On a per capita basis, health spending has grown from $353 per year in 1970 to $14,570 per year in 2023. In constant 2023 dollars, the increase was from $2,151 in 1970 to $14,570 in 2023. From 1970 through 1980, the average annual per capita growth in the U.S. economy was 9.3% per year, compared to per capita health spending growth of 12% Although the health spending growth rate has since moderated (5.1% in the first half of the 2020’s), it consistently continues to outpace growth of the economy

That’s all for today. See you back here again tomorrow!