New plan will fundamentally rewire NHS, says PM
The House of Representatives has voted to advance President Donald Trump’s $3.3 trillion "big, beautiful bill" to its final phase in Congress, overcoming fears of a potential Republican mutiny.
It’s a significant victory for House Speaker Mike Johnson, R-La., though the fight is not over yet.
Lawmakers voted to proceed with debate on the mammoth-sized Trump agenda bill in the early hours of Thursday – a mechanism known as a "rule vote" – teeing up a final House-wide vote sometime later Thursday morning.
The House adopted the rules for debate on the measure in a dramatic 219 to 213 vote – with all but moderate Rep. Brian Fitzpatrick, R-Pa., voting to proceed.
The vote had been stalled for hours, since Wednesday afternoon, with five House Republicans poised to kill the measure before lawmakers could weigh the bill itself.
Several members of the conservative House Freedom Caucus and their allies, meanwhile, appeared ready to skip the vote altogether in protest of GOP leaders' compromise bill.
But both Johnson and Trump spent hours negotiating with holdouts, apparently to some success.
But the process could still take hours. Democrats could still call up various procedural votes to delay the final measure, as they did when the legislation passed the House by just one vote for the first time in late May.
Plus, the bill itself could still face opposition from both moderates and conservative Republicans.
Conservative lawmakers were threatening to derail the rule vote as recently as Wednesday over changes the Senate made to the legislation, which fiscal hawks argued would add billions of dollars to the federal deficit.
But those concerns appear to have been outweighed by pressure from House GOP leaders and the president himself – who urged House Republicans to coalesce around the bill.
The Senate passed its version of the bill late on Tuesday morning, making modifications to the House’s provisions on Medicaid cost-sharing with states, some tax measures, and raising the debt ceiling.
SENATE PASSES TRUMP'S 'BIG, BEAUTIFUL BILL' AFTER MARATHON VOTE-A-RAMA
Moderates are wary of Senate measures that would shift more Medicaid costs to states that expanded their programs under Obamacare, while conservatives have said those cuts are not enough to offset the additional spending in other parts of the bill.
Two members of the conservative House Freedom Caucus who also sit on the House Rules Committee, Reps. Ralph Norman, R-S.C., and Chip Roy, R-Texas, voted against the measure during the Rules Committee's 12-hour hearing to consider the bill.
Johnson himself publicly urged the Senate to change as little as possible in the run-up to the vote. But the upper chamber’s bill ultimately passed by a similarly narrow margin as the House – with Vice President JD Vance casting the tie-breaking vote.
"I’m not happy with what the Senate did to our product," Johnson told reporters late on Tuesday afternoon. "We understand this is a process that goes back and forth, and we'll be working to get all of our members to yes."
But Trump took to Truth Social after the Senate passed the bill to urge House Republicans to do the same.
"It is no longer a ‘House Bill’ or a ‘Senate Bill’. It is everyone’s Bill. There is so much to be proud of, and EVERYONE got a major Policy WIN — But, the Biggest Winner of them all will be the American People, who will have Permanently Lower Taxes, Higher Wages and Take Home Pay, Secure Borders, and a Stronger and More Powerful Military," the president posted.
"We can have all of this right now, but only if the House GOP UNITES, ignores its occasional ‘GRANDSTANDERS (You know who you are!), and does the right thing, which is sending this Bill to my desk. We are on schedule — Let’s keep it going, and be done before you and your family go on a July 4thvacation. The American People need and deserve it. They sent us here to, GET IT DONE."
Both the House and Senate have been dealing with razor-thin GOP majorities of just three votes each.
THOM TILLIS ANNOUNCES RETIREMENT FROM SENATE AFTER CLASH WITH TRUMP
The bill would permanently extend the income tax brackets lowered by Trump's 2017 Tax Cuts and Jobs Act (TCJA), while temporarily adding new tax deductions to eliminate duties on tipped and overtime wages up to certain caps.
It also includes a new tax deduction for people aged 65 and over.
The legislation also rolls back green energy tax credits implemented under former President Joe Biden's Inflation Reduction Act, which Trump and his allies have attacked as "the Green New Scam."
The bill would also surge money toward the national defense, and to Immigrations and Customs Enforcement (ICE) in the name of Trump's crackdown on illegal immigrants in the U.S.
The bill would also raise the debt limit by $5 trillion in order to avoid a potentially economically devastating credit default sometime this summer, if the U.S. runs out of cash to pay its obligations.
New and expanded work requirements would be implemented for Medicaid and federal food assistance, respectively.
Democrats have blasted the bill as a tax giveaway to the wealthy while cutting federal benefits for working-class Americans.
But Republicans have said their tax provisions are targeted toward the working and middle classes – citing measures eliminating taxes on tipped and overtime wages – while arguing they were reforming federal welfare programs to work better for those who truly need them.
Progressive Rep. Maxwell Frost, D-Fla., told reporters it was Democrats' intent to delay proceedings on Wednesday for as long as possible.
"This last go around, we were able to delay the bill upwards of 30 hours. And so we're going to do the same thing, do everything we can from a procedural point of view to delay this," Frost said.
Meanwhile, there were earlier concerns about if weather delays in Washington could delay lawmakers from getting to Capitol Hill in time for the planned vote.
"We're monitoring the weather closely," Johnson told reporters. "There's a lot of delays right now."
Fox News' Dan Scully contributed to this report.
President Donald Trump took to Truth Social early Thursday to call out Republicans who are still refusing to get behind a House procedural vote on the "Big Beautiful Bill."
With the vote having stalled late Wednesday – with five Republican "nays" and another eight Republicans having yet to cast a vote – the president touted the benefits the country is poised to gain with the bill’s passage.
"Largest Tax Cuts in History and a Booming Economy vs. Biggest Tax Increase in History, and a Failed Economy," Trump wrote on Truth Social before turning his ire to GOP holdouts: "What are the Republicans waiting for??? What are you trying to prove??? MAGA IS NOT HAPPY, AND IT’S COSTING YOU VOTES!!!"
SENATE REPUBLICANS RAM TRUMP'S 'BIG, BEAUTIFUL BILL' THROUGH KEY TEST VOTE
Trump later wrote that the vote should be an "EASY YES" for Republicans, calling the holdouts’ refusal to vote, "RIDICULOUS."
A procedural "rule vote" allows lawmakers to debate ahead of a final vote on the "Big Beautiful Bill" before it would head to the president’s desk for a signature.
By early Thursday, the following House Republicans were a no on the procedural vote: Reps. Andrew Clyde of Georgia, Brian Fitzpatrick of Pennsylvania, Keith Self of Texas, Victoria Spartz of Indiana, and Thomas Massie of Kentucky – who changed his vote from a "yay" to a "nay."
When asked why he switched his vote, Massie told Fox News Digital, "Because most of the world isn’t concerned about the difference between the rule resolution vote and the final passage vote."
MIKE JOHNSON, DONALD TRUMP GET ‘BIG, 'BEAUTIFUL’ WIN AS BUDGET PASSES HOUSE
The following Republican lawmakers have yet to cast their vote: Reps. Josh Brecheen of Oklahoma, Tim Burchett of Tennessee, Eric Burlison of Missouri, Michael Cloud of Texas, Andy Harris of Maryland, Bob Onder of Missouri, Scott Perry of Pennsylvania, and Chip Roy of Texas.
Leaving a room with other holdouts and critics of the bill just after 1 a.m. on Thursday, Burchett told reporters, "We're just getting very close, I think, to getting something resolved."
He would not say how he would vote for the legislation, however.
GOP lawmakers can only afford to lose three votes. Republican leaders have now kept the rule vote open for over four hours to try to pressure the holdouts to get a majority vote.
House Speaker Mike Johnson had recalled lawmakers to Washington, eager to seize on the momentum of the bill's passage the day before in the Senate and vowed to press ahead.
"Everybody wants to get to yes," Johnson told Fox News as the voting was underway.
Quickly convening for the vote on the more than 800-page bill was risky gambit, one designed to meet Trump's demand for a holiday finish. Republicans have struggled mightily with the bill nearly every step of the way this year, often succeeding by the narrowest of margins, only one vote.
Their slim 220-212 majority, leaving little room for defections.
The Senate’s version of the "one big, beautiful bill" includes a tiny, 1% tax on international cash transfers — called a remittance tax — which, according to experts, will have a major impact on immigrants working in the U.S.
A remittance is a money transfer to another country outside the U.S., which is a common practice among immigrant workers who send part of their wages back to family in their native countries. Tens of billions of dollars in remittances are sent to other countries from the U.S. every year.
Earlier versions of the bill included higher tax rates and specifically targeted illegal immigrants sending money outside the U.S. The current version of the "big, beautiful bill," however, imposes a 1% fee only on cash transfers, not electronic transfers, sent to other countries. U.S. citizens who want to send cash to other countries will also be subject to the 1% tax.
The tax is expected to generate $10 billion in extra revenue for the federal government, according to an estimate done by Politico.
TRUMP'S 'BIG, BEAUTIFUL BILL' CLEARS FINAL HURDLE BEFORE HOUSE-WIDE VOTE
Besides generating extra revenue, Lora Ries, director of the Border Security and Immigration Center at The Heritage Foundation, told Fox News Digital that the remittance tax has the potential to discourage illegal immigration into the U.S. by making it harder to send money back home.
"Illegal aliens generally want five things when coming to the U.S.: to enter, to remain here, work, send money home (remittances), and bring family and/or have children here," she explained. "Prevent those five things, and you prevent illegal immigration and encourage self-deportation."
The administration has been pushing hard for illegal immigrants to self-deport, incentivizing them by offering to front the cost of commercial flights and providing a $1,000 stipend to those who opt to self-deport. Ries said the remittance tax could be another effective strategy besides ICE raids that could help to crack down on illegal immigration into the country and reduce the number of illegal immigrants in the U.S.
TRUMP TO BEGIN ENFORCING BIRTHRIGHT CITIZENSHIP ORDER AS EARLY AS THIS MONTH, DOJ SAYS
Ries said, however, that the 1% needs to be much higher to be effective.
"A 1% tax only on cash transfers does very little. The tax should be much higher and cover all types of money transfers," she said.
"Until now, the U.S. government has not touched the annual billions of dollars going out of the country, not benefiting the U.S. economy," she went on. "Remittances should be taxed to discourage unauthorized employment and its earnings."
ELON MUSK'S ATTACKS ON TRUMP'S 'BIG, BEAUTIFUL BILL' HAVE 'NO BASIS,' SAYS NO 2 HOUSE REPUBLICAN
Meanwhile, Ariel Ruiz Soto, a senior policy analyst at the Migration Policy Institute, told Fox News Digital that though he believes the remittance tax will have a significant impact, it may not be in the way the Trump administration hopes.
He argued that discouraging remittances to countries like El Salvador, Guatemala, and Honduras — where such payments account for more than 20% of the GDP — could actually drive more migration from those nations.
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"If you're Honduras, if you're El Salvador and Guatemala, even a 1% tax, if it decreases the remittances, could actually be a significant toll in the development of those countries," he said. "If the remains were actually to decrease significantly, that could potentially backfire on President Trump's agenda to reduce irregular migration because he could actually make circumstances, economic circumstances in these countries more difficult and spur new irregular immigration in the future."
The House of Representatives is currently considering the Senate’s version of the "big, beautiful bill."
President Donald Trump’s Justice Department filed an emergency appeal with the Supreme Court on Wednesday, seeking to overturn lower court rulings that blocked the administration from firing three Biden-appointed regulators.
The emergency appeal asks the High Court to allow the Trump administration to fire three members of the U.S. Consumer Product Safety Commission (CPSC), a five-member independent regulatory board that sets standards and oversees safety for thousands of consumer products. The appeal comes after the Supreme Court, in May, granted a separate emergency appeal request from the Trump administration pertaining to the firing of two Biden-appointed agency officials from the National Labor Relations Board (NLRB) and the Merit Systems Protection Board (MSPB).
"It's outrageous that we must once again seek Supreme Court intervention because rogue leftist judges in lower courts continue to defy the high court's clear rulings," said White House spokesperson Harrison Fields.
SUPREME COURT ALLOWS TERMINATION OF INDEPENDENT AGENCY BOARD MEMBERS FOR NOW
"The Supreme Court decisively upheld the president's constitutional authority to fire and remove executive officers exercising his power, yet this ongoing assault by activist judges undermines that victory," he continued. "President Trump remains committed to fulfilling the American people's mandate by effectively leading the executive branch, despite these relentless obstructions."
Mary Boyle, Alexander Hoehn-Saric and Richard Trumka Jr. were appointed to serve seven-year terms on the independent government agency by former President Joe Biden. Their positions have historically been protected from retribution, as they can only be terminated for neglect or malfeasance.
After Trump attempted to fire the three Democratic regulators, they sued, arguing the president sought to remove them without due cause. Eventually, a federal judge in Maryland agreed with them, and this week an appeals court upheld that ruling.
However, according to the emergency appeal from the Trump administration, submitted to the High Court on Wednesday morning, the three regulators in question have shown "hostility to the President's agenda" and taken actions that have "thrown the agency into chaos."
The emergency appeal to the Supreme Court added that "none of this should be possible" after the High Court ruled in favor of the Trump administration's decision to fire two executive branch labor relations officials.
"None of this should be possible after Wilcox, which squarely controls this case. Like the NLRB and MSPB in Wilcox, the CPSC exercises 'considerable executive power,' 145 S. Ct. at 1415—for instance, by issuing rules, adjudicating administrative proceedings, issuing subpoenas, bringing enforcement suits seeking civil penalties, and (with the concurrence of the Attorney General) even prosecuting criminal cases," Solicitor General John Sauer wrote in the emergency appeal to the Supreme Court.
The request, according to Politico, will go to Chief Justice John Roberts, who is in charge of emergency appeals stemming from the appeals court that upheld the previous Maryland court ruling blocking the Trump administration's firings.
A Biden-appointed federal judge on Tuesday stepped in to halt the Trump administration's efforts to dramatically reorganize the Department of Health and Human Services (HHS) after 19 Democratic attorneys general sued to stop the reforms.
HHS announced in March it would be laying off around 20,000 full-time agency employees, while also reducing the number of regional offices across the country and consolidating several HHS divisions. A fact sheet from HHS about the cuts said the reforms were aimed at making the agency more efficient, saving money and ensuring Americans' most critical health needs are adequately met.
In response, 19 Democratic state attorneys general sued to block the Trump administration's reforms. On Tuesday, U.S. District Judge Melissa DuBose granted a temporary injunction in their favor.
‘ONLY THE BEGINNING’: TRUMP ADMIN RELEASES DATA SHOWING FEDERAL WORKFORCE SLASHED SINCE JANUARY
DuBose's ruling Tuesday temporarily blocks the Trump administration from enforcing its proposed workforce reduction or sub-agency restructuring, and HHS was also ordered to file a status report by July 11.
"We stand by our original decision to realign this organization with its core mission and refocus a sprawling bureaucracy that, over time, had become wasteful, inefficient and resistant to change," HHS spokesperson Andrew Nixon said in response to the ruling.
"The reorganization was designed to restore the department around bold, measurable public health goals like reversing the chronic disease epidemic and advancing U.S. leadership in biomedical research. While we strongly disagree with the decision by a Biden-appointed district court judge, HHS remains committed to modernizing a health workforce that for too long prioritized institutional preservation over meaningful public health impact."
RUBIO OFFICIALLY KILLS USAID, REVEALS FUTURE HOME FOR FOREIGN ASSISTANCE PROGRAMS
Nixon added that HHS is reviewing the decision and considering next steps.
Last month, the Supreme Court limited the use of nationwide injunctions to halt President Donald Trump's executive actions.
However, the ruling did not shut the door on legal challenges to Trump's executive orders.
FEDERAL APPEALS COURT THROWS ROADBLOCK AT TRUMP'S EDUCATION REFORM AGENDA
In DuBose's ruling Tuesday, she asked both parties to address how that ruling affects the scope of her order, if at all, by July 11.
"HHS is the backbone of our nation’s public health and social safety net – from cancer screenings and maternal health to early childhood education and domestic violence prevention," said New York Attorney General Letitia James, one of the 19 state attorneys general who sued to stop the Trump administration's reduction in force at HHS.
"Today's order guarantees these programs and services will remain accessible and halts the administration’s attempt to sabotage our nation’s healthcare system. My office will continue fighting to stop this unlawful dismantling and defend the essential services that protect our most vulnerable communities."
Since the Trump administration began its restructuring at HHS, some employees who were let go have been brought back.
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During a CBS News interview in April, HHS Secretary Robert F. Kennedy Jr. said, in some instances, personnel were cut that should not have been.
"We're reinstating them. And that was always the plan. Part of the — at DOGE, we talked about this from the beginning, is we're going to do 80% cuts, but 20% of those are going to have to be reinstated, because we'll make mistakes," Kennedy said in April.
Former President George W. Bush joined up with former President Barack Obama and U2 singer Bono to comfort United States Agency for International Development employees Monday, while also taking shots at President Donald Trump and his administration for shuttering the agency plagued by accusations of fraud and abuse.
"Gutting USAID is a travesty, and it’s a tragedy," Obama said in a video that was shown to departing USAID employees Monday, according to the Associated Press. "Because it’s some of the most important work happening anywhere in the world."
Obama summed up the decision to shutter the agency as "a colossal mistake," and added that "sooner or later, leaders on both sides of the aisle will realize how much you are needed."
Bush, Obama and Bono spoke to departing USAID employees Monday in a videoconference as the agency officially was shuttered following the Trump administration's reporting that it was overrun with alleged corruption and mismanagement. The videoconference did not include members of the media, with the Associated Press reviewing and reporting on clips of the conference later that day.
RUBIO OFFICIALLY KILLS USAID, REVEALS FUTURE HOME FOR FOREIGN ASSISTANCE PROGRAMS
USAID is an independent U.S. agency that was established under the Kennedy administration to administer economic aid to foreign nations. It was one of the first agencies investigated by the Department of Government Efficiency (DOGE) in early February for alleged mismanagement and government overspending, with DOGE's then-leader Elon Musk slamming the agency as "a viper’s nest of radical-left marxists who hate America."
USAID officially was absorbed by the State Department Tuesday.
Bush, who overwhelmingly has shied away from publicly criticizing Trump, lamented in his recorded message to the staffers that the end of USAID marks an end to his administration's work rolling out an AIDS and HIV program that is credited with saving 25 million people nationwide.
FOUR PLEAD GUILTY IN MASSIVE BRIBERY SCHEME AT AGENCY DEMOCRATS FOUGHT TO PROTECT FROM DOGE
"You’ve showed the great strength of America through your work — and that is your good heart,’’ Bush told USAID staffers, according to the Associated Press. "Is it in our national interests that 25 million people who would have died now live? I think it is, and so do you."
Bono of U2 fame recited a poem he wrote reflecting on USAID's closure and his claims that millions around the world will likely now die, according to the Associated Press.
"They called you crooks. When you were the best of us," Bono said.
Fox News Digital reached out to Obama's and Bush's respective offices Wednesday morning for additional comment, but did not receive responses.
Other longtime Trump foes, such as former Secretary of State Hillary Clinton, thanked foreign service officers for their work before USAID's closure.
"In all my years of service, I found that foreign service officers and development professionals were among the most dedicated public servants I encountered," Clinton posted to X Tuesday. "Their work saves lives and makes the world safer. Today, and every day, I stand with them."
Obama and Bush overwhelmingly have remained tight-lipped on their views of Trump under his second administration, with both former presidents attending Trump's inauguration and not weighing in on the majority of Trump's policies. Obama has taken issue with Trump's "big, beautiful bill," which is clearing its final hurdles to passage and will fund Trump's agenda on social media, while Bush has consistently shied away from public rebukes of Trump in recent history.
Bono previously has claimed that cuts to USAID would kill hundreds of thousands of people, and had slammed Trump in 2016 as "potentially the worst idea that ever happened to America."
Secretary of State Marco Rubio, who was serving as acting administrator of USAID, announced the State Department absorbed USAID's foreign assistance programs Tuesday after decades of failing to ensure the programs it funded actually supported America's interests.
"Beyond creating a globe-spanning NGO industrial complex at taxpayer expense, USAID has little to show since the end of the Cold War," Rubio wrote in his announcement. "Development objectives have rarely been met, instability has often worsened, and anti-American sentiment has only grown."
RISCH URGES 'TOP TO BOTTOM' USAID SPENDING REVIEW AFTER WASTE, FRAUD EXPOSED
"This era of government-sanctioned inefficiency has officially come to an end," he continued. "Under the Trump Administration, we will finally have a foreign funding mission in America that prioritizes our national interests. As of July 1st, USAID will officially cease to implement foreign assistance. Foreign assistance programs that align with administration policies—and which advance American interests—will be administered by the State Department, where they will be delivered with more accountability, strategy, and efficiency."
The shuttering comes after DOGE gutted USAID as part of Trump's effort to remove waste, fraud and abuse from the federal government earlier in 2025.
BONO’S ‘300,000 DEAD’ CLAIM OVER USAID CUTS GETS SMACKED DOWN BY ROGAN, MUSK: ‘LIAR/IDIOT’
Trump repeatedly had touted DOGE's work uncovering fraud and mismanagement within the federal government, including in his March address before Congress celebrating that DOGE identified $22 billion in government "waste," including at USAID.
"Forty-five million dollars for diversity, equity and inclusion scholarships in Burma," Trump said as he rattled off various examples of federal waste. "Forty million to improve the social and economic inclusion of sedentary migrants. Nobody knows what that is. Eight million to promote LGBTQI+ in the African nation of Lesotho, which nobody has ever heard of. Sixty million dollars for indigenous peoples and Afro-Colombian empowerment in Central America. Sixty million. Eight million for making mice transgender."
MSNBC host Rev. Al Sharpton has called on Andrew Cuomo to drop out of the New York City mayoral race, urging the former governor to consider what would be in the best interest of New York City residents.
"I think Andrew Cuomo should look at what is best for the city and let them have a one-on-one race," Sharpton said on MSNBC’s ‘Morning Joe’ on Wednesday.
Sharpton, adding that he had previously reached out to the Cuomo camp to encourage the former governor to drop out, said that Cuomo removing his name from the NYC mayoral ballot this fall would also be in "the best interest" of the legacy of the 56th Governor of New York.
"He can endorse one or the other and let them have a battle over what is best for New York," Sharpton said.
In response to a question about Sharpton's comments, a spokesperson for Cuomo's campaign told Fox News Digital in an email that "everyone is entitled to their own political opinion."
CUOMO'S LEAD SHRINKS WITH UNDER ONE WEEK UNTIL NEW YORK CITY MAYORAL PRIMARY: POLL
"We understand President Trump supports Eric Adams, and do not believe socialism is the answer," the spokesperson said. "Most New Yorkers are not Trumpers, and most New Yorkers are not socialists — the majority lies in the middle. We will continue to assess the current situation in the best interest of the people of the City of New York."
Also on Wednesday, President Donald Trump vowed to "save New York City" from mayoral candidate Zohran Mamdani. Mamdani has faced criticism from conservatives and even some Democrats over his socialist policies and refusal to condemn terrorism-linked rhetoric.
CUOMO TEAM DENIES AOC’S CLAIM HE’S USING NYC MAYOR RUN AS A SPRINGBOARD TO THE WHITE HOUSE
"As President of the United States, I’m not going to let this Communist Lunatic destroy New York," Trump wrote on Truth Social. "Rest assured, I hold all the levers, and have all the cards. I’ll save New York City, and make it 'Hot' and 'Great' again, just like I did with the Good Ol’ USA!"
In a victory over Cuomo and nine other candidates, Mamdani on Tuesday was officially declared the winner of New York City's Democratic Party primary for mayor.
The New York City Board of Elections posted the official results of three rounds of the ranked choice voting from last week's mayoral primary, and Mamdani grabbed a majority in the third round, with 56% of the vote.
Eric Adams and Zohran Mamdani did not immediately respond to Fox News Digital's request for comment.
There is a healthcare crisis brewing in the nation’s heartland, as evidenced by a landmark study conducted by the RAND Corporation in conjunction with top national emergency physicians.
The study from the Arlington nonprofit research institute found that emergency rooms (ERs) are no longer the safety net but the proverbial "front door" to the U.S. healthcare system, particularly after a 1986 law passed requiring ERs to stabilize patients or deliver babies from women in labor regardless of their ability to pay.
That has led to instability and hospital closures across the heartland, including in states where a dozen or more have closed, like Texas, Oklahoma, and Tennessee. States like West Virginia, Pennsylvania, the Carolinas and Alabama have also been affected.
"This RAND study is the first ever that points to this crisis, which is that the emergency departments and the care that patients receive in them usually is so critical that, especially for time-sensitive conditions that patients can have, just the fact that you have to travel as far as you might have to, or that even in some cases if a hospital is close to you, but it still doesn't have the resources to operate efficiently," said Dr. Randy Pilgrim, an ER doctor and chief medical officer for emergency room services company SCP Health in Atlanta.
"[I]n emergency medicine, we do time-sensitive, high-quality care as long as we have the resources to do it. And this study shows that we really have a crisis brewing here."
Nearly $5.9 billion in emergency services go unpaid every year, the study found. Overcrowding and spates of violence towards staff have exacerbated the problem.
EMTALA, the aforementioned law, is essentially an unfunded mandate in many cases, and lack of funding for hospitals that treat a large proportion of that uncompensated care — which tends to fall in rural areas or poor neighborhoods in cities — leads to the dual issue of higher patient volumes and more uninsured patients being seen.
Many hospitals outside of cities cannot fully account for the funding gap, Pilgrim said.
"The economics of reimbursement for physician care play a huge role. … We need more physicians generally in America, and we need physicians to feel like they can and will go to where they're needed," he said.
"Physicians won't go where they are needed if there's not enough resources or reimbursement to attract them."
Rural hospitals characteristically pay less than higher-end urban hospitals and have fewer local resources.
With hospital demand "higher than ever," all of the above factors mean help is needed now.
Pilgrim said he has met with HHS Secretary Robert F. Kennedy, Jr., and other top officials at the agency, to discuss the issue — and hopes Washington can help.
"Secretary Kennedy… did a beautiful job of listening to what we were saying about the impending crisis that would probably happen during this administration," Pilgrim said.
TEXAS HOSPITALS HIT WITH $122 MILLION BILL FOR ILLEGAL IMMIGRANTS' CARE IN SINGLE MONTH
"And he was concerned about it because he could tell that you can't make patients healthy unless you have a healthy healthcare system for them to engage. So I'm very encouraged about what Secretary Kennedy and his staff are doing to try to make a difference on the pieces that they control."
He also said Congress must act, particularly as 10,000 Americans turn 65 every day and are therefore eligible for Medicare, which presents a different environment than separate Medicaid.
"That's where we see more volume of patients, more complexity, and much more clinical demand. But if the reimbursement in Medicare doesn't keep pace with that demand, once again, you're in this vicious cycle where emergency departments will be at greater risk, starting with the rural and underserved areas and moving forward from there."
Some in Congress have banded together to advocate for healthcare-related issues, including members of the bicameral "Doctors Caucus."
One member, Rep. Greg Murphy, R-N.C., is a urologist from Greenville who previously served as chief of staff at a Level-I trauma center. "Congress cannot leave rural America behind," he said.
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"The most important thing Congress can do is to fix dwindling Medicare reimbursements for rural providers and ensure health insurance companies don’t play games with denied care and denied payments," he said, pinning the decrease at 33% since 2001 if adjusted for inflation," Murphy told Fox News Digital.
The lawmaker added that many hospitals in his area do not have commercial payers as part of their funding sources to help offset losses from Medicare and Medicaid disbursement amounts — and that all hospitals must root out waste as well.
Pilgrim was also asked why Americans outside the heartland with more reliable emergency care should be supportive of added funding or resources miles away from them.
"In a large city like Atlanta, if rural healthcare is not healthy and patients have to go somewhere else, they will eventually end up in your hospital… So spending a dollar somewhere else besides in your own hospital if you're in a better place makes a lot of sense for you…" he said.
The chairman of the Federal Communications Commission (FCC), Brendan Carr, delivered his first major speech in his new role with the Trump administration, announcing six priorities he plans to focus on during his tenure, including pushing the United States to dominate the "space economy."
"Continuing to move vertically from the ground to the airwaves. Next up is space," Carr said during a speech in South Dakota Wednesday afternoon. "The Build America agenda will expand America's space economy. The Final Frontier is home to an emerging constellation of satellites that have become an essential part of America's economic and geopolitical strategy. So I want to see U.S. companies dominate in orbit.
"Our efforts on this front will be driven by a few key guiding principles: speed, simplicity, security and satellite spectrum abundance," Carr continued.
Carr served as an FCC commissioner since 2017, before Trump tapped him to serve as the agency's chair as of Trump's inauguration in January. Carr traveled to Sioux Falls, South Dakota, on Wednesday to deliver his speech at the headquarters of a telecommunications infrastructure construction company called VIKOR.
TRUMP-APPOINTED FCC CHAIRMAN PROBES BIDEN CYBERSECURITY PROGRAM OVER CHINA CONCERNS
The speech was dubbed the "Build America Agenda" and outlined six priorities the Federal Communications Commission will tackle under Carr's leadership.
On the topic of dominating the space economy, Carr said the FCC is already making progress.
The FCC is "clearing backlogs of applications for satellite systems," he said. "And this type of acceleration is certainly needed. In fact, if you look back over the past couple of years, it actually took a faster amount of time for America's innovators and entrepreneurs to build and launch satellite constellations, than it would take for federal agencies in Washington to process the paperwork necessary to approve those launches. But that ends here."
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"The Build America agenda will inject rocket fuel into our licensing process by standardizing our reviews through more objective metrics, protecting America's orbital advantage for years to come," he said.
Carr outlined that the other five priorities include: unleashing high-speed infrastructure builds, restoring America’s leadership in wireless, cutting red tape and modernizing FCC operations, advancing national security and public safety and strengthening America’s workforce.
The FCC chief remarked that the FCC still has rules on the books related to the use of telegraphs and "rabbit ear broadcast TV receivers" and that his leadership will clear the agency of outdated guidance and focus on the future.
FCC COMMISSIONER SIMINGTON EXPECTED TO ABRUPTLY LEAVE AGENCY, POTENTIAL REPLACEMENT REVEALED
"The FCC right now still has rules on the books regulating telegraph service, rabbit ear broadcast TV receivers and phone booths," he said. "Starting next month, that will change, and doing so in eliminating those outdated rules, the FCC will move directly to delete 40 rules or requirements, and over 7,000 words from the Code of Federal Regulations. A good step forward."
Carr said that he and President Donald Trump are focused on keeping America as a tech leader, including broadening its 5G capabilities and beating China in the artificial intelligence race.
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"One of the very first actions that I took when I became chairman of the FCC was to establish a new council on National Security within the agency," he said. "Our Build Agenda will ensure that the U.S. extends its lead over China in the race for critical technologies. Whether it's 5G, 6G or AI, we're going to do so by making sure that U.S. businesses and the standards they set continue to be the gold standard for businesses all across the world."