WASHINGTON ― Senate Republicans on Tuesday passed President Donald Trump’s so-called Big Beautiful Bill, a sweeping package that would kick nearly 12 million people off of their health insurance to give tax cuts to wealthy people.
The bill passed 50-50 along party lines, with Vice President JD Vance casting the tiebreaking vote. Every Democrat voted no, along with three Republicans: Sens. Thom Tillis (N.C.), Susan Collins (Maine) and Rand Paul (Ky.)
The Senate vote came after Republican leaders scrambled for days to patch together the bill with quick fixes to win over senators worried about how the bill would hurt their constituents.
Sen. Lisa Murkowski (R-Alaska) had been wavering on the bill until the very end, and her vote was badly needed for its passage. Party leaders reworked the bill for hours to try to win her support, huddling with her on the Senate floor in the early hours of Tuesday. In the end, Murkowski voted yes after what she described as an “agonizing” experience.
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“I struggled mightily with the impact on the most vulnerable in this country,” Murkowski told reporters.
The bill provides billions of dollars for immigration enforcement and about $4 trillion in tax cuts for wealthy Americans, partially paid for by nearly $1 trillion in cuts to Medicaid, the state-federal program that covers health care costs for more than 70 million Americans.
The Senate’s version of the One Big Beautiful Bill Act still has to win approval from the House before it can become law. Many House Republicans have said they don’t like the Senate version, but it’s not clear if they’d be willing to face Trump’s wrath by blocking major legislation enacting much of his second-term agenda.
One gripe from conservative House Republicans is that even with the extra Medicaid cuts added by Senate Republicans, the tax cuts are so large the bill would add more than $3 trillion to the national debt, contrary to everything Republicans have said for years about fiscal responsibility.
Murkowski said she won changes partially shielding Alaska from cuts to Medicaid and the Supplemental Nutrition Assistance Program aimed at shrinking enrollment in the two programs.
“What I tried to do was to ensure that my colleagues understood what that means when you live in an area where there are no jobs, it is not a cash economy,” Murkowski said.
Still, Murkowski said she hoped the bill isn’t final and that the House and Senate would meet in a conference committee to hash out their differences ― an unlikely prospect.
“The House will work quickly to pass the One Big Beautiful Bill that enacts President Trump’s full America First agenda by the Fourth of July,” House Speaker Mike Johnson (R-La.) said after the Senate vote.
The legislation’s changes to Medicaid and the Affordable Care Act health insurance subsidies will result in 11 million fewer people having insurance coverage nationwide, according to the Congressional Budget Office. Health care executives have said the reduced Medicaid spending could force some hospitals and nursing homes to close.
Sen. Josh Hawley (R-Mo.) had threatened to vote against the bill over its Medicaid cuts but got in line after leaders added a $25 billion fund for rural hospitals. He told HuffPost that Missouri would wind up with more funding as a result.
Democrats sharply criticized both the bill itself and the ad hoc provisions benefiting specific states.
“If a bill is so bad that you have to exempt entire states from its consequences to win the votes you need — just don’t pass the bill!” Sen. Patty Murray (D-Wash.) said Tuesday.
Sen. Jim Justice (R-W.Va.) said “yes and no” when HuffPost asked if it bothered him that Republicans were willing to give Alaska a break on Medicaid cuts but not West Virginia.
“I think they probably had more severe need and so I think it’ll be fine,” Justice said. “There’s so much good about this bill, if you look at it as a whole, there’s so much good about it.”
CORRECTION: This story has been amended to reflect that Murkowski voted in favor of the bill.