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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.

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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

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