As Senate Republicans rushed to pass a massive budget package known as the “big, beautiful bill,” the political consequences of pushing for the deepest cuts in decades to Medicaid and other safety net programs serving millions of people were already becoming clear. After working overnight to vote on a number of amendments and pass the package ahead of an entirely symbolic July 4 deadline imposed by President Donald Trump, Senate Majority Leader John Thune was still struggling to find enough votes by the morning of July 1.
Vice President J.D. Vance arrived at the Capitol Tuesday morning to cast the tie-breaking vote, allowing the GOP majority to pass the package by a slim 51-50 margin that largely fell along party lines, with Republican Senators Thom Tillis (North Carolina), Rand Paul (Kentucky), and Susan Collins (Maine) joining Democrats to vote against the bill. The final version now goes back to the House for approval, where Speaker Mike Johnson must bridge divisions between far-right fiscal hawks and moderates wary of defunding rural hospitals in their districts before sending the bill to Trump’s desk.
Democrats and opposition groups call the bill the Trump Tax Scam, and with solid majorities turning against it in poll after poll, they are preparing to hammer Republicans for supporting cuts that will harm their constituents ahead of the 2026 midterms. Republicans are repeating falsehoods about the bill’s impacts, especially on health care, and lashing out in response — or calling it quits altogether.
Tillis and Rep. Don Bacon of Nebraska both announced this week that they would not seek reelection after becoming embroiled in the controversy over proposed cuts to Medicaid, the health insurance program for lower-income people that has expanded in both of their home states.
“Every single Republican senator has to decide whether they’re more afraid of Trump than the consequences of taking away lifesaving health coverage from their own constituents,” said Leor Tal, director of the Unrig Our Economy campaign, which calls on lawmakers to reject the cuts, in a statement on Monday ahead of the final vote.
The budget legislation slashes funding for Medicaid and other health programs by $1.1 trillion, leaving an estimated 11.8 million people without health coverage by 2034 and saddling states with new costs and additional bureaucratic red tape. Millions more could lose coverage and face higher costs due to changes to tax credits and subsidies for lower- and middle-income people who rely on Affordable Care Act plans.
Experts say the added stress on the health system could drive up health costs for everyone, but Republicans must make cuts to federal spending to pay for Trump’s priorities, including his mass deportation campaign and an extension of the 2017 tax breaks. Even with deep cuts to the social safety net, the Senate version of the budget package would add more than $3 trillion to the national debt. The Senate bill became more regressive as negotiations dragged on, with the latest analysis by the Joint Committee on Taxation showing tax hikes on people making less than $30,000 a year and generous tax cuts for the rich.
Doctors warn the cuts would devastate rural hospitals and newly opened addiction clinics that rely on Medicaid, and patients will die as a result. In the end, the GOP mantra about targeting “waste, fraud and abuse” was not enough to win over Tillis, whose home state of North Carolina expanded Medicaid to cover an additional 600,000 people in 2023. Tillis made statements referencing his personal experience growing up in a low-income family and, shortly after announcing his retirement on Sunday, warned his colleagues in a speech on the Senate floor that they would have to face constituents who lose access to health care in the years to come.
“What do I tell 663,000 people in two years or three years, when President Trump breaks his promise by pushing them off of Medicaid because the funding’s not there anymore, guys?” Tillis said on Sunday.
Democrats point out that Tillis, who was first elected to Congress in 2014, rode a wave of right-wing backlash to President Barack Obama and the passage of the Affordable Care Act (ACA), which made Medicaid expansion possible in North Carolina and across the country. While Tillis opposes these particular cuts, critics point out that he pushed to repeal the ACA and block Medicaid expansion in the past.
“If Thom Tillis says the Medicaid cuts are this bad, you know they’re bad,” said Rev. Dr. William J. Barber II, a civil rights leader and co-chair of the Poor People’s Campaign, in a social media post on Tillis’s remarks.
On Saturday, Tillis and Sen. Rand Paul were the only Republicans who voted against advancing the “big, beautiful bill” during a procedural vote, but Republicans leveraged their majority in a 51-49 vote to move the package forward. Tillis quickly drew the ire of Trump, who attacked his fellow Republican on social media and pledged to back a primary challenger should Tillis pursue reelection in 2026.
“Too many elected officials are motivated by pure raw politics who really don’t give a damn about the people they promised to represent on the campaign trail,” Tillis said in a statement on Sunday announcing his retirement from Congress at the end of the term.
In order to woo moderates wary of shuttering rural hospitals, the Senate approved $50 billion over five years in funding that states can apply for in order to prevent clinics from closing. However, moderate Republicans in the House have called the measure “bullshit” because the funds will provide little or no support to many districts, and some still oppose changes to the tax code for local Medicaid providers that will pass massive costs onto states, according to Politico.
The Senate bill also slashes environmental protections and grant funding for clean energy initiatives that have flourished under investments made during the Biden administration. Oil Change International, a group fighting pollution and climate change, called the package “perhaps the most harmful piece of legislation for the environment in U.S. history.”
“New research shows the bill includes nearly $18 billion in new giveaways to the fossil fuel industry over the next 10 years,” said Collin Rees, the U.S. campaigns manager at Oil Change International, in a statement on Tuesday. “That’s on top of the $170 billion in taxpayer-funded subsidies the industry is already set to receive over the next decade.”
Now, House Republicans are feeling the heat. Rep. Mike Lawler of New York was “taken to task” over Medicaid cuts during a “stormy” town hall meeting in his home district in the Hudson Valley on Saturday, according to the Poughkeepsie Journal. Lawler reportedly defended the proposed changes to Medicaid, but a video of a constituent declaring “you failed and should leave” went viral after the town hall. At a previous town hall, Lawler faced voters Politico described as “pissed off and fired up.” An estimated 1.5 million New Yorkers could lose health coverage under the House version of the budget bill.
Republican Rep. Don Bacon was under mounting pressure to reject Medicaid cuts from frustrated constituents and the medical community back home in Nebraska before announcing on Monday that he would not seek reelection in his key swing district. Bacon initially expressed some hesitation about the sweeping cuts but said he decided to vote for the House version of the budget bill after receiving “assurances” that it would not degrade the quality of health care for Medicaid recipients — if they manage to keep their coverage.
In a statement, Bacon called himself a “traditional conservative” at odds with his party on foreign policy and Trump’s erratic tariff regime. However, Bacon has also faced a blistering ad campaign, paid for by Unrig Our Economy, that features working mothers and other Medicaid recipients in Nebraska demanding Bacon vote against cuts to their health care. At one point the National Republican Congressional Committee sent a threatening but toothless letter to a local TV station demanding the ads be taken off the air.
Meanwhile, Bacon took to social media to defend the GOP’s controversial work requirements for Medicaid enrollees, accusing Unrig Our Economy of being a proxy group for Democrats.
“We hope Congressman Bacon has an easier time finding health care than the 40,000 Nebraskans he voted to rip health coverage away from,” said Tal of Unrig Our Economy. “When the Tax Scam returns to the House, Congressman Bacon has one more opportunity to do the right thing and finally vote against cuts to Medicaid and SNAP programs his constituents rely on.”
Last week, the advocacy group Nebraska For Us convened a panel of experts from the state to discuss the potential fallout from the Republican plan to drastically reduce Medicaid rolls by introducing work requirements and using other budgetary tactics. David Palm, director of the Center for Health Policy at the University of Nebraska Medical Center, said federal health spending could fall by $3 to $4 billion in the state.
“Hospitals and physician clinics would take a hit and potentially even close — affecting patients and employees,” Palm said. “This would also create more stress on health departments and nonprofits that are already underfunded. These cuts are so huge, and it is difficult for people to wrap their arms around them.”
Angie Lauritsen, the state director of Nebraska For Us, said the group has also held a discussion on proposed cuts to the Supplemental Nutrition Assistance Program (SNAP), which helped 150,000 Nebraskans put food on the table last year.
“At the same time, we raised awareness of the rising cost of back-to-school expenses and child care along with the [Omaha] metro’s growing food insecurity crisis while Congressman Bacon voted to cut health care and take food from his constituents to give more tax breaks to the wealthy,” Lauritsen said in a statement on Monday.
The advocacy may be paying off. On June 25, Bacon joined 15 other House Republicans in penning a letter to House Speaker Mike Johnson and Senate Majority Leader John Thune warning that they cannot support a budget bill that transfers significant Medicaid costs onto their states. With a slim majority, only a handful of GOP defects could still sink the “big, beautiful bill” in the House.
“We urge Congressman Bacon to end his congressional career on a positive note and vote against it rather than once again voting for those cuts just to fund tax breaks for the top 1 percent,” Lauritsen said.
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