As Republican leaders in the House worked Wednesday to drum up the votes to pass President Donald Trump’s sweeping domestic policy bill, which comes with substantial cuts to programs like Medicaid, two Virginians could be poised to play a pivotal role.

Virginia Reps. Rob Wittman and Jen Kiggans, both Republicans, voted for the House bill in May, despite expressing reservations over some of the initial provisions. They joined a group of 16 Republican House members who wrote June 24 to party leadership in the House and Senate expressing concerns about the then-pending Senate version. They said cuts to Medicaid went beyond what was included in the House version.

“Protecting Medicaid is essential for the vulnerable constituents we were elected to represent. Therefore, we cannot support a final bill that threatens access to coverage or jeopardizes the stability of our hospitals and providers,” the letter read.

The House initially passed it’s version of the “Big Beautiful Bill” in May, with the Senate narrowly passing a different version Tuesday. The House is now considering the Senate’s version, and both chambers must pass identical versions for the president to sign.

“One way to see this is as a substantial repeal of major parts of the Affordable Care Act,” said Chris Howard, a government and public policy professor at William & Mary, of the cuts the Senate’s version of the bill would make to Medicaid.

Howard said that repeal looks like a variety of technical changes to the program that will cumulatively have the effect of unwinding some of Medicaid expansion and putting a big dent in the ACA marketplace.

“One of the big changes is boosting the work requirements for able-bodied adults on Medicaid,” he said. “The real effect is it’s going to push a lot of people off Medicaid, and they don’t have jobs that provide health insurance. They will be uninsured.”

In the joint letter, Kiggans and Wittman urged Senate leadership to reconsider provisions that would reduce provider taxes, which is how Virginia pays for its Medicaid expansion program.

“The Senate proposal also undermines the balanced approach taken to craft the Medicaid provisions in H.R. 1—particularly regarding provider taxes and state directed payments,” the letter read. “The Senate version treats expansion and non-expansion states unfairly, fails to preserve existing state programs, and imposes stricter limits that do not give hospitals sufficient time to adjust to new budgetary constraints or to identify alternative funding sources.”

The Virginian-Pilot and Daily Press asked Kiggans and Wittman if those remaining sticking points on the legislation would preclude them from voting yes on the bill, but did not hear back in time for publication.

In the Senate, three Republicans — Thom Tillis of North Carolina, Susan Collins of Maine and Rand Paul of Kentucky — joined all Democrats in voting against the reconciliation bill. In the end the tally was 50-50, with Vice President JD Vance casting the tie-breaking vote.

Kiggans also joined other Republicans in sending a letter to Senate leadership asking them to make changes to the bill’s proposed clean energy credits policy, including adjusting when clean energy tax credits would be phased out. The House version, she said, included “an abrupt expiration of clean energy tax credits” that could jeopardize ongoing clean energy projects, like Dominion Energy’s Coastal Virginia Offshore Wind project.

“While I supported H.R. 1 in its current form, there remains significant room for improvement in preserving the clean energy tax credits,” Kiggans said in a June 6 statement. “I am hopeful that our Senate partners can make these necessary changes as the legislative process moves forward.”

Meanwhile, Virginia Democrats strongly criticized the passage of the Senate version of the bill.

Sens. Mark Warner and Tim Kaine voted against the bill and said the cuts to critical programs were being used “to pay for massive tax breaks to the very rich.”

“We are committed to doing everything we can to ensure all Virginians have the support they need in the wake of this disastrous legislation,” they said in a joint statement.

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(Virginian-Pilot staff writer Natalie Anderson contributed to this report.)

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