The Senate’s deep cuts to Medicaid in the tax and spending megabill are setting off alarm bells among some Republicans, complicating leadership’s effort to get the legislation passed by July 4. It seeks to clamp down on two tactics states use to boost Medicaid funding to hospitals: state-directed payments and Medicaid provider taxes.

The Senate released the Medicaid portion of President Donald Trump’s “One Big, Beautiful Bill” this week, proposing steep cuts to the health care program amid pushback from moderate members. “I’m shocked,