Mitchell Berman is seeking the 2026 Democratic nomination to run for the U.S. House of Representatives in Wisconsin's 1st Congressional District. (Berman for Congress photo)

Mitchell Berman, a Racine County nurse, announced Tuesday he will seek the Democratic nod to run for Congress in Wisconsin’s 1st District against fourth-term incumbent U.S. Rep. Bryan Steil (R-Janesville).

Berman is the most recent candidate to officially announce he is entering the Democratic primary race for the seat. Randy Bryce, who lost to Steil in 2018 in one of the nation’s most closely watched congressional contests, announced May 20 that he would try again. Gage Stills, a third Democratic hopeful for the seat, launched a campaign in mid-July. 

Berman introduced his candidacy Tuesday with a video shot on a mobile phone that stresses his working class background and rural Wisconsin upbringing.

“I’m running for Congress because Bryan Steil isn’t looking out for families like mine,” Berman says in the video. “We deserve a government that works for us, not the elite.”

Berman worked as a nurse at the Milwaukee VA hospital for 10 years and in the video highlights his service to military veterans.

He told the Wisconsin Examiner on Tuesday that he left the job when he decided to run for Congress because the federal Hatch Act bars federal employees from running for partisan  office.

The father of two and a 15-year resident of the 1st Congressional District, Berman said concern for his daughters “about whether or not they have the ability to make their own health care decisions” motivated his run for the seat.

“Seeing the cuts to the VA and just the overall gutting of Medicaid in general has also prompted me to get into this race,” he said. Cuts to Medicaid and the SNAP federal nutrition aid program were part of the Republican budget reconciliation bill that Steil voted for and President Donald Trump signed on July 4.

“These things were made for tax cuts for billionaires,” Berman said, adding that in the process, Congress added $3.5 trillion to the federal budget deficit instead of  reducing it.

“I think the No. 1  issue that we need to focus on is affordability,” Berman said. “And I think that umbrella covers many different issues … decreasing the cost of child care, decreasing the cost of health care, decreasing the cost at the grocery store.”

As of July 30, the Cook Political Report rated the 1st District a likely Republican win in 2026 with a 2-point edge for the incumbent, Steil. Cook defines seats rated “likely” for one or the other party as “not considered competitive at this point” but adds that they “have the potential to become engaged.”

Berman said he believes his life experiences will attract voters.

“I’ve lived paycheck to paycheck. I had to work three jobs in college,” Berman said. “I was a first-generation college student. I graduated with student loan debt. My wife and I, we struggled with fertility issues and our children are a blessing of IVF [in vitro fertilization]. So a lot of these kitchen table concerns for people, a lot of these things that people care about close to home, are things that I’ve experienced.”

Berman said he followed news accounts of Steil’s July 31 public event in Elkhorn, where the congressman was met with an angry, noisy crowd and questioners who loudly pushed back on many of his comments.

“I think that’s a good representation of people’s dismay and how upset they are in how Bryan Steil … his lack of representation for the district.”

A first-time political candidate, Berman said he’s been active in local politics as a volunteer, including filing a successful lawsuit that charged the Town of Raymond School District violated the state open meetings law in holding a school board retreat in 2022. The suit was settled in December 2024.

The school district was also embroiled in a dispute among parents over its  social-emotional learning curriculum and the firing of a popular principal. Berman was a leader in a campaign to recall two board members who opposed the curriculum. One of the board members resigned before the recall vote was held, while the other survived the recall election.

“Everyone in my community, everyone I’ve talked to about this opportunity, has been very encouraging,” Berman said.

A reliably Democratic seat in the 1970s and ‘80s, the 1st District has remained in GOP hands since 1994, despite recurring attempts by Democrats to unseat Republican incumbents. The seat was held for two decades by former Rep. Paul Ryan (R-Janesville), who rose to become U.S. House speaker before leaving office at the end of 2018.

Steil, a corporate lawyer who previously worked as Ryan’s aide, won his first term against Bryce with more than 54% of the vote to Bryce’s 42%. He won his two most recent races by similar margins. He beat former state Department of Revenue Secretary Peter Barca 54-44 in 2024 and Ann Roe, now a Wisconsin state representative from Janesville, 54-45 in 2022.

This report was updated 8/18/2025 to clarify that Berman, originally identified here as the “second Democrat” in the race, was preceded by another candidate, Gage Stills. 

A sign in an Indianapolis store shown on Aug. 1, 2023, says SNAP benefits are accepted. A new analysis by the Congressional Budget Office projects 2.4 million fewer people per month will participate in the program under Republicans’ tax cut and spending law. (Photo by Getty Images)

About 10 million people, mostly Medicaid recipients, will lose access to health insurance and 2.4 million fewer people per month will participate in a federal food aid program under Republicans’ massive tax cut and spending law, the nonpartisan Congressional Budget Office said Monday.

Median-income U.S. households will see a small overall gain in resources from President Donald Trump and the GOP’s “big, beautiful” law, CBO said.

But major changes to Medicaid and the Supplemental Nutrition Assistance Program, or SNAP, mean Americans at the bottom of the income distribution will see a net loss of benefits, CBO said.

The law, which both chambers of Congress passed without any Democratic votes and Trump signed July 4, significantly narrows eligibility for Medicaid and SNAP.

Those changes, even combined with federal tax cuts, will lead to a roughly 3% drop in resources over the next nine years for households in the bottom tenth of earners, the CBO analysis said.

“The changes in resources will not be evenly distributed among households,” the congressional scorekeeper said. “The agency estimates that, in general, resources will decrease for households toward the bottom of the income distribution, whereas resources will increase for households in the middle and toward the top of the income distribution.”

The projection shows households in the bottom two-tenths of the income distribution would see a net loss of resources.

Households in the middle 20% of the income distribution would receive, on average, between $800 and $1,200 more per year, which would account for 0.8% to 1% of their income.

At the top of the income distribution, households in the top tenth would see, on average, $13,600 more annually, about 2.7% of their projected income, from 2026 to 2034, the CBO said.

But the lowest tenth of households by income would see a drop of about $1,200 per year, which accounts for 3% of that group’s projected income, the CBO said.

Millions to lose benefits

Roughly 10 million people will lose access to health insurance by 2034, the CBO projected. Most of that group, 7.5 million, would lose Medicaid benefits.

A single section of the law creating new work requirements for Medicaid recipients would result in 5.6 million people losing access to care, the CBO said.

The law also creates new work requirements for SNAP participants and mandates that at least some states pay for a portion of the benefits. States had never been required to cover any share of the cost of SNAP benefits.

The changes to work requirements will result in reduced participation in the program by about 2.4 million people, the CBO said in another analysis published Monday.

The changes to state cost-share in SNAP will save the federal government about $41 billion from 2026 to 2034, CBO said. The agency expects states to pick up most, $35 billion, of that spending.

But the new requirements for states would still likely lead to 300,000 people fewer accessing benefits monthly. The report considered state officials would choose from policy responses including cutting benefits, reducing eligibility or leaving the program altogether in response to the new cost-share.

‘Stealing from working families’

In a press release, a quartet of Democratic leaders in Congress highlighted the regressive impact the CBO projected.

“Prices keep rising and American families are struggling,” House Budget Committee ranking Democrat Brendan Boyle of Pennsylvania said. “So what are President Trump’s Republicans doing to help? They passed a law that will make things worse by stealing from working families to give billionaires a tax break.”

“It is truly unfathomable that Trump and Republicans in Congress are championing a bill that gives the top 10 percent $13,600 more per year – while the least affluent 10 percent will lose $1,200 per year,” Senate Budget ranking Democrat Jeff Merkley of Oregon said. “This is families lose, and billionaires win.”

Senate Minority Leader Chuck Schumer and House Minority Leader Hakeem Jeffries, both of New York, made similar statements in the release.

A teacher and students in a classroom. (Photo by Klaus Vedfelt/Getty Images)

I recently read over my son’s last report card and was overwhelmed with pride.

It showed how far he’s come — progress that, not long ago, felt out of reach. I made mental notes of the areas where we still need to do some work, but mostly I just sat with the joy of seeing comments like “participates well in class” and “a pleasure to have in class.”

A few years ago, those kinds of remarks seemed impossible.

My son is on the autism spectrum. He’s bright, curious, and kind, but he faces challenges in areas that come more naturally to his peers — things like socializing, staying focused, and following multi-step directions.

To support his growth, our family relies on services in Milwaukee made accessible through Medicaid. Without it, we couldn’t afford the therapies and supports that have made such a profound difference in his life.

One of the most transformative resources we’ve accessed through Medicaid is applied behavior analysis (ABA) therapy. Before my son began this program, he had a hard time sitting still, struggled with completing even small tasks, and rarely interacted meaningfully with others. The world often overwhelmed him, and those feelings showed up as frustration or withdrawal.

Our family was doing everything we could to support him, but we needed help. Medicaid made that possible.

The ABA therapy was intensive and, at times, exhausting — but it worked. Over time, we watched our son develop new skills, regulate his emotions, and engage with the world in a completely new way.

By the time the program ended, we had a different child. Not in that he changed who he was — but because he could finally show the world the amazing person he had always been. He could carry on a conversation, initiate play with peers, connect with adults, and begin building friendships.

Today, thanks to Medicaid, he continues to receive occupational therapy and speech therapy at school. These services help him strengthen motor skills, improve communication, and better navigate daily life. He also receives support through his Individualized Education Plan (IEP), ensuring he has the accommodations he needs to succeed. Because of this, my son is not just surviving — he is thriving.

But now, all of this is under threat.

Millions of families like mine could lose Medicaid because the Trump-GOP budget — the so-called “One Big Beautiful Act” — strips away the very support that children like my son depend on, all to finance tax breaks for corporations and the wealthy. It’s hard to describe the fear that takes hold when you realize that your child’s future has been jeopardized with the stroke of a pen.

Some 37 million children — roughly half of kids in the United States — rely on Medicaid for health care, therapies, and other essential services. For kids with disabilities, Medicaid is often the only option for accessing the support they need. Without it, families face impossible choices — foregoing therapies, draining savings, or going without care altogether.

What’s even more heartbreaking is the callousness with which some elected officials treat this issue. Watching Republican Senators dance to a disco song as they celebrated the passage of this harmful bill made me physically ill. While they partied, families across the country worried about how to care for their children, afford therapy, or keep a roof over their heads.

This isn’t political for me — it’s personal. My child is not a budget line item. He is a human being who deserves the chance to live a full and meaningful life. Every child does.

Medicaid has been a lifeline for us, and it should be protected, not gutted. No parent should have to fight this hard for basic support, and no child should have their future jeopardized by politics.

The promise of America is an opportunity for all. That promise cannot be fulfilled if we dismantle the very systems that allow families like mine to survive — let alone thrive — simply to cut taxes for the wealthy.

We need to do better. We must do better.

From left, Minnesota Gov. Tim Walz, Rhode Island Gov. Dan McKee, Kansas Gov. Laura Kelly, Wisconsin Gov. Tony Evers and Kentucky Gov. Tony Evers said Democratic governors need to respond "in kind" to GOP mid-decade redistricting that's intended to protect the Republican House majority. (Photo by Baylor Spears/Wisconsin Examiner.)

MADISON — Wisconsin Gov. Tony Evers, Kansas Gov. Laura Kelly and other Democratic governors said responding “in kind” to Republican mid-decade redistricting is necessary at a Friday Democratic Governors Association press conference.

Kelly said she thinks courts would rule that redrawn maps from Republicans and Democrats are unconstitutional. If Republicans take this path, however, Democratic governors must also pursue mid-decade redistricting to “protect the American people,” she said.

“It’s incumbent upon Democratic governors, if they have the opportunity, to respond in-kind,” Kelly said. “Things are bad enough in Washington right now. What it would look like if there’s even a greater majority that this President controls — God help the United States of America.”

Kelly and other Democratic governors were in Madison for the DGA’s summer policy conference. 

Discussion over redistricting ahead of midterm elections started in Texas, where President Donald Trump’s political team pressured state leaders to redraw its map to gain more seats in the U.S. House and help Republicans maintain their congressional majority in 2026. Trump said a “very simple redrawing” of the state’s maps could help pick up five seats. 

Redistricting, the process of redrawing state legislative and congressional district boundaries, typically happens every ten years after the U.S. Census. 

Other Republican-led states, including Florida and Ohio, also said they would look at redrawing their maps mid-decade.

California Gov. Gavin Newsom, who was not at the press conference, was the first Democrat to float the idea of gerrymandering the Democratic state to have fewer Republican seats in response. Democrats in New York and Maryland have also been looking for a path to gain additional seats in their states as well. 

None of the governors at the press conference said they would pursue that route but said they supported those that had a path to use it. Kelly joked that she “could” do mid-decade redistricting. “But what would I do? I’d just give them another Republican.” 

Evers said the blatant direction from Trump to pursue redistricting is a “constant threat to our democracy.” 

“I’m really pissed frankly, and we’re going to do whatever we can do to stop this,” Evers said, adding that Wisconsin would not be changing its maps. He said the state has already worked hard to “get fair maps.”

The Republican-led Legislature and Evers adopted new maps for the state Legislature in 2024 following a state Supreme Court ruling. Some have been calling for new Congressional maps, though those efforts have so far been rejected by the state Supreme Court. 

Wisconsin’s current congressional maps were drawn in 2022 by Evers and selected by the state Supreme Court with a conservative majority at the time. Democrats and their allies filed a new challenge to the maps in Dane County Circuit Court in July, arguing they are unconstitutional because they’re anti-competitive. Republicans currently represent six of Wisconsin’s eight congressional districts. 

“Because of those fair [state legislative] maps that we had, we were able to pass a relatively bipartisan budget, and it was a good budget, and so, in my heart of hearts, this is where we have to be, but… when you have a gun up against your head, you gotta do something,” Evers said.

“This move is unconstitutional. It’s again breaking the system. It’s, again, meant to game the system,” Minnesota Gov. Tim Walz said. “Democrats are expected to have the decorum — we’re expected to protect the institutions, we’re expected to follow the rules on this.”

The times call for a different approach, however, he argued. 

“We’re not playing with a normal administration,” Walz said. “We’re playing with one that has thrown all the rules out of there… I think it is incumbent upon states that have the capacity or the ability to make sure that we are responding in kind.”

Governors criticize GOP over effects of the Republican megabill 

The Democratic governors also warned about the potential effects of Republicans’ federal reconciliation package. Kelly, who chairs the Democratic Governors Association, said government systems and programs being cut are not set up for states to operate on their own. 

“They were set up with the federal government as a very robust partner, and without them being a partner, there is no way that any of our states will be able to pick up the tail,” Kelly said. “The best we could do is perhaps mitigate the pain, but even that will be difficult.” 

The legislation, ” signed by President Donald Trump on July 4, made major changes to the federal Medicaid and the Supplemental Nutrition Assistance Program (SNAP).

Trump and Republicans in Congress are “trying to gut programs that Wisconsin families count on,” Evers said. “They’re willing to break our constitutional system to make that happen.” 

The megabill is just one tool, he suggested. “Whether it’s the Republican budget or the continued illegal action to fire Wisconsin workers, strip funds away from our state, damage public education, we have to fight.” 

A memo released this week by the nonpartisan Wisconsin Legislative Fiscal Bureau found that the exact effects of the federal reconciliation law on Medicaid and FoodShare in Wisconsin are uncertain, but will likely result in fewer enrollees.

Currently, about one in five Wisconsin residents rely on Medicaid for health care coverage. 

“The full impact of the Act’s Medicaid provisions on the state’s MA enrollment and costs remains uncertain,” the fiscal bureau memo states. “This is partly because some of the details of implementation requirements will depend upon forthcoming federal guidance, but also because the eligibility and enrollment requirements are new for the program and so little is known about their actual effects.” 

Starting in January 2027, childless adults will be required to complete 80 hours per month of paid work, school, employment training or community service per month to maintain their Medicaid eligibility. There are about 184,000 childless adults currently enrolled in Wisconsin. DHS estimates that 63,000 Wisconsinites will be at high risk of losing their coverage.

The LFB memo said that enrollment will likely drop due to the work requirement provisions. 

“Enrollment reductions could occur either because of the additional complexity of the application process or because the work requirements cause some individuals to increase their earnings to above the eligibility threshold. The magnitude of the program disenrollment, and associated reduction in [Medicaid] benefits costs, is uncertain,” the memo states. 

The governors warned that hospitals still face a difficult environment under the federal law. 

“Our rural hospitals in particular are extremely at risk,” Kelly of Kansas said. “We’ve already closed 10 of them in those 10 years and many more are on the brink, and this reconciliation bill is going to throw them over the edge.” 

Kentucky Gov. Andy Beshear said 35 hospitals are at risk in his state, making it the state with the most hospitals at risk in the nation. 

“Donald Trump’s big ugly bill is the single worst, most devastating piece of legislation that I have seen in my lifetime. It is a direct attack on rural America,” Beshear said. 

Three hospitals in Wisconsin have been identified as at risk of closure. 

Costs for the SNAP program will increase in Wisconsin as the law reduces the federal share of the program — known as FoodShare in Wisconsin — from 50% to 25%. This will leave states responsible for 75% of the costs, a change that the Wisconsin Department of Health Services estimates will require an additional $51 million annually from the state. 

The FoodShare program currently helps nearly 700,000 Wisconsinites access food, and nearly 90,000 Wisconsinites will be at risk of losing their benefits due to the new federal provisions, according to the Wisconsin Department of Health Services. 

Rhode Island Gov. Dan McKee echoed concerns over the ability of the state  to pick up the gaps left by federal cuts in social programs.

“We’re not going to be able to absorb in funding what’s coming our way,” McKee said. “The taxpayers are going to pay for it in our states or the benefits are going to get reduced.” 

The law extends work requirements for SNAP recipients from the current top age of 54 to age 64. It narrows the work requirement exemption for caregivers and parents by changing the definition of “dependent child” from under 18 years of age to under 14, meaning that parents of 15- to 17-year-olds could now be required to have employment in return for their SNAP benefits. 

It provides an exception from work requirements for a married person responsible for a child under age 14 and residing with someone who complies with the work requirements. It also exempts individuals who are eligible for the Indian Health Services. 

“While Wisconsin just passed a Wisconsin budget that invests in our kids, cuts taxes for working families and supports our rural hospitals, Trump and Congressional Republicans are moving in just the opposite way,” Evers said. “Democratic governors aren’t going to just sit idly and watch it happen. When Trump tried to strip hospital funding, we moved real quickly to protect $1.5 billion dollars in health care funding for Wisconsin. When they threaten our schools, we stand up and fight back. When they attack programs that matter to working families, we find ways to fill the gaps.”

“Republican governors fall in line behind Trump’s agenda. Democratic governors are standing up for the people that we serve,” Evers said before mentioning 2026 elections. He said Wisconsinites will “make a choice about the future of our state when they elect our next governor. They’re going to choose a leader who will work together and expand health care, support working families and build an economy that works for everybody.”

Evers announced on July 24 that he would not be running for a third term in office, setting up the first open race for governor in Wisconsin since 2010.

“I know that [Evers’] leadership is not going to end just because the title might, and that he is going to be out there fighting for what he believes in moving into the future,” said Kentucky Gov Andy Beshear, who won’t be able to run for another term in 2027 due to term limits.

So far, Wisconsin Lt. Gov. Sara Rodriguez has announced her campaign, Milwaukee County Executive David Crowley is planning on entering the race and other Democrats are still mulling a decision. There will likely be a crowded Democratic primary. Two Republicans have officially launched their campaigns for governor, while U.S. Rep. Tom Tiffany has been teasing a run.

U.S. Reps. Adriano Espaillat and Nydia Velazquez, both New York Democrats, speak to the media opposite the Jacob K. Javitz Federal Building, where they unsuccessfully attempted to gain access to Immigration and Customs Enforcement holding facilities to observe on June 8, 2025 in New York City. (Photo by Adam Gray/Getty Images)

WASHINGTON — The massive tax and spending cuts package signed into law by President Donald Trump earlier this month will affect not only Latinos using federal safety net programs but also those living in communities vulnerable to environmental pollution, Democrats and advocates said during a Tuesday virtual press conference.

The president’s domestic policy agenda bill that congressional Republicans passed without Democrats’ approval, through a process known as reconciliation, made permanent the 2017 tax cuts and provided billions of dollars for immigration enforcement by cutting funds for clean energy, environmental justice grants, food assistance and Medicaid, a health care insurance program for low-income people.

The bill will add $3.394 trillion to deficits during the next decade and lead 10 million people to lose access to health insurance, according to an analysis by the nonpartisan Congressional Budget Office.

Chair of the Congressional Hispanic Caucus Adriano Espaillat, Democrat of New York, said the bill passed through reconciliation reduces spending on “Medicaid dramatically and (the Supplemental Nutrition Assistance Program) dramatically.”

He said Democrats in their messaging should focus on the changes coming for Medicaid and how the cuts will impact people across the United States. Republicans’ numerous changes to health programs, predominantly Medicaid, will reduce federal spending during the next decade by $1.058 trillion.

“It’s really a conversation about life and death, because if you’re on Medicaid and now they’re cutting your benefits, the treatment that you receive to save your life could be in jeopardy,” Espaillat said. 

Rural hospitals and Latinos

Rep. Raul Ruiz, a member of the Congressional Hispanic Caucus, said the cuts to Medicaid are “devastating,” especially to hospitals in rural communities.

“First, what hospitals will do is they will close services that aren’t the money-making services for a hospital, like pediatrics, labor delivery and mental health, and then beyond that, they’ll eventually just close their hospital,” said the California Democrat, a former emergency room doctor.

“This is devastating because usually these rural hospitals serve a high Latino population, medically underserved, resource-poor areas,” Ruiz said. “If you have a medical emergency and you don’t have a local emergency department or hospital to go to, chances of your survivability during an emergency greatly drops.”

Antonieta Cádiz, the executive director of Climate Power En Acción, said that most of those effects, such as new reporting requirements for Medicaid patients that could result in people losing coverage, won’t be felt until after the midterm elections in 2026, when those changes go into effect.

Climate Power En Acción is an arm of the clean energy advocacy group Climate Power that focuses on reaching out to Latinos about the impacts of climate change.

$170 billion for immigration crackdown

Vanessa Cárdenas, executive director of the immigration advocacy group America’s Voice, said the bill will also affect Latino communities because of its more than $170 billion increase for immigration enforcement.

She said Democrats should lean into immigration policy and push back against the Trump administration’s aggressive immigration crackdown and plans for mass deportations.

“Democrats need to take this opportunity and need to be able to bring people in to share in their vision of what a functional immigration system is,” she said. “It is very frustrating that we are not seeing again, more Democrats really leaning in on this issue.”

Espaillat acknowledged that Democrats’ communication strategy on immigration “has been one of our weaknesses.”

“We at the Congressional Hispanic Caucus have done a good job at first, exposing the inequities and irregularities and discriminatory practices of immigration to the degree that now we’re seeing,” he said.

“In addition to that, I think it’s important that we message on Medicaid …  SNAP, and then, of course, environmental justice is one that’s also a real path for which we are working on having a very structured and disciplined message,” Espaillat continued.

Higher energy bills

Cádiz said the bill Republicans passed will lead to a loss of clean energy jobs and it also lessens incentives for energy efficient appliances, which will lead to higher energy bills for Latinos. Compared to the average U.S. family, Latino households pay roughly 20% more in energy costs, according to the American Council for an Energy-Efficient Economy.

“It guts clean energy programs crucial for savings amid rising heat and energy demand, leaving us with higher bills,” she said of the bill. “This is a direct attack on Latino families, workers and every person struggling with rising costs to meet essential needs.”

She added that environmental justice grants totaling $300 million were eliminated, while roughly 15 million Latinos live in communities with high levels of air pollution.

Espaillat said that the cuts to clean energy programs provided by the Biden administration’s massive climate and clean energy bill, which also passed through the process of reconciliation but under Democratic control, benefited local communities.

“Now there’s going to be a major disinvestment for these programs,” he said. 

People listen to a sermon before being admitted to lunch at the Hope Center, which assists homeless and addicted residents in Hagerstown, Md. Experts say Medicaid cuts will exacerbate rural communities’ access to mental health care. (Photo by Spencer Platt/Getty Images)

Across the nation, Medicaid is the single largest payer for mental health care, and in rural America, residents disproportionately rely on the public insurance program.

But Medicaid cuts in the massive tax and spending bill signed into law earlier this month will worsen mental health disparities in those communities, experts say, as patients lose coverage and rural health centers are unable to remain open amid a loss of funds.

“The context to begin with is, even with no Medicaid cuts, the access to mental health services in rural communities is spotty at best, just very spotty at best — and in many communities, there’s literally no care,” said Ron Manderscheid, former executive director of the National Association of County Behavioral Health and Developmental Disability Directors.

Cuts over the next 10 years could force low-income rural families to pay for mental health care out of pocket on top of driving farther for care, experts say. Many will simply forgo care for depression, bipolar disorder and other illnesses that need consistent treatment.

“Not only do you have very few services available, but you don’t have the resources to pay for the services,” Manderscheid said. “That makes the problem even worse.”

Rural communities are already at higher risk of suicide, with rates almost doubling over the past two decades. Already, rural communities are grappling with a shortage in mental health professionals, making them more vulnerable to losses compared with more urban areas, experts say.

Paul Mackie, assistant director of the Center for Rural Behavioral Health at Minnesota State University, Mankato, studies rural mental health workforce shortages.

“If it [coverage] goes away, what would then be the person’s next option if they already don’t have the resources?” said Mackie, who grew up on a rural Michigan dairy farm. “You can have a rural psychologist or a rural clinical social worker working under a shingle, literally alone.”

Small rural hospitals often provide critical behavioral health care access, he said. One analysis found the cuts next year would leave 380 rural hospitals at risk of shutting down.

States such as Mackie’s Minnesota, which expanded Medicaid eligibility under the 2010 Affordable Care Act, would suffer significant slashes in federal matches as a result of President Donald Trump’s signature legislation. The law, which includes tax cuts that disproportionately benefit the wealthy, cuts the federal government’s 90% matching rate for enrollees covered under expansion to anywhere from 50% to 74%.

States will have to redetermine eligibility twice a year on millions enrolled under Medicaid expansion. Some Medicaid recipients also will have to prove work history. The new law creates work requirement exceptions for those with severe medical conditions — including mental disorders and substance use — but experts say proving those conditions may be convoluted. The exact qualifications and diagnoses for the exceptions haven’t been spelled out, according to a report by KFF, a health policy research organization.

“You can’t work when your mental illness is not treated,” said Dr. Heidi Alvey, an emergency and critical care medicine physician in Indiana. “It’s so counter to the reality of the situation.”

Alvey worked seven years at Baylor Scott & White Health’s hospital in Temple, Texas. As nearby rural critical access hospitals and other mental health centers shut down, the hospital became the only access point for people hours away, she said.

“People who just had absolutely no access to care were coming hours in to see us,” she said. Many had serious untreated mental health conditions, she said, and had to wait days or weeks in the emergency department until a care facility had an open bed.

She’s concerned that Medicaid cuts will only make those problems worse.

Jamie Freeny, director of the Center for School Behavioral Health at advocacy group Mental Health America of Greater Houston, worries for the rural families her center serves. The organization works with school districts across the state, including those in rural communities. Nearly 40% of the state’s more than 1,200 school districts are classified as rural.

She remembers one child whose family had to drive to another county for behavioral health. The family lost coverage during the Medicaid unwinding, as pandemic provisions for automatic re-reenrollment expired. The child stopped taking mental health medication and ended up dropping out of school.

“The child wasn’t getting the medicine that they needed, because their family couldn’t afford it,” Freeny said. “The catalyst for that was a lack of Medicaid. That’s just one family.

“Now, you’re multiplying that.”

Family medicine physician Dr. Ian Bennett sees Medicaid patients at the Vallejo Family Health Services Center of Solano County in California’s Bay Area. The community health clinic serves patients from across the area’s rural farm communities and combines primary care with mental health care services, Bennett said.

“When our patients lose Medicaid, which we expect that they will, then we’ll have to continue to take them, and that will be quite a strain on the finances of that system,” Bennett said. The center could even close, he said.

“The folks who are having the most difficulty managing their lives — and that’s made worse by having depression or substance use disorder — are going to be the folks most likely to drop off,” said Bennett, a University of Washington mental health services researcher. “The impacts down the road are clearly going to be much worse for society as we have less people able to function.”

The psychiatric care landscape across Michigan’s rural western lower peninsula is already scarce, said Joseph “Chip” Johnston. He’s the executive director of the Centra Wellness Network, a publicly funded community mental health care provider for Manistee and Benzie counties. The network serves Medicaid and uninsured patients from high-poverty communities.

“I used to have psychiatric units close by as an adjunct to my service,” he said. “And they’ve all closed. So, now the closest [psychiatric bed] for a child, for example, is at least two hours away.”

Those facilities are also expensive. A one-night stay in an inpatient psychiatric facility can be anywhere from $1,000 to $1,500 a night, he said.

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org.

President Donald Trump holds up the "One Big Beautiful Bill Act" that was signed into law during an Independence Day military family picnic on the South Lawn of the White House on July 4, 2025 in Washington, D.C.  (Photo by Alex Brandon - Pool/Getty Images)

WASHINGTON — Republicans’ “big, beautiful” law will add $3.394 trillion to deficits during the next decade and lead 10 million people to lose access to health insurance, according to an analysis released Monday by the nonpartisan Congressional Budget Office.

The updated assessment of the sweeping tax and spending cuts law came weeks after nearly every GOP lawmaker voted to approve the legislation ahead of a self-imposed Fourth of July deadline. The law made permanent the 2017 tax cuts from President Donald Trump’s first term and provided billions to carry out his plans of mass deportations, an immigration crackdown and increased defense spending.

Maya MacGuineas, president of the Committee for a Responsible Federal Budget, wrote in a statement that it is “still hard to believe that policymakers just added $4 trillion to” deficits after Republican lawmakers “have spent months or years appropriately fuming about our unsustainable fiscal situation.”

“This is a dangerous game we are playing,” MacGuineas wrote. “It has been going on for years, and it was brought to new levels with this bill. And it is time to stop.” 

CBO released numerous reports throughout the months-long process showing how various parts of the bill would affect federal spending and health care access, but the scorekeeper needed additional time to evaluate changes Republicans made during the last few days of debate.

The latest figures are similar to a preliminary report CBO released earlier this month projecting the final version of the package, which underwent considerable changes in the Senate, would likely lead to a $3.4 trillion increase in deficits between 2025 and 2034.

That total was significantly higher than the $2.4 trillion increase in deficits CBO expected the original House version of the bill would have had during the next decade.

Health spending to fall by more than $1 trillion

Republicans’ numerous changes to health programs, predominantly Medicaid, will reduce federal spending during the next decade by $1.058 trillion.

The law made more than a dozen changes to the state-federal health program for lower income individuals and certain people with disabilities, though some of those have larger budget impacts than others.

Language barring Medicaid spending from going to Planned Parenthood for one year would actually increase federal deficits during the 10-year window by $53 million.

The CBO score shows that policy change would decrease federal spending by $44 million this fiscal year and another $31 million during the next fiscal year, before increasing deficits by $91 million during fiscal year 2027 and continuing.

That section of the law is on hold for the moment after a federal judge issued a temporary restraining order earlier this month that required the Trump administration to continue paying Planned Parenthood for routine health care coverage for Medicaid enrollees.

Federal law for decades has barred the federal government from spending taxpayer dollars for abortion services with limited exceptions, so the one-year prohibition on Medicaid funding to Planned Parenthood would have blocked patients enrolled in the program from going to their clinics for routine health appointments, like annual physicals and cancer screenings.

The CBO report didn’t include a state-by-state breakdown of the effects of the health care changes in the law, but the agency is expected to release more detailed analysis of the health impacts in the coming weeks.

Nutrition assistance cuts

Apart from Medicaid, two large projected deficit reductions in the law come in the agriculture title’s sections on the Supplemental Nutrition Assistance Program, or SNAP.

A provision requiring states to pay for some portion of SNAP benefits starting in fiscal 2028 would save the federal government between $5.7 billion and $6 billion per year, totalling just less than $41 billion for the first seven years it will be in effect.

And new work requirements for SNAP would result in $68.6 billion less in federal spending over the 10 years starting in fiscal 2026, the CBO projected.

Federal student loan program

Republicans’ streamlining of the federal student loan program is projected to reduce federal spending in the next decade by $270.5 billion.

As part of a sweeping overhaul of higher education, the law limits repayment options for borrowers with any loans made on or after July 1, 2026, to either a standard repayment plan or an income-based repayment plan.

Extension and expansion of tax cuts

The extension of Trump’s 2017 tax law, plus new tax breaks, will cost $4.472 trillion over the next decade, according to the latest CBO score.

The United States collects the majority of its revenue from individual taxpayers, and the continuation of lowered income tax brackets, plus an increased standard deduction, will comprise the bulk of lost revenue over 10 years, adding up to $3.497 trillion.

Trump also campaigned on several other tax cut promises, including no tax on tips and overtime, as well as no tax on car loan interest. The temporary provisions come with stipulations and will end in 2029. Together they will cost $151.868 billion.

The child tax credit increases under the new law to $2,200, up from $2,000, though lawmakers did not increase the amount lower income families can receive as a tax refund. The CBO estimates the bumped-up tax credit will cost $626.345 billion over the next decade.

Lawmakers offset some costs of the bill by repealing clean energy tax credits, including ending tax credits for personal and commercial electric vehicles, nixing energy efficiency improvement credits for homeowners, and terminating clean electricity production credits. In all, Republicans saved $487.909 billion from axing the measures meant to address the effects of climate change.

Jacob Fischler, Shauneen Miranda and Ashley Murray contributed to this report.

Nichole Robarge, right, describes the challenges faced by people with disabilities she assists when enrolling in Medicaid. With her is Kathleen Cummings, who provides similar assistance to people 60 and older. Both said impending changes to the program are likely to increase those challenges. (Photo by Erik Gunn/Wisconsin Examiner)

With the Congressional mega-bill that cuts $1 trillion from Medicaid now law, people who have relied for their health care on the state-federal insurance plan and their advocates are scrambling to figure out  how and when it will hit home.

The timing of many of the law’s changes is still uncertain.

“This bill was written very hastily,” said Tami Jackson, policy analyst for the Wisconsin Board for People with Development Disabilities (BPDD), at a discussion of the law Thursday morning in the Wisconsin Capitol.

“There are implementation dates for various pieces of Medicaid that are not all in alignment,” Jackson said. “So, you’re going to get this in waves.”

Janet Zander of the Greater Wisconsin Agency on Aging Resources paraphrased promises from members of Congress who publicly defended the bill.

“It’s really easy to listen to what we’re hearing about — ‘This isn’t going to harm us here in Wisconsin. We’re not doing anything that’s going to hurt older adults, people with disabilities, low-income families,’” Zander said. “Those of us who are working in these programs know that’s not the case at all.”

The new law imposes requirements for Medicaid participants to work or be preparing for work — although a majority already are working — or else be approved as exempt from having to meet the requirement.

That provision’s implementation date of Jan. 1, 2027 is less than 18 months away, Jackson said. And it could be up to a year before the federal Department of Health and Human Services (HHS) produces an administrative rule to direct states on how they manage the requirement.

That doesn’t allow for much time to work out “20 or 30 unanswered questions” about how to require people to demonstrate they’re working, qualify for an exemption or prove that they’re exempt, Jackson said.

The added requirements will also impose new demands on agencies in charge of implementing the Medicaid changes in each state, as well as county agencies that help people navigate the program.

“If you are ramping up the workload and how much people have to do, and ramping up the staffing it takes to do that, that’s a lot more that counties are going to be doing locally, or will have to do,” Jackson said. “That’s going to exacerbate how many people lose coverage.”

Other items have no implementation date — which is usually interpreted as taking effect with the bill’s signing, said William Parke-Sutherland, government affairs director at Kids Forward.

“This bill, which is being kind of talked about as a tax and spending bill, is really a health care redesign bill, and it makes the most substantive changes to the health care system that we’ve seen since the Affordable Care Act,” Parke-Sutherland said.

That national health care law had four years to be implemented. With the new Medicaid changes, “we have no time in comparison.”

But the probable long-term impact remains dire, advocates said — making it harder for people to get coverage and keep coverage.

Taking together the projected loss of Medicaid coverage as well as the projected loss of Affordable Care Act coverage for low-income people who lose subsidies for their premiums that expire at the end of this year, as many as 17 million people in the U.S. could lose health care and long-term care coverage, Zander said.

The state Department of Health Services estimated in April that at least 52,000 Wisconsin residents could lose Medicaid coverage. Changes the Senate made in the bill will likely increase those estimates, however, according to advocates.

Safety-net barriers, old and new

As ultimately passed by the U.S. Senate and the House of Representatives and signed into law by President Donald Trump, the legislation has thrown new barriers in front of the nation’s safety-net programs, including Medicaid as well as the federal food aid program, SNAP.

Existing barriers were already very high, advocates said.

Kathleen Cummings works for the Columbia County Aging and Disability Resource Center assisting people who are 60 or older applying for Medicaid and other benefit programs. Based on their annual income and total assets, some people on Medicare also qualify for Medicaid to cover their out-of-pocket Medicare costs.

Cummings recounted the experience of a woman who had qualified for Medicaid but recently contacted her because she was getting bills for her health care. The woman accidentally failed to renew her Medicaid coverage when the renewal form she received got buried in a flurry of other Medicaid-related mail, Cummings said.

Under current law the client can get coverage retroactively for bills incurred in the last three months. But with the new law, “that will be changing to 30 days, so we will not, in the future, be able to request that backdated coverage for bills under the situation that she is in,” Cummings said.

Another client has had extensive treatment for lung cancer, she said. The man “is just barely, barely over the federal poverty level” — about $1,300 a month.

“A lot of my clients are very proud and do what they can with what they have,” Cummings said. “But when something like lung cancer comes along, he’s suddenly faced with all these bills that he only had limited coverage [for].”

She’s helping the man apply for Medicaid coverage backdated three months to cover those bills, she said. “Once he shows proof that he qualified, which he will, [he can] get some of these bills paid.”

Nichole Robarge also works for the Columbia County ARDC, helping people from ages 16 to 59 who qualify for federal Supplemental Security Income (SSI) disability benefits and other programs.

Robarge said that currently the disability application takes 12 to 18 months for a decision. As many as 85% of applications are denied at first, she said, and about 20% get overturned on appeal, which takes another 18 to 24 months. A second appeal, with a hearing before an administrative law judge, can take another two years.

In Wisconsin, approval for SSI automatically qualifies a person for Medicaid coverage. Until the SSI decision is resolved, however, the applicant has to apply for Medicaid separately, Robarge said — something that a disability can make much more difficult.

She pulled out the Medicaid application, which currently must be completed annually — a 41-page document that is a half-inch thick.

“Can you imagine getting one of these in the mail and having a cognitive disability or a physical disability, or maybe you had a stroke?…Or maybe you can’t read at all,” Robarge said.

“I bought a house and had less paperwork. I’ve bought a car and I’ve had less paperwork than what it takes to fill one of these out,” she added. “It’s tedious and it’s treacherous … This first barrier is huge, and this is even without getting the documents that you need to provide the proof that they’re asking for.”

Unintended consequences

The new law is poised to make those delays worse, advocates argue — blocking people from Medicaid coverage even though they meet the program’s qualifications.

“Medicaid is a wildly complicated program,” said Lisa Hassenstab, public policy manager for Disability Rights Wisconsin. “What we’ve seen in this bill is that all of these little changes [and] the unintended consequences, because people don’t understand what the program is. They don’t understand what it is, and so they don’t understand what the impact of these changes is really going to be.”

One thing the law won’t do, advocates said, is protect taxpayers.

“It won’t protect me,” said Tyler Engel, whose Medicaid coverage enables him to live more independently in the community with coverage for his caregivers.

“This bill saves money by making it so that, for somebody who is now currently eligible for health care, the provider who provides that care is not going to get paid,” Parke-Sutherland said. “This saves money by people who are currently eligible for health insurance” with federal help “not getting health insurance or having to pay more for it. That’s the only way that this bill saves money.”

Two-thirds of Medicaid participants are working, and therefore they are taxpayers, too, Jackson said.

“It’s a cost shift to the taxpayers,” said Jackson, because when people aren’t covered by Medicaid, “somebody else picks that up — whether it’s uncompensated care, whether it’s a medical bankruptcy, whether it’s your private insurance or your group premium going up.”

“If you stop paying for care, people’s care needs don’t go away,” Parke-Sutherland said. “You still pay. So this isn’t a boon to the taxpayers.”

Rep. Derrick Van Orden (R-Prairie du Chien) speaks at a hearing in the House of Representatives. Van Orden claims to have engineered the Wisconsin State budget deal that mitigated the Medicaid cuts he voted for. | Screenshot via Youtube

Success has many fathers, but U.S. Rep. Derrick Van Orden is not one of them. Contrary to Van Orden’s triumphant tweets, he did not “secure” $1 billion for rural health care in Wisconsin. He had nothing to do with the bipartisan state budget deal that was drafted and rushed to completion in order to capture those funds — which, by the way, represent just a fraction of the billions the state stands to lose in Medicaid funds under the Republican mega bill Van Orden approved.

What Van Orden did do was vote to cut Medicaid and Affordable Care Act health insurance, with the result that tens of thousands of rural Wisconsinites now face losing their health care coverage and several rural Wisconsin hospitals are in danger of closing. As he prepared to join the narrow, four-vote majority that passed the disastrous federal bill, Van Orden sent some last-minute messages to Gov. Tony Evers urging him to hurry up and sign the deal Evers had already reached with state legislators. Now Van Orden is taking credit for Wisconsin leaders’ work mitigating the harm he caused. It would be laughable if the consequences were not so dire. 

For months, Evers and leaders of the Wisconsin Legislature met behind closed doors to hammer out a deal, even as massive federal cuts to Medicaid, food assistance and other programs essential to the wellbeing of Wisconsinites loomed. Among the issues Evers and legislative leaders agreed on was the importance of getting the budget done before the federal mega bill was signed, so the state could still qualify for $1 billion in soon-to-expire Medicaid matching funds. 

Evers signed the budget in the nick of time last week, at 1:30 a.m. on July 3, just before the U.S. Congress granted President Donald Trump’s wish and sent him his “big beautiful bill” to sign on July 4. 

Van Orden immediately began taking credit for both budgets.

“I just helped secure $1,000,000,000 a year for BadgerCare and $500,000,000 for rural healthcare infrastructure,” Van Orden boasted on X. The $500 million he claimed credit for was added to the bill by U.S. Sen. Susan Collins (R-Maine) and other Senate Republicans worried about the bill’s devastating impact on rural hospitals. Van Orden had nothing to do with it. Nor is the money earmarked for Wisconsin — it’s a nationwide program meant to blunt the blow Van Orden and his GOP colleagues have just dealt to rural health care. 

But the biggest whopper Van Orden told is that he somehow led the bipartisan budget deal between Evers and the Legislature. 

It seemed weird at the time when Van Orden, on the brink of voting for the federal law that will cause so many Wisconsinites to lose their health care, started shouting at Evers on X to hurry up and sign the state budget.

Now it’s clear that he was simultaneously preparing to vote to take health care away from his constituents and planning to take credit for saving them from the effects of his own vote.

After both budgets were signed, Van Orden repeatedly shared a copy of a letter he wrote to Evers on July 2 emphasizing the “importance of signing the proposed state budget into law without delay.” According to Van Orden, the letter and a conversation he claims to have had with Evers caused the governor to sign the deal the next day. 

“Not true,” Evers spokesperson Britt Cudaback wrote on X in response to Van Orden’s bragging. “You never personally advocated to @GovEvers or our office to increase the hospital assessment in the bipartisan budget deal until it was already in the deal. And you had zero to do with Gov. Evers deciding to sign the budget before the reconciliation bill was signed.” 

What Van Orden did do was to vote for a bill that will push an estimated 30,000 rural Wisconsinites off Medicaid and will take away food assistance from another 90,000 people in the state, 1 in 3 of whom are children.

Van Orden was one of several Republicans in the U.S. House of Representatives who expressed concern about the food assistance cuts in the GOP mega-bill — and then voted for the cuts anyway. 

Those cuts only got deeper after the bill moved to the U.S. Senate, and the bill’s cost in massive increases to the federal deficit also grew from $2.5 trillion in the House version to $3.4 trillion in the final deal. Still, Van Orden stayed on board, voting for the bill a second time when it came back to the House and sending it to President Donald Trump to sign into law.

Democratic U.S. Rep. Mark Pocan compares Van Orden to an arsonist who takes credit for recommending the residents of the house he torched take steps to put out the fire. “You know, he poured gasoline around the house. He started throwing matches around, and then he said, ‘you better use that extinguisher,’” Pocan said at a press briefing this week.

Van Orden continues to obfuscate. In between doubling down on his preposterous claims and slinging insults at his detractors on social media, the congressman who has been rebuked by Senate leaders of both parties for yelling vulgarities at high school pages claimed to have given Evers a lesson in civility and bipartisanship:  “Why did Tony sign the bill at 1:30 am? Because I asked him personally to put politics aside,” he declared this week. 

For all his posturing on X, Van Orden still hasn’t been willing to face his constituents in a town hall to stand behind his vote. Pocan decided to hold one for him last month, to explain the details of what he called the worst budget bill he’s seen in 30 years in politics. At a press conference Pocan said, “I think this month I may have to do another visit.”

The U.S. Capitol as lawmakers worked into the night on the "big beautiful bill" on July 2, 2025. (Photo by Ashley Murray/States Newsroom)

WASHINGTON — U.S. House Republicans cleared the “big, beautiful bill” for President Donald Trump’s signature Thursday, marking an end to the painstaking months-long negotiations that began just after voters gave the GOP unified control of Washington during last year’s elections.

The final 218-214 vote on the expansive tax and spending cuts package marked a significant victory for Speaker Mike Johnson, R-La., and Senate Majority Leader John Thune, R-S.D., who were able to unify centrist and far-right members of the party against long odds and narrow majorities.

But the legislation’s real-world impacts include millions of Americans expected to lose access to Medicaid through new requirements and slashed spending, and state governments taking on a share of costs for a key nutrition program for low-income families. If voters oppose Republicans at the ballot box in return, it could mean the GOP loses the House during next year’s midterm elections.

In the end just two Republicans in the House and three in the Senate opposed the measure, which the Senate approved earlier in the week with Vice President JD Vance casting the tie-breaking vote.

Trump posted on social media numerous times in the days leading up to the vote, thanking supportive Republicans who were praising the bill during interviews and threatening to back primary challenges against GOP lawmakers who stood in the way of passage.

“Largest Tax Cuts in History and a Booming Economy vs. Biggest Tax Increase in History, and a Failed Economy,” Trump posted just after midnight when it wasn’t yet clear the bill would pass. “What are the Republicans waiting for??? What are you trying to prove??? MAGA IS NOT HAPPY, AND IT’S COSTING YOU VOTES!!!”

Trump told reporters while on his way to Iowa for an event that he would sign the bill at 5 p.m. Eastern on Friday, with military aircraft flying over the White House and Republican lawmakers in attendance.

Johnson said during a floor speech the legislation is a direct result of the November elections, when voters gave the GOP control of the House, Senate and the White House.

“That election was decisive. It was a bellwether. It was a time for choosing,” Johnson said. “And I tell you what — the American people chose, overwhelmingly, they chose the Republican Party.”

The package, he said, would make the country “stronger, safer and more prosperous than ever before.”

“We’ve had spirited debates, we’ve had months of deliberation and now we are finally ready to fulfill our promise to the American people,” Johnson said.

Republicans were spurred to write the tax provisions in the legislation to avoid a cliff at the end of the year, created by the party’s 2017 tax law. But the legislation holds dozens of other provisions as well, spanning border security, defense, energy production, health care and higher education aid.

The bill raises the country’s debt limit by $5 trillion, a staggering figure that many fiscal hawks would have once balked at, but is enough to get Republicans past the midterm elections before they’ll have to negotiate another deal to raise the country’s borrowing limit.

The nonpartisan Congressional Budget Office’s latest analysis of the measure projects it would add $3.4 trillion to deficits during the next decade compared to current law.

Jeffries: “It guts Medicaid’

House Minority Leader Hakeem Jeffries, D-N.Y., called the health care provisions “reckless” during a speech that lasted nearly nine hours, forcing the vote to take place in the afternoon rather than early morning, and said the “bill represents the largest cut to health care in American history.”

“Almost $1 trillion in cuts to Medicaid,” Jeffries said. “This runs directly contrary to what President Trump indicated in January, which was that he was going to love and cherish Medicaid. Nothing about this bill loves and cherishes Medicaid. It guts Medicaid.”

The speech broke the eight-hour-and-32-minute record that then-Minority Leader Kevin McCarthy, R-Calif., set in 2021 when he sought to delay Democrats from passing a $1.9 trillion coronavirus relief package. House leaders are allowed to exceed normal speaking limits through a privilege called the “magic minute.”

The nonpartisan health research organization KFF’s analysis of the package shows it would reduce federal spending on Medicaid by nearly $1 trillion during the next decade and lead to 11.8 million people becoming uninsured.

Republicans made numerous changes to the state-federal health program for lower income people and some people with disabilities, including a requirement that some enrollees work, participate in community service, or attend an educational program for at least 80 hours a month.

Medicaid patients will no longer be able to have their care covered at Planned Parenthood for routine appointments, like annual physicals and cancer screenings, for one year. Congress has barred federal taxpayer dollars from going to abortions with limited exceptions for decades, but the new provision will block all Medicaid funding from going to Planned Parenthood, likely leading some of its clinics to close.

Overnight drama

House passage followed several frenzied days on Capitol Hill as congressional leaders and Trump sought to sway holdouts to their side ahead of a self-imposed Fourth of July deadline.

The Senate, and then later the House, held overnight sessions followed by dramatic votes where several Republicans, who said publicly they didn’t actually like the bill, voted to approve it anyway. 

GOP leaders didn’t have much room for error amid a narrow 53-seat Senate majority and a 220-212 advantage in the House. That delicate balance hovered in the background during the last several months, as talks over dozens of policy changes and spending cuts in the bill appeared deadlocked.

Any modifications meant to bring on board far-right members of the party had to be weighed against the policy goals of centrist lawmakers, who are most at risk of losing their seats during next year’s elections.

The House passed its first version of the bill following a 215-214 vote in May, sending the legislation to the Senate, where Republicans in that chamber spent several weeks deciding which policies they could support and which they wanted to remove or rework.

The measure changed substantially to comply with the complex rules for moving a budget reconciliation bill through the upper chamber. GOP leaders chose to use that process, instead of moving the package through the regular legislative pathway, to avoid having to negotiate with Democrats to get past the Senate’s 60-vote legislative filibuster.

In the end nearly every one of the 273 Republicans in Congress approved the behemoth 870-page bill.

Maine’s Susan Collins, Kentucky’s Rand Paul and North Carolina’s Thom Tillis voted against it in the Senate and Pennsylvania Rep. Brian Fitzpatrick and Kentucky Rep. Thomas Massie opposed passage in the House.

Fitzpatrick wrote in a statement that while he voted to approve the House’s original version of the bill, he couldn’t support changes made in the Senate.

“I voted to strengthen Medicaid protections, to permanently extend middle class tax cuts, for enhanced small business tax relief, and for historic investments in our border security and our military.” Fitzpatrick wrote. “However, it was the Senate’s amendments to Medicaid, in addition to several other Senate provisions, that altered the analysis for our PA-1 community.”

Massie posted on social media that he couldn’t vote for the measure because it would exacerbate the country’s annual deficit.

“Although there were some conservative wins in the budget reconciliation bill (OBBBA), I voted No on final passage because it will significantly increase U.S. budget deficits in the near term, negatively impacting all Americans through sustained inflation and high interest rates,” Massie wrote. 

GOP holdouts delay passage

Floor debate on the bill in the House, which began around 3:30 a.m. Eastern Thursday and lasted 11 hours, was along party lines, with Democrats voicing strong opposition to changes in the package and GOP lawmakers arguing it puts the country on a better path.

GOP leaders didn’t originally plan to begin debate in the middle of the night while most of the country slept, but were forced to after holdouts refused to give their votes to a procedural step.

When the House did finally adopt the rule, Pennsylvania’s Brian Fitzpatrick was the sole member of his party to vote against moving onto floor debate and a final passage vote.

Fitzpatrick had posted on social media earlier in the day that he wanted Trump “to address my serious concern regarding reports the United States is withholding critical defense material pledged to Ukraine.”

“Ukrainian forces are not only safeguarding their homeland—they are holding the front line of freedom itself,” he wrote. “There can be no half-measures in the defense of liberty. We must, as we always have, stand for peace through strength.”

Tax breaks and so much more

House Ways and Means Chairman Jason Smith, R-Mo., made significant promises to middle-class Americans during floor debate about the tax provisions in the bill that many voters will be watching for in the months ahead. 

“Households making under $100,000 will see a 12% tax cut compared to what they pay today. The average family of four will see nearly 11,000 more in their pockets each year,” Smith said. “Real wages for workers will rise by as much as $7,200 a year. A waitress working for tips will keep an extra $1,300, a lineman working overtime after a storm will keep an extra $1,400.”

Massachusetts Democratic Rep. Richard Neal, ranking member on the tax writing panel, said the legislation’s benefits skew largely toward the very wealthy.

“If you made a million dollars last year, you’re going to make a plus of $96,000 in the next tax filing season,” Neal said. “If you made under $50,000 last year, you’re going to get 68 cents a day in terms of your tax relief.”

The extension of the 2017 tax law would predominantly benefit high-income earners. The top 1% would receive a tax cut three times the size of those with incomes in the bottom 60% of after-tax income, according to analysis from the left-leaning Center on Budget and Policy Priorities.

Some other tax incentives that critics say skew toward wealthier families include a $1,000 deposit from the federal government for babies born between 2024 and 2028, known as a “Trump account.” The program would track a stock index and gain interest accordingly and families with disposable income could contribute additional funding.

And while Republicans included an extension of the child tax credit to $2,200 per child, it requires the parents to have a Social Security number to claim the tax credit.

The bill will give the president more than $170 billion to carry out his campaign promise of mass deportations of people in the country without permanent legal status. The package would give the Department of Homeland Security $45 billion for the detention of immigrants and give its immigration enforcement arm another $30 billion to hire up to 10,000 Immigration and Customs Enforcement agents.

Food aid, higher education

The legislation will overhaul federal loans for higher education and how states pay for food assistance that roughly 42 million low-income people rely on, known as the Supplemental Nutrition Assistance Program, or SNAP.

The bill would cap federal graduate loans to $100,000 per borrower and $200,000 per borrower who is attending law school or medical school. It would also cap the ParentPLUS loans to $65,000.

Under the SNAP changes, the package would require states to shoulder more of the burden in food assistance. Currently, the federal government covers 100% of the cost. The legislation tightens eligibility for SNAP, requiring parents with children aged 6 and older to meet the work requirements when they were previously exempt.

Current estimates from CBO show that changes in  federal nutrition programs including SNAP would reduce federal spending by roughly $186 billion over 10 years.

The GOP megabill cuts clean energy tax credits and claws back some of the funding in former president Joe Biden’s signature climate bill, known as the Inflation Reduction Act.

Some of those cuts to clean energy tax credits include terminating at the end of September a nearly $8,000 rebate for the purchase of an electric vehicle, ending a tax credit by December for energy efficient home upgrades such as solar roof panels and heat pumps.

The package rescinds funds to help local governments and states adopt zero emission standards, and eliminates environmental justice block grants that communities used to address health impacts due to environmental pollution, among other things.

Shelley Feist, 61, of Washington, D.C., who was raised in North Dakota, protests outside the U.S. Capitol on Wednesday, July 2, 2025, as House Republicans try to pass the "big beautiful bill." Feist said she's worried about effects on rural hospitals as a result of Medicaid cuts because her parents, in their 80s, depend on rural health care in Minot, North Dakota. (Photo by Ashley Murray/States Newsroom)

WASHINGTON — Protesters demonstrated against the “big beautiful bill” outside the U.S. Capitol Wednesday as House Republicans whipped votes to get the bill across the finish line and to President Donald Trump’s desk by a self-imposed July Fourth deadline.

Shelley Feist stood on Independence Avenue near the entrance to the House of Representatives holding signs above her head, one reading “Cruel Corrupt Cowards,” the other a Republican elephant with the word “Treason” written on it.

“I think they’re being cruel. I think cruelty is the point,” Feist, 61, of Washington, D.C., and originally from North Dakota, told States Newsroom. “It’s also extremely alarming that there’s such cowardice in the GOP.”

The massive budget reconciliation package, passed by Senate Republicans Tuesday with a tie-breaking vote by Vice President JD Vance, extends and expands 2017 tax cuts at a cost of roughly $4.5 trillion over the next decade. It also yanks funding from federal food and health safety net programs.

The bill aggressively rolls back clean energy tax credits, as well as raising the nation’s borrowing limit to $5 trillion.

Latest figures from the nonpartisan Congressional Budget Office show the package would add $3.4 trillion to the nation’s deficit over the next decade, when the country is mired in record-breaking debt. That office’s earlier analysis of the House-passed bill found the package would reduce resources for low-income families while padding higher earners.

Rep. Virginia Foxx of North Carolina, who chaired an hours-long final committee hearing about the bill overnight, said Wednesday the package is an “embodiment of the America First agenda and we would all do well to remember that.”

Medicaid cuts

Top of mind for Feist is the bill’s cuts to Medicaid, the federal-state health insurance program for low-income individuals and some with disabilities. The Senate version of the package, passed Tuesday, included a  $1 trillion cut to Medicaid over 10 years, according to the CBO.

“I have parents in North Dakota who are 85 and 86. They already have difficulty seeing their doctor. For every doctor that leaves, he takes on 14 times more burden. Rural health care is already extremely difficult. I would expect there will not be a hospital near where my parents live if this bill is signed into law,” said Feist, whose parents live near Minot.

Rural hospitals rely on Medicaid payments. In a last-minute move before Tuesday’s vote, Senate Republicans doubled a fund to $50 billion to subsidize hospitals that will lose funding. Critics say that amount is not enough to fill the gap.

GOP Sens. Susan Collins of Maine and Thom Tillis of North Carolina voted no after voicing concerns over Medicaid cuts.

Nadine Seiler, 60, of Waldorf, Maryland, stood near a press conference by the Congressional Hispanic Conference protesting the bill. Seiler held a large spray-painted sheet above her head with a message on each side: “Free America from Big Bad Bill” and “Coming Soon Freedom in Name Only.”

“I’m concerned about my fellow citizens who are going to be losing Medicaid, food stamps, human health services. People are going to die,” Seiler said.

“And I know Joni Ernst says that we all gonna die, but we gonna die faster and unnecessarily and I care about that.”

Seiler was referring to Sen. Ernst’s response to her Iowa constituents who expressed concern about Medicaid cuts at a town hall on May 30.

SNAP and ICE

Mark Starr sang a protest song he wrote about the “big beautiful bill” as he played guitar and harmonica outside the Longworth House Office Building Wednesday.

The 39-year-old Albuquerque, New Mexico, native told States Newsroom he drove to the capital in late April to begin protesting the bill. He said he’s particularly focused on additional funding for Immigration and Customs Enforcement contained in the package as well as cuts to the Supplemental Nutrition Assistance Program, or SNAP, which provides food benefits to low-income households.

“New Mexico is pretty poor, and so if these cuts to SNAP go, kids can go hungry in New Mexico,” Starr said. “It’s just, like, really gonna mess us up, and we’re just one of the many states that will be affected that way.”

New Mexico has one of the highest poverty rates in the nation.

A provision in the bill will shift food assistance costs to state governments for the first time in the federal program’s history. Critics worry that states could tighten eligibility requirements or drop the program because of the financial burden.

The left-leaning Center for Budget and Policy Priorities estimates 55,000 teens age 14 and up, and adults up to age 64 could lose food assistance in New Mexico because of the bill’s cuts to state work requirement waivers. Children would remain eligible but households would overall see significantly decreased SNAP dollars.

The CBO found in late May that the House-passed bill would result in over 3 million people nationwide losing food assistance.

Starr said he’s also against additional funding provided for immigration enforcement.

“I think they have enough,” he said, pointing to Trump’s visit to a new detention facility in Florida that the White House is touting as “Alligator Alcatraz.”

The Senate-approved version includes an additional $45 billion for ICE detention facilities and $29.9 billion for ICE enforcement and deportation, among billions more directed toward the Southern border.

Clean energy to take a hit

Tiernan Sittenfeld, of the League of Conservation Voters, huddled just outside the House with a group wearing t-shirts that read “Hands off our air, land and clean energy.”

Sittenfeld, the organization’s senior vice president of government affairs, argues the rollbacks of clean energy tax credits in the Senate version will “kill clean energy jobs.”

“It is bad for our economy. It’s bad for jobs. It’s going to raise people’s energy bills. And of course, it’s bad for the planet,” she said.

Senate Republicans accelerated the phase-out of some residential, manufacturing and production credits at a faster rate than the House bill. A last-minute change loosened the timeline on some tech-neutral energy credits though, and removed a previously added tax on wind and solar projects.

Industry groups and energy companies small and large have warned early termination of the credits will have a major impact on growth.

The tax credits for solar, wind, batteries for energy storage, and electric vehicles, among others, were enacted under Democrats’ own 2022 budget reconciliation bill known as the “Inflation Reduction Act.”

The majority of investment in new clean energy manufacturing and production has been concentrated in rural states and states that elected Trump to his second term, according to data collected since 2022 by the Clean Investment Monitor, a joint project by the Rhodium Group and the Massachusetts Institute of Technology’s Center for Energy and Environmental Policy Research.

“Any Republican who votes for this legislation is voting against the interest of their constituents, voting to kill jobs in their district, voting to kill clean energy projects, voting to make their constituents’ energy bills go up,” Sittenfeld said.

Far-right House members who as of Wednesday afternoon were withholding their votes maintain the rollbacks on the clean energy tax cuts, which they’ve dubbed the “green new scam,” do not go far enough.

Speaker of the House Mike Johnson, R-La., talks with reporters before heading to the House chamber for a procedural vote on the "One, Big, Beautiful Bill Act" at the U.S. Capitol on July 2, 2025 in Washington, D.C.  (Photo by Chip Somodevilla/Getty Images)

This report has been updated.

WASHINGTON —  U.S. House Republican efforts to pass the “big, beautiful bill” hit a roadblock Wednesday, when leaders left the chamber in a holding pattern for more than seven hours before calling a procedural vote that stalled amid opposition from hard-right members and others.

The House must adopt the rule in order to set up floor debate and a final passage vote for the tax break and spending cut package. But with four Republicans voting against it and nine withholding their votes, the House remained at a standstill around 11 p.m. Eastern.

GOP Reps. Andrew Clyde of Georgia, Brian Fitzpatrick of Pennsylvania, Keith Self of Texas and Victoria Spartz of Indiana had cast votes against approving the rule, though they could flip since leadership hadn’t closed the vote. Freedom Caucus Chairman Andy Harris of Maryland was among the members withholding their votes in protest.

Far-right members of the House GOP objected strongly to the Senate version passed Tuesday, which reflected changes made during the past month compared to an earlier version passed in the House. Members of the House Freedom Caucus opposed provisions dealing with immigration and the repeal of clean energy tax credits, as well as the measure’s increase in the deficit.

The nonpartisan Congressional Budget Office released an analysis after the Senate voted, showing the bill would increase deficits by $3.4 trillion during the next decade compared to current law.

‘We can’t make everyone 100% happy’

Speaker Mike Johnson, R-La., said earlier in the day he felt ​​”very positive about the progress” made during ongoing negotiations, but didn’t commit to having the necessary votes.

“The thing about it is, when you have a piece of legislation that is this comprehensive and with so many agenda items involved, you’re going to have lots of different priorities and preferences among people because they represent different districts and they have different interests,” Johnson said. “But we can’t make everyone 100% happy. It’s impossible.”

Johnson said he would never ask lawmakers to “compromise core principles, but preferences must be yielded for the greater good.”

South Dakota Republican Rep. Dusty Johnson told reporters before the delay that “the rule going down would be a very unfortunate development.”

But he expressed confidence in Speaker Johnson’s ability to bring holdouts on board eventually, potentially by making commitments tied to future bills.

“Speaker Johnson has not made any promises. He has been really good about talking about legislative vehicles that will exist in the months to come,” Dusty Johnson said. “Reconciliation is not the only tool in the Republican, or I should say in the congressional toolbox. Mike Johnson’s done a good job of making people understand there are other ways we can get things done.”

Texas Republican Rep. Chip Roy said a few hours before the rule vote began that holdouts were “exploring all of the options legislatively and through the executive.”

“We were not happy with what the Senate produced,” Roy said. “We thought there was a path forward as of late last week, even though I had concerns. I’ve been public about them. But then they jammed it through at the last minute in a way that we’re not overly excited about.”

Roy said that “everything is on the table at the moment,” when asked by States Newsroom if he hoped to get concessions from leaders on this package or deals struck for future bills.

Trump presses House GOP

Several House GOP lawmakers traveled to the White House earlier in the day to meet with President Donald Trump, who was also attempting to assuage concerns through several social media posts.

“It looks like the House is ready to vote tonight,’ Trump posted minutes before the rule vote began. “We had GREAT conversations all day, and the Republican House Majority is UNITED, for the Good of our Country, delivering the Biggest Tax Cuts in History and MASSIVE Growth. Let’s go Republicans, and everyone else – MAKE AMERICA GREAT AGAIN!”

House Rules Chairwoman Virginia Foxx, R-N.C., urged support for approving the rule during floor debate, arguing it was essential for GOP lawmakers to deliver on campaign promises.

“This legislation is the embodiment of the America First agenda and we would all do well to remember that,” Foxx said. “Failure at this critical juncture is not an option. This clock is ticking, the president and the American people are waiting. ”

Massachusetts Democratic Rep. Jim McGovern, ranking member on the panel, railed against the dozens of provisions Senate Republicans bundled together in the 870-page package, including some added just Tuesday.

“This process — an abomination, legislative malpractice,” McGovern said. “Final text of this bill came out less than 24 hours ago. We met in committee an hour after it was posted and now we’re here considering a rule that only allows for one hour of debate.

“This bill is within the jurisdiction of 12 different committees. One hour is ridiculous. And every minute we’re finding out new things that were snuck into the bill: a tax cut for whalers and now we’re learning about a gambling tax.”

Tax cuts favor higher incomes

The bill — which underwent weeks of revisions in the Senate after a prior version barely passed the House in May — will extend and expand the 2017 GOP tax law while overhauling several safety-net programs and slashing spending on Medicaid.

Those tax cuts skew toward wealthier income earners. The top 1% would receive a cut three times the size of those with incomes in the bottom 60% of after-tax income, according to analysis from the left-leaning Center on Budget and Policy Priorities. It also makes permanent some tax breaks on business investments and research and development costs.

The package makes substantial changes to Medicaid, including requiring some people on the program to work, participate in community service, or attend an educational program for at least 80 hours a month.

It will block any Medicaid funding from going to Planned Parenthood for one year, essentially requiring enrollees to find other health care options for routine appointments such as cancer screenings, birth control and sexually transmitted infections treatment and screening. Using federal taxpayer dollars for abortion coverage has been restricted for decades, with limited exceptions.

The legislation requires state governments to pay for a portion of the Supplemental Nutrition Assistance Program for the first time if they cannot get error payment rates under a certain percentage. SNAP is the primary federal nutrition program that feeds low-income people and roughly 42 million rely on it.

It bolsters spending on border security and defense by hundreds of billions of dollars, including line items for the “golden dome” missile defense system and additional barriers along the southern border.

The measure would provide a substantial funding increase to federal immigration enforcement for detention and removal of people without permanent legal status, aiding the president in carrying out his campaign promise of mass deportations.

The bill would raise the debt limit by $5 trillion, a figure designed to get Congress past next year’s midterm elections before the country would once again bump up against the borrowing limit.

Protesters milled about and held signs on street corners outside the U.S. Capitol as Republicans worked to pass the megabill. Several spoke out against cuts to Medicaid and SNAP, as well as rollbacks to clean energy tax credits contained in the budget reconciliation package.

Senate turmoil

The House voted 215-214 mostly along party lines to approve the first version of the package in late May.

Senate Republicans spent much of the last month reading through that, trying to determine what proposals their members supported and which elements would need to come out to comply with the strict rules that go along with writing a budget reconciliation bill.

The parliamentarian, that chamber’s referee, continued to issue rulings on whether various policies in the legislation were in bounds for days before the Senate officially began debating the measure and even after they launched into vote-a-rama Monday morning.

That “Byrd bath” process eventually wrapped up, allowing Senate GOP leaders to release updated text of the package shortly before the chamber took its final vote.

Even with near-constant negotiations among Senate Republicans, Senate Majority Leader John Thune, R-S.D., was unable to get everyone on board.

3 Senate Republicans voted no

Maine Sen. Susan Collins, Kentucky Sen. Rand Paul and North Carolina Sen. Thom Tillis opposed the measure, which the Senate approved on Tuesday with Vice President JD Vance casting the tie-breaking vote.

Collins wrote in a statement that while she supported “extending the tax relief for families and small businesses,” her opposition to the legislation “stems primarily from the harmful impact it will have on Medicaid, affecting low-income families and rural health care providers like our hospitals and nursing homes.”

Collins also cited “additional problems” with how the legislation addressed tax credits for certain forms of energy production, which she wrote “should have been gradually phased out so as not to waste the work that has already been put into these innovative new projects and prevent them from being completed.”

Tills spoke about his opposition to the bill’s changes to Medicaid during a floor speech before the Senate’s vote, arguing its cuts to spending to the state-federal health program for low-income people and some people with disabilities weren’t in the best interest of GOP voters.

“I’m telling the president that you have been misinformed,” Tillis said. “You supporting the Senate mark will hurt people who are eligible and qualified for Medicaid.”

Tillis said he supports a policy change in the bill that would require people on Medicaid to work, participate in community service, or attend an educational program. But he was critical of other changes implemented by his Senate colleagues, and announced he won’t seek reelection hours after voting against advancing the package.

“I love the work requirement. I love the other reforms in this bill. They are necessary and I appreciate the leadership of the House for putting it in there,” Tillis said. “In fact, I like the work of the House so much that I wouldn’t be having to do this speech if we simply started with the House mark.”

Paul said he decided to vote against the legislation because it will increase federal deficits during the next few years. 

“To me the most pertinent question is, how will the bill affect the deficit in the next year?” Paul said. “Currently our deficit is estimated to be a little under $2 trillion this year. What will happen to the (deficit) in 2026 if this bill passes? Well, using the math most favorable to the supporters of the bill, referred to as the policy baseline, the deficit in 2026 will still be $270 billion more than this year.”

Paul added “that’s just not good if you profess to be fiscally conservative.”

Republican Sens. John Barrasso of Wyoming, John Thune of South Dakota, Mike Crapo of Idaho and Lindsey Graham of South Dakota speak to reporters after passage of their sweeping tax break and spending cut bill on Tuesday, July 1, 2025. (Photo by Ashley Murray/States Newsroom)

This report has been updated.

WASHINGTON — U.S. Senate Republicans approved their signature tax break and spending cuts package Tuesday with a tie-breaking vote cast by Vice President JD Vance, following days of tense, closed-door negotiations that went until the few last minutes of a marathon amendment voting session.

The 51-50 mostly party-line vote sends the legislation back to the House, where GOP leaders hope to clear the bill for President Donald Trump’s signature this week. But frustrations throughout the conference over changes made in the Senate could delay or even block final approval. 

Republican Sens. Susan Collins of Maine, Rand Paul of Kentucky and Thom Tillis of North Carolina voted against approving the legislation over concerns it would not benefit the country’s finances or Republican voters.

Changes made in final negotiations were not immediately clear or publicly available.

Majority Leader John Thune said the passage marked “a historic day.”

“We’re very excited to be a part of something that is going to make America stronger, safer and more prosperous, and it really starts with the agenda that President Trump laid out when he was running last year.

“He talked about modernizing our military, securing our borders, restoring energy dominance in this country, bringing tax relief to working families and low income taxpayers in this country, and doing something about the runaway, spiraling spending and debt,” the South Dakota Republican said minutes after the vote.

“So this was an incredible victory for the American people, and we as a team are delighted to be a part of it.”

The bill now heads back to the House. The chamber’s Committee on Rules is expected to meet Tuesday afternoon, which will be the final stop for the bill before it reaches the House floor.

Thune said he believes Senate Republicans have given the House “a really strong product.”

“I think we took what they sent us and strengthened and improved upon it. And so I’m hopeful that now, when it gets sent over there, as they deliberate about how they want to handle it, we’ll find the votes that are necessary to pass it and want to put it on the president’s desk,” he said.

Trump praised the Senate’s passage on his Truth Social media platform, saying “Almost all of our Great Republicans in the United States Senate have passed our ‘ONE, BIG, BEAUTIFUL BILL.’”

He added: “We can have all of this right now, but only if the House GOP UNITES, ignores its occasional “GRANDSTANDERS” (You know who you are!), and does the right thing, which is sending this Bill to my desk. We are on schedule — Let’s keep it going, and be done before you and your family go on a July 4th vacation.”

Several House conservatives have railed against the Senate version, including Reps. Andy Ogles of Tennessee, Ralph Norman of South Carolina and others.

House Speaker Mike Johnson issued a joint statement with House Republican leaders saying the chamber “will work quickly to pass the One Big Beautiful Bill that enacts President Trump’s full America First agenda by the Fourth of July. The American people gave us a clear mandate, and after four years of Democrat failure, we intend to deliver without delay.”

“Republicans were elected to do exactly what this bill achieves: secure the border, make tax cuts permanent, unleash American energy dominance, restore peace through strength, cut wasteful spending, and return to a government that puts Americans first,” the Louisiana Republican said in the statement that included House Majority Leader Steve Scalise of Louisiana, Majority Whip Tom Emmer of Minnesota and conference chair Lisa McClain of Michigan.

Alaska Sen. Lisa Murkowski , whose support had been unclear until the vote, and Majority Whip John Barrasso, of Wyoming, left the chamber to catch an elevator together just after 9:30 a.m. Eastern.

Asked if the bill was in the hands of the parliamentarian, Murkowski quipped, “I think it’s in the hands of the people that operate the coffee machine.”

Barrasso said “Yes” when asked if it would pass this morning.

Murkowski: ‘difficult and agonizing legislative 24-hour period’

Flooded by reporters after the vote, Murkowski said “we do not have a perfect bill by any stretch of the imagination.”

“My hope is that the House is gonna look at this and recognize that we’re not there yet, and I would hope that we would be able to actually do what we used to do around here, which is work back and forth in the two bodies to get a measure that’s gonna be better for the people in this country and more particularly, for the people in Alaska,” she said.

“This is probably the most difficult and agonizing legislative 24-hour period that I have encountered, and I’ve been here quite a while, and you all know I’ve got a few battle scars underneath me,” Murkowski added. “But I think I held my head up and made sure that the people of Alaska are not forgotten in this, but I think that there is more that needs to be done, and I’m not done.”

“I am gonna take a nap, though,” she said.

When asked about Murkowski’s decision to vote for the bill, Thune said, “She, as you know, is a very independent thinker and somebody who studies the issues really, really hard and well. And I’m just grateful that at the end of the day, she included what the rest of us did, or at least most of the rest of us did, and that is that this was the right direction for the future of our country.”

Democrats react

Senate Democrats walking off the floor seemed somber, a sentiment that Senate Leader Chuck Schumer said also extended to Republicans after the bill’s passage.

“On the Republican side, when the bill passed, there was a bit of somberness that I don’t think was expected, and that’s because they knew deep in their hearts how bad this bill is for them, their states and the Republican Party,” Schumer said.

“When people start losing their Medicaid, when they start losing their jobs, when their electric bills go up, when their premiums go up, when kids and parents lose SNAP funding, the people of America will remember this vote,” the New York Democrat continued.

Criticism poured in from others as well, including the nonpartisan Committee for a Responsible Federal Budget, which likened the Senate’s bill passage to jumping “off a budget cliff.”

“The level of blatant disregard we just witnessed for our nation’s fiscal condition and budget process is a failure of responsible governing. These are the very same lawmakers who for years have bemoaned the nation’s massive debt, voting to put another $4 trillion on the credit card,” the organization’s president Maya MacGuineas said in a statement.

CRFB estimates the Senate version of the bill would add $600 billion to the national deficit just in 2027.

The nonpartisan Congressional Budget Office released a calculation Sunday showing the bill would add $3.25 trillion to deficits over 10 years.

Trump weighs in ahead of vote

Trump told reporters on Tuesday morning before leaving for a Florida visit to the “Alligator Alcatraz” immigrant detention site that “it’s very complicated stuff” when asked about Senate Republicans’ debate over spending cuts.

“We’re going to have to see the final version. I don’t want to go too crazy with cuts. I don’t like cuts. There are certain things that have been cut, which is good. I think we’re doing well,” Trump said. “We’re going to have to see, it’s some very complicated stuff. Great enthusiasm as you know. And I think in the end we’re going to have it.”

The heart of the nearly 1,000-page legislation extends and expands the 2017 tax law to keep individual income tax rates at the same level and makes permanent some tax breaks on business investments and research and development costs.

The bill would also put in motion some of Trump’s campaign promises, including no tax on qualifying tips, overtime or car loan interest, but only for a few years.

And it slashes spending on the Medicaid program for low-income people and some people with disabilities as well as shifting significant costs of the federal Supplemental Nutrition Assistance Program, or SNAP, to states for the first time. It also overhauls federal education aid.

It would also bolster spending on border security and defense by hundreds of billions of dollars, including line items for the “golden dome” missile defense system and additional barriers along the southern border.

The measure would provide a substantial funding increase for federal immigration enforcement for detention and removal of people without permanent legal status, aiding the president in carrying out his campaign promise of mass deportations.

The Senate version of the bill also would revive the Radiation Exposure Compensation Act fund, a bipartisan measure championed by Sen. Josh Hawley of Missouri. The fund provides money to victims of certain types of cancer and surviving family members in several states affected by the United States atomic bomb testing program and radioactive waste left behind. 

Uranium miners would also be eligible under the measure. While reviving the fund has received wide bipartisan approval in the Senate, the House has not shown the same support.

The Senate bill would raise the debt limit by $5 trillion, a figure designed to get Congress past next year’s midterm elections before the country would once again bump up against the borrowing limit.

On to the House

House approval is far from guaranteed.

Johnson can only lose four Republicans if all lawmakers in that chamber attend the vote. Several GOP members have voiced frustration with how the Senate has reworked the legislation, signaling an uphill climb for the bill.

House Ways and Means Chair Jason Smith said as he left the Senate cloakroom just after 9:20 a.m. Eastern that lawmakers are “getting closer to a bill signing on July Fourth.”

“If you followed this journey over the last six months, over and over, people said that we could not accomplish a budget (reconciliation bill). We did. They said we would never pass it out of the House. We did. The Senate is going to pass it. The House is going to pass it, and the president’s going to sign it into law,” the Missouri Republican said.

Three amendments succeed

The Senate had adopted three amendments to the bill following an all-night amendment voting session, known as a vote-a-rama.

Tennessee Republican Sen. Marsha Blackburn was able to remove language from the package that would have blocked state and local governments from regulating artificial intelligence for five years if they wanted access to a $500 million fund. That vote was 99-1 with only North Carolina’s Tillis voting to keep the language in the package.

Blackburn said the change was necessary because lawmakers in Congress have “proven that they cannot legislate on emerging technology.”

Senators approved an amendment from Iowa GOP Sen. Joni Ernst by voice vote that would disqualify “anyone making a million dollars or more from being eligible for unemployment income support.”

Louisiana Republican Sen. John Kennedy was able to get an amendment adopted by a voice vote that would move up the date when Medicaid administrators must begin checking the Social Security Administration’s death master file to determine if a new enrollee is alive before adding them to the health program. It was set to begin on Jan. 1, 2028, but will now begin one year earlier.

Senators rejected dozens of amendments offered by both Democrats and Republicans, some of which deadlocked on 50-50 votes. Maine’s Collins and Alaska’s Murkowski broke with their party several times to vote with Democrats.

National private school voucher program

Hawaii Democratic Sen. Mazie Hirono tried to eliminate a sweeping private school voucher program that’s baked into the reconciliation package, but that vote failed 50-50. Collins, Nebraska Republican Sen. Deb Fischer and Murkowski voted in support.

The original proposal called for $4 billion a year in tax credits beginning in 2027 for people donating to organizations that provide private and religious school scholarships.

But the parliamentarian last week deemed the program to not comply with the “Byrd Bath,” a Senate process named for the late Sen. Robert Byrd, forcing senators to rework the program.

Details on the finalized version of the program remain unknown as the final bill text has not been released.   

Safety funding for Virginia airport across from D.C.

Virginia Democratic Sen. Mark Warner tried to add language to the bill that would have increased safety funding for airports near Washington, D.C., and established a memorial for the victims who died in a crash this January. The vote failed on a tied 50-50 vote, with Collins, Kansas GOP Sen. Jerry Moran and Murkowski voting with Democrats in support.

“Colleagues, we all know that on January 29 of this year, 67 individuals lost their lives when a military helicopter and a passenger jet collided near Reagan National Airport. This tragedy underscores the need for more safety improvements at National Airport,” Warner said. “The reconciliation bill increases, actually doubles, the amount of rent that National and Dulles pay the government but doesn’t use any of that money to make those airports and the people who use them any safer.”

He argued there was “no good rationale for increasing those rents and not using them for aviation safety.”

Texas Republican Sen. Ted Cruz spoke against Warner’s amendment, saying the rents for the two airports in Virginia near the nation’s capital haven’t been updated in decades.

“The federal government originally calculated the rent in 1987 at $7.5 million dollars, massively below market rates,” Cruz said. “This bill increases that to $15 million, still dramatically below market rates.”

Cruz — chairman of the Committee on Commerce, Science and Transportation — said the legislation includes $12.5 billion for the Federal Aviation Administration to “transform the air traffic control system” and said his panel is looking into the collision in order to prevent something similar from happening again. 

Trump budget director’s office targeted

Maryland Democratic Sen. Chris Van Hollen also got within one vote of having an amendment adopted when he tried to remove a section from the bill that would increase funding for the White House budget office by $100 million.

“This is at a time when (Federal Emergency Management Agency) grants to many of our states have been canceled, grants for law enforcement have been frozen, grants for victims of crimes are on hold,” Van Hollen said. “That is not efficiency. That is creating chaos and uncertainty. And I ask my colleagues, why in the world would we want to send another $100 million to OMB?”

Wisconsin Republican Sen. Ron Johnson opposed the efforts, saying “the Office of Management and Budget needs to identify budgeting and accounting efficiencies in the executive branch. They need the resources to do it.”

The amendment was not added to the bill following another tied 50-50 vote with Collins, Murkowski and Paul voting with Democrats in favor.

Had GOP leadership wanted either of those proposals added to the package, they could have had Vance break the tie, but they did not.

Collins loses vote on rural hospital fund

Maine’s Collins tried to get an amendment added to the legislation that would have increased “funding for the rural health care provider fund to $50 billion dollars and expand the list of eligible providers to include not only rural hospitals but also community health centers, nursing homes, ambulance services, skilled nursing facilities and others.”

Collins said the additional $25 billion in funding for the fund would be paid for by “a modest increase in the top marginal tax rate, equal to the pre-2017 rate for individuals with income above $25 million and married couples with income above $50 million.”

Collins’ amendment was subject to a Senate procedural limit known as a budget point of order. She was unable to get the votes needed to waive that on a 22-78 vote.

Oregon Democratic Sen. Ron Wyden spoke against Collins’ proposal, calling it “flawed,” and introduced the budget point of order against her amendment.

“The danger Senate Republicans are causing for rural hospitals is so great, Republicans have had to create a rural hospital relief fund so they can look like they are fixing the problem they are causing,” Wyden said. “It is a Band-Aid on an amputation. It provides just a tiny fraction of the nearly $1 trillion in cuts the bill makes to Medicaid. It would be much more logical to simply not cut $1 trillion from Medicaid in the first place.”

Collins received a mix of support from Republicans, including West Virginia Shelley Moore Capito, Louisiana’s Bill Cassidy, Utah’s John Curtis, Nebraska’s Fischer, South Carolina’s Lindsey Graham, Missouri’s Josh Hawley, Ohio’s Jon Husted and Bernie Moreno, Mississippi’s Cindy Hyde-Smith and Roger Wicker, Louisiana’s Kennedy, Kansans Roger Marshall and Moran, Kentucky’s Mitch McConnell, Alaskans Dan Sullivan and Murkowski and Indiana’s Todd Young.

Also voting to waive the point of order and move forward with the amendment were Georgia’s Jon Ossoff and Raphael Warnock and Virginia’s Warner, all Democrats, and independent Maine Sen. Angus King. 

Senate Minority Leader Chuck Schumer, D-N.Y., walks back onto the Senate floor after speaking to reporters at the U.S. Capitol Building on June 30, 2025 in Washington, D.C. (Photo by Andrew Harnik/Getty Images)

WASHINGTON — Senate Republicans were closing in Monday on passing their version of the “big beautiful” tax break and spending cut bill that President Donald Trump wants to make law by a self-imposed July Fourth deadline.

But the chamber’s Democrats first kicked off a marathon of amendment votes, forcing their GOP colleagues to go on the record on tough issues, including cuts to health and food safety net programs. As of early evening, Democrats had not prevailed on any votes.

The tactic is used by the opposition party during massive budget reconciliation fights to draw attention to specific issues even as their amendments are likely to fail.

Democrats decried numerous measures in the mega-bill, including new work reporting requirements for Medicaid, the federal-state health insurance program for low-income people and people with disabilities.

Loud opposition has also swelled as legislative proposals shift significant costs of the federal Supplemental Nutrition Assistance Program, or SNAP, to states for the first time.

“I say to our colleagues, ‘Vote for families over billionaires,’” Sen. Amy Klobuchar of Minnesota said on the Senate floor.

The heart of the nearly 1,000-page legislation extends and expands the 2017 tax law to keep individual income tax rates at the same level and makes permanent some tax breaks on business investments and research and development costs.

The bill would also put in motion some of Trump’s campaign promises, including no tax on qualifying tips, overtime or car loan interest, but only for a few years.

The tax cuts are estimated to cost nearly $4.5 trillion over 10 years, and a provision in the bill raises the nation’s borrowing limit to $5 trillion as the United States faces record levels of debt.

Overall, the Senate bill is projected to add $3.25 trillion to deficits during the next decade, according to the latest calculation from the nonpartisan Congressional Budget Office.

Here are some key votes so far:

Planned Parenthood 

Washington Democratic Sen. Patty Murray tried to remove language from the bill that would block Medicaid payments from going to Planned Parenthood for one year unless the organization stops performing abortions.

Federal law already bars funding from going toward abortions, with limited exceptions, but GOP lawmakers have proposed blocking any other funding from going to the organization, effectively blocking Medicaid patients from going to Planned Parenthood for other types of health care.

Murray said the proposal would have a detrimental impact on health care for lower-income women and called it a “long-sought goal of anti-choice extremists.”

“Republicans’ bill will cut millions of women off from birth control, cancer screenings, essential preventive health care — care that they will not be able to afford anywhere else,” Murray said. “And it will shutter some 200 health care clinics in our country.”

Mississippi Republican Sen. Cindy Hyde-Smith opposed efforts to remove the policy change and raised a budget point of order, which was not waived following a 49-51 vote. Maine Republican Sen. Susan Collins and Alaska’s Lisa Murkowski voted with Democrats.

“There was a time when protecting American tax dollars from supporting the abortion industry was an uncontroversial, nonpartisan effort that we could all get behind,” Hyde-Smith said.

Medicaid for undocumented immigrants

Senators from both political parties crossed the aisle over whether the federal government should reduce how much a state is given for its Medicaid program if that state uses its own taxpayer dollars to enroll immigrants living in the country without proper documentation.

The provision was included in an earlier version of the bill, but the Senate parliamentarian ruled it didn’t comply with the complex rules for moving a budget reconciliation bill.

The vote was 56-44, but since it was on waiving a budget point of order, at least 60 senators had to agree to set aside the rules and move forward with the amendment, so the vote failed.

Democratic Sens. Catherine Cortez Masto of Nevada, Maggie Hassan of New Hampshire, and Jon Ossoff and Raphael Warnock of Georgia voted with GOP senators. Maine’s Collins voted with most of the chamber’s Democrats against moving forward.

Texas Republican Sen. John Cornyn asked for the vote, saying he believes the policy change would reduce undocumented immigration.

“Border patrol talks about push and pull factors,” Cornyn said. “One of the pull factors for illegal immigration is the knowledge that people will be able to receive various benefits once they make it into the country.”

Senate Budget Committee ranking member Jeff Merkley, D-Ore., opposed Cornyn’s attempt to get the language back in the bill, saying the policy change would financially harm states that expanded Medicaid under the 2010 health care law for simple mistakes.

“What this amendment says is that if one person, despite state law, through a bureaucratic mistake, is receiving funds, then the whole state pays the price and has their rate on expanded Medicaid changed from 90% to 80%,” Merkley said, referring to the percentage paid by the federal government.

Reduction in funding for Consumer Financial Protection Bureau

An amendment to stop a nearly 50% reduction in funding for the Consumer Financial Protection Bureau was blocked by Republican Sen. Tim Scott of South Carolina, who chairs the Senate Committee on Banking, Housing and Urban Affairs.

Sen. Elizabeth Warren, a Democrat who championed the CFPB after the 2008 financial collapse, attempted to bring the amendment to the floor saying the agency “is the financial watchdog to keep people from getting cheated on credit cards and mortgages and Venmo and payday loans and a zillion other transactions.”

“When this financial cop can’t do its job there is no one else in the federal government to pick up the slack,” Warren said.

Scott blocked her using a budget point of order, saying the reduction still provides “ample funding” for the agency. Democrats tried to waive that procedural tactic, but failed following a 47-53 vote.

An original provision to completely zero out the budget for the CFPB was not included because it did not meet the reconciliation process’ parameters.

Medicaid hospitals and maternal mortality

Senators voted 48-52 to reject Delaware Democratic Sen. Lisa Blunt Rochester’s proposals to send the legislation back to committee to remove language cutting certain funding for Medicaid, which she said would negatively impact “vital hospital services, especially labor and delivery rooms.”

“Today, Medicaid is the single largest payer of maternity care in the United States, covering 40% of births nationwide and nearly half of the births in our rural communities,” Blunt Rochester said. “Obstetric units, particularly in rural hospitals, are closing at alarming rates, actually creating maternity deserts.”

No Republicans spoke in opposition to the proposal, though Maine’s Collins voted in support. 

Supplemental Nutrition Assistance Program

New Mexico Democratic Sen. Ben Ray Luján offered a motion to commit the bill back to committee in order to remove all changes related to the Supplemental Nutrition Assistance Program, or SNAP. It was rejected following a 49-51 vote, though Alaska Republican Sens. Dan Sullivan and Murkowski voted in favor.

“I’m offering my colleagues the opportunity to step away from these devastating cuts, to show our fellow Americans that in this country we care for our friends, family and neighbors who need support,” Luján said.

Senate Agriculture Chairman John Boozman, R-Ark., opposed the proposals, saying that SNAP is “on an unsustainable path wrought with mismanagement and waste.”

“This program has devolved into viewing success as enrolling more individuals to be dependent on government assistance,” Boozman said. “SNAP is long overdue for change.”

Medicaid work requirements

Senators voted 48-52 to reject a proposal from Delaware Democratic Sen. Chris Coons that would have sent the bill back to committee to remove language requiring Medicaid enrollees to work, participate in community service, or attend an educational program at least 80 hours a month. Alaska’s Murkowski was the only member of her party to vote in favor of the effort.

Democrats have expressed concern for weeks that some people would lose access to Medicaid if they forgot to complete paperwork proving that time commitment or didn’t understand how to show the government they met the new requirement.

“It is cruel and dishonest to bury patients, kids and seniors in paperwork and then blame them when they lose their health care, all to further rig our tax code for the very wealthiest,” Coons said.

Kansas Republican Sen. Roger Marshall urged opposition to the proposal, saying that working helps people.

“My question is, don’t you think a job brings value, that it brings dignity?” Marshall said. “Do you not think it brings purpose and meaning to life?”

Rural hospitals and Medicaid

Maine’s Collins and Alaska’s Murkowski both voted for a proposal from Massachusetts Democratic Sen. Ed Markey that would have removed parts of the bill changing Medicaid.

But even with some bipartisan support, the changes were rejected on a 49-51 vote that would have technically sent the bill back to committee for three days to implement the changes.

“My Republican colleagues’ so-called Medicaid cuts replacement fund is like giving aspirin to a cancer patient,” Markey said. “It is not enough. It is pathetically inadequate to deal with the health care crisis Republicans are creating here today on the Senate floor. No billionaire tax break or Donald Trump pat-on-the-back is worth the risk of people’s lives.”

Senate Finance Committee Chairman Mike Crapo, R-Idaho, spoke out against the proposal, saying that rural hospitals have long had financial challenges and that it was clearly “intended to derail this very bill.”

“Unfortunately for far too long some rural hospitals have struggled to achieve financial stability, even with a wide-range of targeted payment enhances,” Crapo said. “These issues pre-date the consideration of the reforms that we are including in the legislation today.” 

Senate Majority Leader John Thune, R-S.D., speaks to reporters as returns to his office from the Senate chamber at the U.S. Capitol Building on June 30, 2025 in Washington, D.C. (Photo by Andrew Harnik/Getty Images)

WASHINGTON — The U.S. Senate launched a marathon amendment voting session Monday during which lawmakers will debate dozens of proposals from Republicans and Democrats that could significantly reshape the “big, beautiful bill” even as a final vote nears.

The vote-a-rama is expected to last throughout Monday and potentially into Tuesday, challenging senators who aren’t accustomed to having to stay on the floor for all hours of the day and night. At the end, the Senate will vote on final passage and if the tax and spending cut bill is successful it will be taken up next in the House, possibly as soon as Wednesday morning.

The first big debate and vote Monday centered around Republicans’ decision to use current policy instead of current law to determine the bill’s fiscal impacts.

Congress has long used current law to determine how much legislation will add or subtract from annual deficits, especially when it comes to the budget reconciliation process that is being used for this bill.

But since Republicans’ 2017 tax law was set to expire at the end of the year, using the current law baseline showed significantly higher deficits than using current policy — which could prove to be a political problem.

The debate, wonky even for the Senate, could have ripple effects in the future, especially if Democrats ever get unified control of government and use the change in process that GOP lawmakers set this time around for their own policy goals.

Budget Chairman Lindsey Graham, R-S.C., said during brief debate before the vote that using current policy would allow the GOP to make many of the tax levels in the 2017 law permanent, instead of having to sunset them to comply with reconciliation rules.

“What I’m trying to do, and I’m very happy about it, is to make sure the tax cuts don’t expire 10 years from now,” Graham said.

Reconciliation bills cannot increase the deficit after the 10-year budget window ends.

Senate Democratic Leader Chuck Schumer of New York spoke out against using current policy over current law, rebuking his Republican colleagues, though his arguments were ultimately unsuccessful. 

“Republicans are doing something the Senate has never done before — deploying fake math, accounting gimmicks to hide the true cost of the bill,” Schumer said. “Look, Republicans can use whatever budgetary gimmicks they want to try to make the math work on paper but you can’t paper over the real-life economic consequences of adding tens of trillions to the debt.”

The nonpartisan Congressional Budget Office released its current law score of the bill on Sunday, showing the legislation would add $3.253 trillion to deficits during the next decade.

Senators voted 53-47 along party lines against overruling Graham’s decision to use current policy.

Narrow majority

Senators spent the next few hours debating Democratic changes to the bill that would have addressed Medicaid and the Supplemental Nutrition Assistance Program. But no Democratic proposals had been adopted as of Monday afternoon and Republicans had yet to start voting on their own amendments.

Once both sides exhaust themselves, the Senate will move on to a final passage vote. With a narrow 53-seat majority, GOP leaders can only afford to lose three members and still have the bill pass with Vice President JD Vance breaking the tie.

Two Republican senators — Thom Tillis of North Carolina and Rand Paul of Kentucky — already indicated they’ll oppose the bill when they voted against advancing it late Saturday night. Altering the bill could cause issues for other senators, making the entire process a headache for GOP leadership.

Senate Majority Leader John Thune, R-S.D., said during a floor speech that the core of the sweeping package is focused on avoiding a cliff created when Republicans approved lower tax rates during President Donald Trump’s first term.

“This is about extending that tax relief so the same people that benefited from it back in 2017 and for the last eight years don’t end up having a colossal, massive tax increase hitting them in the face come January 1,” Thune said.

Schumer sharply criticized the policy changes and spending cuts in the mega-bill, saying they would lead to fewer people being able to access safety-net programs, like Medicaid, which provides health insurance coverage for low-income people and some people with disabilities, and the Supplemental Nutrition Assistance Program, which provides food assistance for low-income people.

“How can any senator go home and tell their constituents, ‘I’m sorry, I took away your health care because I wanted to give tax breaks to billionaires?’” Schumer said. “And yet Republicans are dead set on walking off a cliff by passing a bill they know will be ruinous to their own constituents.”

‘Wraparound amendment’

Depending on how popular an amendment is and exactly what aspects of the legislation it seeks to change, it could increase or decrease the number of GOP senators willing to vote for the final version of the bill.

Republican leaders will want to fend off all Democratic amendments, though if some do get added, Thune can use a procedural tactic called a “wraparound amendment” at the end to cut any problematic changes by wiping out Democratic amendments with a majority vote.

In addition to providing an opportunity for senators to debate nitty gritty policy details, the vote-a-rama serves a political purpose for Democrats, who will try to get at-risk senators to take votes that can then be used during the midterm elections to try to sway voters. 

Those amendments will mostly focus on Maine’s Susan Collins after North Carolina’s Tillis announced his retirement Sunday.

While Democrats have more incentive for so-called “gotcha amendments” since they’re trying to flip the Senate from red to blue, GOP leaders may also bring up amendments challenging vulnerable Democratic senators, like Georgia’s Jon Ossoff.

And since the opportunity to put up as many amendments as a senator pleases is rare, both Democrats and Republicans may have an eye on purple-state lawmakers up for reelection in 2028. 

U.S. Sen. Josh Hawley, R-Mo., talks to reporters at the U.S. Capitol on Saturday, June 28, 2025. Hawley said he will vote for the budget reconciliation measure after a rural hospital fund was added. (Photo by Ashley Murray/States Newsroom)

This report has been updated.

WASHINGTON — The U.S. Senate voted mostly along party lines late Saturday night to move forward with Republicans’ “big, beautiful bill” that President Donald Trump wants on his desk in less than a week, after a dramatic three-hour pause when several GOP senators withheld their votes.

Republican Sens. Thom Tillis of North Carolina  and Rand Paul of Kentucky voted against moving forward with the sweeping tax break and spending cuts package that contains many of the GOP’s campaign promises. All Democrats were opposed. Vice President JD Vance came to the Capitol in case a tie-breaking vote was required, but in the end was not needed.

Tillis, who is up for reelection in 2026, had told reporters earlier that he would vote “no” on what is called a motion to proceed and on final passage. 

He said in a statement the legislation would result in tens of billions of dollars in lost funding for North Carolina and force the state to make “painful decisions” about Medicaid. Trump in a post on social media later threatened to find primary candidates to challenge Tillis.

The 51-49 vote doesn’t guarantee the bill will make it through a final passage vote but does make it significantly more likely, even with Republicans’ narrow 53-47 majority.

The procedural vote kicked off a maximum of 20 hours of floor debate on the bill, with half of that time controlled by Democrats and the other half by Republicans — though Democrats after the motion to proceed vote forced a reading of the giant bill expected to take as long as 15 hours. That would mean floor debate would not begin until sometime Sunday.

Unlike regular bills, budget reconciliation packages are not subject to the Senate’s 60-vote legislative filibuster, so as long as at least 50 Republicans support the package, and Vance casts the tie-breaking vote if needed, the measure will go back to the House.

The vote on the motion to proceed that began at about 7:30 p.m. Eastern was held open for more than three hours, with the votes of four senators in suspense — Lisa Murkowski of Alaska, Mike Lee of Utah, Cynthia Lummis of Wyoming and Rick Scott of Florida. All four eventually voted aye and Wisconsin Sen. Ron Johnson switched his vote to aye after earlier voting against the measure.

Lee, however, just before the vote was over, announced he had pulled from the bill an extremely controversial proposal to sell some public lands that was opposed by other lawmakers from the West. He said because of the process being used for the bill, he was unable to obtain enforceable safeguards to ensure the land would be sold to American families and not China or foreign interests.

The latest version of the measure had set up the Interior Department to sell at least 600,000 acres of public land and up to 1.2 million acres of public land within 10 years, advocates said.

Critics, including hunters, anglers and other Western state constituents, have ripped the measure as a “land grab,” as put by Jennifer Rokala, executive director for the Center for Western Priorities.

A summary of the provisions by the Energy and Natural Resources Committee said the Bureau of Land Management “must sell a minimum of 0.25% and a maximum of 0.50% of their estate for housing and associated community needs. This will increase the supply of housing and decrease housing costs for millions of American families.”

Golfing with Trump

Senate GOP leaders released new bill text just before midnight Friday that satisfied rural state lawmakers’ worries about financial threats to rural hospitals posed by cuts in Medicaid. The bill also addresses concerns by Murkowski and Dan Sullivan of Alaska about access to food assistance for their constituents despite new restrictions on a USDA program for low-income people.

As talks continued on Capitol Hill Saturday afternoon, a handful of Senate Republicans, including Missouri’s Eric Schmitt and Lindsey Graham of South Carolina, were on the golf course with Trump, according to the White House. Graham said on social media that Kentucky’s Paul also played.

Senate Democrats said a fresh financial analysis from the nonpartisan Congressional Budget Office estimated the preliminary Senate text would result in $930 billion in cuts to Medicaid, the joint federal-state low-income health insurance and disability assistance program.

The CBO score was not yet publicly available but Sen. Ron Wyden, the top Democrat on the Senate Committee on Finance, pointed to it and slammed the Medicaid provisions as “cruel” in a statement Saturday afternoon. 

Sen. Elizabeth Warren of Massachusetts, ranking Democrat on the Senate Banking, Housing, and Urban Affairs Committee, also cited the preliminary analysis, pointing to the nearly $1 trillion in Medicaid cuts.

Collins promises amendments

Senate Republicans planned to take their negotiations to the floor and push for amendments after the procedural vote that triggered official debate on the bill, which in its current public version runs 940 pages.

GOP Sen. Susan Collins of Maine, who voiced concerns throughout negotiations about rural hospitals and health cuts that would harm low-income individuals, said her vote on the motion to proceed “does not predict my vote on final passage.”

“I will be filing a number of amendments,” she told reporters as she headed into a closed-door working lunch before the Senate convened at 2 p.m. Eastern.

While Sen. Tim Sheehy wrote on social media Saturday afternoon that he was a “no” on the motion to proceed because of a provision to sell off federal public lands, the Montana Republican changed his mind nearly an hour later and declared he would propose an amendment to strip the provision — which was later removed by its sponsor.

GOP Sen. Markwayne Mullin of Oklahoma painted somewhat of a rosier picture of the mood in the Senate, telling reporters “we’re good.”

“We won’t bring it to the floor if we don’t have the votes,” said Mullin, who was the lead negotiator with House Republicans on state and local tax deductions, or SALT — a sticking point for Republicans who represent high-tax blue states like New York and California.

The lawmakers settled on a $40,000 deduction through 2029 for taxpayers who earn up to $500,000 annually. The level then reverts to $10,000, the current limit under the 2017 tax law.

Medicaid turmoil

Proposed changes to Medicaid have been strongly resisted by rural medical providers who say they are already financially strapped.

Missouri Republican Sen. Josh Hawley told reporters Saturday he would be a “yes” on both the motion to proceed vote and the final bill based on the new rural hospital “transformation program” Senate leadership included in the bill overnight. The measure has yet to be finalized.

The bill’s new version includes $25 billion in a stabilization fund for rural hospitals from 2028 through 2032. The amount is frontloaded to give more of the funds in the first two years.

Critics warn that amount will not fill the financial gaps that rural medical providers will face from losing a sizable portion of federal funding via Medicaid cuts.

While Hawley called the fund a “win” for Missouri over the next several years, he said his party needs to do some “soul searching” over the “unhappy episode” of wrangling over Medicaid cuts.

“If you want to be a working-class party, you’ve got to deliver for working-class people. You cannot take away health care for working people,” he said.

Senators had not yet agreed on other Medicaid provisions as of Saturday afternoon, including a phase-down of the provider tax rate from 6% to a possible 3.5% that’s become hugely controversial.

States use a combination of general revenues, provider tax revenues and in some cases local contributions to fund their Medicaid programs.

Advocates warn that it’s not a guarantee states would be able to backfill the lost revenue, and if they can’t, provider rate cuts and losses of benefits for patients could be on the horizon.

The nonpartisan Congressional Budget Office found that the House version’s provider tax changes — not as deep as the current Senate proposal — could lead to 400,000 people losing Medicaid benefits.

A full and final financial score for the Senate bill is not yet out as the several provisions remain up in the air.

Hawley also praised the inclusion of the Radiation Exposure Compensation Act fund, or RECA, that revives payments for survivors and victims who suffered cancer as a result of U.S. atomic bomb testing and radioactive waste dumps.

Clean energy tax credits

In what clean power advocates dubbed a “midnight dumping,” Senate GOP leadership added language to accelerate the phase out of clean energy tax credits that were enacted under Democrats’ own massive mega-bill in 2022 titled the “Inflation Reduction Act.”

The language, which wasn’t yet finalized by Senate GOP tax writers as of 6 p.m. Eastern Saturday, tightened restrictions on foreign components in wind and solar projects — and added a new tax on those that don’t comply.

Senators largely targeted wind and solar credits, ending them for projects not plugged into the electricity grid by 2028. Additionally credits for wind turbine manufacturers would terminate in 2028.

Other tax credits would be phased out at a faster pace, including those for the production of critical minerals, though a credit for metallurgical coal, used in steelmaking, was added in.

Clean energy industry manufacturers and small businesses had hoped Senate Republicans would ease up rollbacks in the House version.

Kurt Neutgens, president and chief technology officer of Orange EV, told States Newsroom in an interview Friday that any further rollbacks would amount to “cutting our legs out from underneath us.”

Neutgens, whose Kansas City, Kansas-based company manufactures heavy duty electric trucks and chargers, was watching for changes to credits to the commercial clean vehicles credit. New Senate GOP text would terminate the credit in September of this year.

Jason Grumet, president of the Clean Power Association, said in a statement Saturday that imposing new taxes on the industry “will strand hundreds of billions of dollars in current investments, threaten energy security, and undermine growth in domestic manufacturing and land hardest on rural communities who would have been the greatest beneficiaries of clean energy investment.”

Alaska carve-outs

Proposed cuts to federal food assistance remained largely unchanged in the new text released Friday night except for a few carve-outs for Alaska.

If the bill were enacted as written, Alaska’s state government could request a waiver for its citizens from stricter work reporting requirements that critics say will result in some SNAP recipients losing their food benefits.

GOP lawmakers also slightly shifted the timeline for when states will have to begin shouldering SNAP costs — the first time states will be on the hook for the federal food assistance outside of administrative costs.

States would be required to pick up a portion of the costs depending on their “payment error rate” — meaning how accurate states are at determining who needs SNAP, including both overpayments and underpayments.

States that have error rates at 6% or above would responsible for up to 15% of the food program’s cost. According to SNAP error rate data for 2023, the latest available, only seven states had an error rate below 6%.

The new text delays the cost-sharing for states until 2028 and allows states to choose the lesser of their two error rates in either 2025 or 2026.

Starting in 2029, states will be required to use their error rate from three years prior to the current year.

The new text includes the option for Alaska and Hawaii to waive their cost share burden for up to two years if their governments implement an improvement plan. In 2023, Alaska had the highest payment error rate of all states, reaching just above 60%. 

Advocates for low-income families worry the cost, which will amount to billions for most state governments, will incentivize states to tighten eligibility requirements for the program, or even drop SNAP altogether.

The left-leaning Center on Budget and Policy Priorities estimates the cuts will affect up to 40 million people who receive basic SNAP assistance, including 16 million children and 8 million seniors.

The Senate bill would also increase a state’s share of administrative costs for the program to 75%, up from the previous 50% cost-sharing responsibility with the federal government.

Despite inaccurate public statements from Republicans as recently as in a bill summary released overnight, the bill does nothing to limit food assistance to immigrants without documentation because SNAP was never available to them.

SNAP benefits will remain available to legal permanent residents, and Republicans loosened some language to allow certain immigrants from Cuba or Haiti to access the program.

But if the bill passes, federal food assistance will not be available to refugees and asylees who are already in the U.S. — for example, people from Afghanistan, Ukraine and other war-torn places.

Education revisions

Republicans on the Senate Committee on Health, Education, Labor and Pensions revised or scrapped several measures that the parliamentarian deemed to not comply with the “Byrd Bath,” a Senate process named for the late Sen. Robert Byrd, according to a summary and new bill text out Friday.

Under the revised text, for any loans made starting July 1, 2026, borrowers will have only two repayment plan options: a standard repayment plan and an income-driven repayment plan. The original proposal would have applied these restrictions to existing borrowers, but the parliamentarian struck that down.

Republicans also nixed a proposal that opened up the Pell Grant — a government subsidy that helps low-income students pay for college — to institutions that are not accredited.

The new plan also scraps a restriction that barred payments made by students enrolled in a medical or dental internship or residency program from counting toward Public Service Loan Forgiveness.

‘Even worse than any draft’

Senate Democrats remain united in opposition to the bill and are expected to slow down final passage by introducing numerous amendments on the floor during what is called the vote-a-rama.

Senate Minority Leader Chuck Schumer continued to rally against the package during remarks on the Senate floor Saturday afternoon, saying it’s “hard to believe this bill is worse — even worse — than any draft we’ve seen this far.”

The New York Democrat said “it’s worse on health care, it’s worse on SNAP (the Supplemental Nutrition Assistance Program), it’s worse on the deficit.”

Schumer added that “if Republicans proceed, Senate Democrats will hold them to account.”

“We’ll gear up for another night of vote-a-rama very soon. We’ll expose this bill piece by piece. We will show how it cuts health care, raises costs, rewards the ultra rich.”

The Center on Budget and Policy Priorities condemned the cuts to safety net programs as “all in service to tax cuts that are heavily skewed toward the wealthy and corporations.”

“None of this harm has anything to do with fiscal responsibility: our deficits and debts would soar under this bill,” said Sharon Parrott, the think tank’s president, in a statement Saturday.

The Committee for a Responsible Federal Budget, a nonpartisan watchdog, released a new analysis Saturday finding the Senate version will add roughly $4 trillion to the national deficit over 10 years.

“If you thought the House bill borrowed too much — and it did — the Senate manages to make things even worse,” CRFB’s president Maya MacGuineas said in a statement.

House action

Senate Republicans have spent more than a month rewriting the bills that make up the measure in order to meet the strict rules for moving a budget reconciliation package and to earn support from enough Republicans to actually pass the legislation.

The lawmakers have been struggling to maintain spending cuts passed by House Republicans that will pay for the nearly $4 trillion price tag for extending and expanding the 2017 tax cuts.

The House voted 215-214 to approve its 11-bill version of the package in May. Many of that chamber’s GOP lawmakers hoped the Senate wouldn’t change much, though that hasn’t been the case.

The Senate has modified numerous proposals, including those addressing tax law; Medicaid; and SNAP. The Senate bill also raises the country’s debt limit by $5 trillion, a full $1 trillion more than the House version.

The revisions have led to concerns among both centrist House GOP lawmakers and far-right members of the party, muddying the waters around whether Speaker Mike Johnson, R-La., can cobble together the votes needed to clear the package for Trump’s signature.

Republicans hold a 220-212 majority in the House, so leaders there can only lose four members if all of the chamber’s lawmakers are present and voting.

Trump has encouraged Congress to approve the legislation before the Fourth of July, but with time running short and some tempers rising over how the legislation will impact the country’s deficits, that might not be possible.

“The Great Republicans in the U.S. Senate are working all weekend to finish our ‘ONE, BIG, BEAUTIFUL BILL’,” Trump posted on social media Friday.

“The House of Representatives must be ready to send it to my desk before July 4th — We can get it done,” he added. “It will be a wonderful Celebration for our Country, which is right now, ‘The Hottest Country anywhere in the World’ — And to think, just last year, we were a laughingstock. Thank you for your attention to this matter!”

U.S. Senate Majority Leader John Thune, R-S.D., left, listens as Sen. Mike Crapo, R-Idaho, speaks to reporters outside of the West Wing of the White House on June 4, 2025 in Washington, D.C.  after a meeting with President Donald Trump. (Photo by Anna Moneymaker/Getty Images)

This report has been updated.

WASHINGTON — President Donald Trump on Thursday told his supporters to call members of Congress and lobby them to support the “big, beautiful bill,” a crucial push with just days to go before a self-imposed Fourth of July deadline.

Trump’s plea follows several tumultuous days on Capitol Hill as GOP leaders struggled to find consensus on multiple policy disagreements, especially after the parliamentarian ruled core elements of the package don’t meet the complex rules for moving a budget reconciliation bill.

Trump during an event in the White House’s East Room that was attended by several GOP lawmakers also cautioned Republicans against voting down the tax and spending cut package.

“We don’t want to have grandstanders,” Trump said. “Not good people. They know who I’m talking about. I call them out. But we don’t need grandstanders. We have to get our country back and bring it back strong.”

Some Republican senators remain optimistic they can work through the weekend and that the House votes will come together next week, despite growing opposition from members in that chamber.

Sen. Eric Schmitt said he doesn’t think the parliamentarian’s rulings will delay the votes “outside the weekend window, which has been the goal all the time.”

“We’re probably voting into the weekend, though. That’s probably my guess — Saturday and I suppose even Sunday — but, that’s the goal, I don’t think that materially changes too much,” the Missouri Republican said.

Senate Majority Leader John Thune, R-S.D., however, appeared a bit less definite, telling reporters in the afternoon that he didn’t know when the chamber would take the procedural vote that kicks off floor consideration.

“I’ll get back to you on that,” he said.

Medicaid provisions tossed

Earlier Thursday, Senate Republicans suffered a significant setback when the parliamentarian ruled several changes to Medicaid in the bill don’t comply with the rules, which means billions of dollars in savings are no longer available for the GOP to offset the cost of tax cuts.

Finance Committee Chairman Mike Crapo. R-Idaho, must rework or completely eliminate nine changes the committee proposed to the health care programs, though more of the panel’s proposals are still under review.

Republicans can no longer reduce the amount of federal matching funds for state governments that use their own tax dollars to provide Medicaid coverage for immigrants in the country without proper documentation.

The GOP bill cannot bar gender-affirming care for Medicaid patients.

And Republicans need to change or scrap a proposal to reduce states’ Medicaid provider tax credits, an issue that is relatively in the weeds of health care policy but has sharply divided the GOP and drawn fierce opposition from states.

The changes or eliminations will have a major impact on how much in savings the GOP tax and spending cut bill will generate during the next decade and will likely make the overall package’s deficit impact higher than before. The legislation is intended to extend the 2017 tax cuts and make spending reductions.

The ruling might make it more difficult for Trump and GOP leaders in Congress to get the votes needed to pass the bill at all, let alone before their self-imposed Fourth of July timeline. Senate GOP leaders had said they wanted to begin procedural votes as soon as Friday.

The measure already had been stuck on Wednesday amid growing disputes over how Medicaid changes will impact rural hospitals and far more.

Democrats to continue scrutinizing bill

Senate Budget Committee ranking member Jeff Merkley, D-Ore., who released the parliamentarian’s rulings, wrote in a statement that Democrats will continue to advocate for removing dozens of proposals from the bill that they believe don’t meet reconciliation rules.

“Republicans are scrambling to rewrite parts of this bill to continue advancing their families lose, and billionaires win agenda, but Democrats stand ready to fully scrutinize any changes and ensure the Byrd Rule is enforced,” Merkley wrote.

A staffer, who was granted anonymity to discuss the chairman’s plans, said the Finance Committee will “rework certain provisions to address the Byrd guidance and be compliant with reconciliation.”

The Byrd rule, named for former West Virginia Sen. Robert Byrd, includes several guardrails for reconciliation bills.

Finance Committee ranking member Ron Wyden, D-Ore., wrote in a statement that the parliamentarian’s ruling will lead to “more than $250 billion in health care cuts removed from the Republicans’ big bad bill.

“Democrats fought and won, striking health care cuts from this bill that would hurt Americans’ walking on an economic tightrope. This bill is rotten to its core, and I’ll keep fighting the cuts in this morally bankrupt bill until the end.”

The parliamentarian is still deciding whether several health provisions meet reconciliation rules, including language that would block all Medicaid funding from going to Planned Parenthood, effectively blocking Medicaid patients from visiting the organization for routine health services.

Federal law already bars funding for abortions with exceptions for rape, incest, or the life of the pregnant patient.

The parliamentarian will also decide later whether Republicans’ bill can block the Department of Health and Human Services from implementing a Biden-era rule that would require nursing homes to have a nurse working 24 hours a day, seven days a week.

Higher ed provisions axed

The parliamentarian also struck down several attempts from congressional Republicans to overhaul the higher education system.

GOP lawmakers cannot streamline student loan repayment options for current borrowers to just a standard repayment plan or an income-driven repayment plan, making such restrictions apply to only new borrowers.

Republicans have to nix a proposal that opened up the Pell Grant — a government subsidy that helps low-income students pay for college — to institutions that are for-profit and not accredited.

The parliamentarian scrapped a proposal that would have barred payments made by students enrolled in a medical or dental internship or residency program from counting toward Public Service Loan Forgiveness.

The federal program eliminates remaining debt for borrowers when meeting certain requirements, including working for a qualified employer within the government or nonprofit sector.

The parliamentarian rejected GOP lawmakers’ proposal to end federal student aid eligibility for certain immigrants who are not U.S. citizens.

‘Too many Medicaid cuts’

Missouri Republican Sen. Josh Hawley said the parliamentarian’s ruling on the Medicaid provider tax rate will give lawmakers “a chance to get it right.”

“This is a chance for the Senate to fix a problem that they created and not defund rural hospitals,” Hawley said, later adding he supports the House language that would freeze the rate at 6% instead of decreasing it to 3.5% over several years. 

Hawley said hours before Trump’s event that he expects the president to get more involved in negotiations now that he’s back from a NATO conference in Europe and said Trump was in a “terrific mood” during a recent phone call.

“I think he wants this done. But he wants it done well. And he does not want this to be a Medicaid cuts bill,” Hawley said. “He made that very clear to me. He said this is a tax cut bill, it’s not a Medicaid cuts bill. I think he’s tired of hearing about all these Medicaid cuts, you know. As am I. It’s because there are too many Medicaid cuts.”

Louisiana Republican Sen. Bill Cassidy early Thursday night called on leaders to put the House’s language regarding Medicaid back into the bill, wiping out changes made by the Finance Committee.

“My position is that cuts, and especially drastic cuts, to Medicaid have to be avoided. The Senate bill cuts Medicaid too much,” the influential chairman of the Health, Education, Labor and Pensions Committee wrote in a social media post. “I agree with President Trump, the House version is better.”

SNAP cuts

The Agriculture Committee also is reworking parts of its bill, some being closely watched by states, to meet the rules that govern reconciliation.

Committee Chairman John Boozman, R-Ark., said he expects to hear from the parliamentarian before the end of Thursday about whether a revised state cost share provision for the Supplemental Nutrition Assistance Program that’s based on error rate payments will be in the final bill.

“It was thrown out the first time, so we actually gave her revised text. If she rules the revised text is fine, then we’ll release it,” Boozman said.

The committee released a statement later in the day announcing the parliamentarian had cleared the revised state cost share for SNAP that’s based on a state’s error payment rate.

States that have SNAP error payment rates higher than 6% will have to contribute some of the cost of the program. The updated proposal will give states the option of choosing between fiscal 2025 and fiscal 2026 to determine their match, which will begin during fiscal 2028. After that, a state’s match will be determined by its error payment rate for the last three fiscal years. 

State and local tax, ‘revenge tax’

Senate Republicans also remained stuck on finding a deduction level for state and local tax, or SALT, that passes muster with House Republicans who represent high-tax blue states.

The House version would allow taxpayers making under $500,000 to deduct up to $40,000 in SALT from their federal tax bill. Both the $40,000 cap and the $500,000 income threshold will increase annually at 1% until hitting a ceiling of $44,000 and $552,000. The deduction cap phases down for higher earners.

Senate Republicans and the White House sought to lower the income threshold but were shot down Thursday by House Republicans, according to multiple reports.

Sen. Markwayne Mullin of Oklahoma, the lead negotiator on SALT for Senate Republicans, said he remained optimistic.

“We’re gonna be in a good spot. We’re gonna find a landing spot,” Mullin said.

A Senate Finance Committee spokesperson declined to comment on current negotiations, including any proposed income level changes.

Treasury Secretary Scott Bessent also weighed in on another tax provision: the so-called “revenge tax” on investments from countries whose trade policies the president views as unfair to U.S. businesses.

Bessent asked lawmakers to remove the up to 20% tax from the mega-bill following an agreement made with G7 partners, he wrote on social media.

“This understanding with our G7 partners provides greater certainty and stability for the global economy and will enhance growth and investment in the United States and beyond,” Bessent said.

The retaliation tax would have raised roughly $116 billion over 10 years, according to the Committee for a Responsible Federal Budget.

Timing on votes

Republican lawmakers don’t have much time left to rework all of the ineligible provisions, clear them with the parliamentarian, read through final bill text, slog through a marathon amendment voting session in the Senate and then move the bill through the House before their self-imposed deadline.

White House press secretary Karoline Leavitt said during a briefing before Trump’s event that the president is “adamant” Congress must pass the “big, beautiful bill” within the next week, despite the latest ruling.  

“We expect that bill to be on the president’s desk for signature by July Fourth. I know there was a ruling by the Senate parliamentarian this morning,” Leavitt said. “Look, this is part of the process, this is part of the inner workings of the United States Senate. But the president is adamant about seeing this bill on his desk here at the White House by Independence Day.” 

The Downtown Children's Center in St. Louis. (Photo by Rebecca Rivas/Missouri Independent.) 

WASHINGTON — Republicans and Democrats on a U.S. House Education and Workforce subcommittee agreed at a Tuesday hearing that child care affordability was a problem, but proposed different solutions.

While Republicans touted a longstanding block grant and called for choice and flexibility in the child care system, Democrats pushed for more federal investments, including legislative efforts that would cap the cost of child care.

For just one child, families spend between 8.9% and 16% of the median family income on full-day care, according to Department of Labor data from 2022.

“Child care is essential to helping working parents thrive and our local economies grow,” Rep. Kevin Kiley, chair of the U.S. House Subcommittee on Early Childhood, Elementary and Secondary Education, said at the panel’s hearing.

“At the same time, child care can be exceedingly expensive — the cost is only climbing,” said the California Republican, whose panel is part of the House Committee on Education and Workforce.

Kiley said the Child Care and Development Block Grant “exists to help working families access affordable child care, giving them the freedom to remain in the workforce and increase their economic opportunity, one solution to the problem of child care affordability and access.”

The grant, funded at roughly $8.75 billion in fiscal 2024, goes to states, tribes and territories to help low-income working families access child care.

Kiley noted that “choice” is a program pillar, “giving parents the freedom to make both lifestyle and economic decisions that best meet their individual family’s needs.”

Caitlin Codella Low, managing director of human capital at the Bipartisan Policy Center, a Washington, D.C., think tank, noted that annually, “the average cost of child care exceeds $10,000 per child, and it’s more than public college tuition in most states, more than the cost of rent in all 50.”

“Employers are paying the price — child care challenges lead to higher absenteeism, lower retention and difficulty recruiting talent,” she added.

Local programs

Todd Barton, the mayor of Crawfordsville, Indiana, highlighted his community’s efforts in addressing a shortage of affordable, high-quality child care.

Barton said that shortage has “deeply affected” the community’s workforce and economic potential.

Some of those efforts include the formation of a child care task force that evolved into an early childhood coalition, a full-day summer program for school-aged children and an early learning center that Barton said has already increased the community’s child care capacity by more than 30%.

Barton said that “to sustain this scale of work, we need strong federal support,” noting that “programs like the Child Care (and) Development Block Grant and Employer-Provided Child Care Credit are essential tools that we need at our disposal.”

Dems blast cuts

Rep. Suzanne Bonamici, ranking member of the subcommittee, said that “without bold and sustained federal investment, child care costs will continue to rise and the workforce that provides the care will continue to struggle.”

The Oregon Democrat blasted the proposed cuts to Medicaid and the Supplemental Nutrition Assistance Program, or SNAP, as part of congressional Republicans’ reconciliation package.

Bonamici described Medicaid and SNAP as “programs that support children, families, child care centers and the child care workforce.”

She also highlighted the Child Care for Working Families Act, which Virginia’s Rep. Bobby Scott, ranking member of the full committee, and Sen. Patty Murray of Washington state, reintroduced in their respective chambers during the previous session of Congress.

Bonamici said the bill “would cap the cost of child care at 7% of income, making it affordable for all parents and also provide historic investments in the child care workforce, including higher pay, better benefits and improved training opportunities.”

Meanwhile, the Trump administration has made sweeping cuts within the Department of Health and Human Services’ Administration for Children and Families.

The administration reportedly closed down at least five Office of Head Start regional offices earlier this year.

Ruth Friedman, a senior fellow at The Century Foundation, a progressive think tank, said “we are already seeing very bad impacts from those closings.”

She added that “local programs are not getting the support and the answers they need, grants are coming slowly to them, which is very, very problematic in Head Start, because they really work month-to-month with their budget and lost an enormous amount of expertise on the local needs those programs serve.”

Rep. Summer Lee also called for more federal investment in child care, saying “existing programs are, quite frankly, not cutting it.”

“We know that for every dollar we invest in early childhood education, we save substantially more on services that children won’t need as they grow up,” the Pennsylvania Democrat said.

She called for passage of the Scott-Murray bill, as well as a measure that would guarantee universal child care access.

“This is why we need to pass the Democrats’ legislation like the Child Care for Every Community Act and Child Care for Working Families Act, which I’m looking forward to introducing with Ranking Member Scott in the near future.” 

House Speaker Mike Johnson of Louisiana speaks to reporters about the Republican budget reconciliation package at a weekly press conference on Tuesday, June 24, 2025, at the U.S. Capitol. (Photo by Ashley Murray/States Newsroom)

This report has been updated.

WASHINGTON — U.S. Senate Republicans were scrambling Tuesday to restructure several proposals in the “big, beautiful bill” that don’t meet their chamber’s strict rules for passing a reconciliation package, while GOP lawmakers on the other side of the Capitol warned those changes may doom its passage in the House.

Senate Majority Leader John Thune, R-S.D., said he and several others are working on a way to bolster rural hospitals, which could experience financial strain as a result of the various changes to Medicaid and other health care programs in the package.

“We are working on a solution for rural hospitals and that’s something that’s been in the works now for several days in response to a number of concerns that our colleagues have mentioned in ensuring that the impact on rural hospitals be lessened, be mitigated,” Thune said. “And I think we’re making good headway on that solution.”

Thune said GOP lawmakers shouldn’t let the “perfect be the enemy of the good,” though he predicted there “could be” two or three Republicans who vote against the package.

“We’ve got a lot of very independent-thinking senators who have reasons and things that they’d like to have in this bill that, in their view, would make it stronger,” Thune said. “But at the end of the day this is a process whereby not everybody is going to get what they want. And we have to get to 51 in the United States Senate.”

More objections to Medicaid cuts

Missouri Sen. Josh Hawley, who has been vocal about Medicaid changes and rural hospitals, said he had “no details whatsoever” about the rural hospital fund or how it would work if it’s added to the bill.

But he said he’s not going to support a bill that takes away working people’s health care.

“We’ve got 1.3 million people on Medicaid in Missouri, hundreds of thousands of kids. That’s 21% of my population. Most of these people are working people. They’re on Medicaid, not because they’re sitting around at home; they’re on Medicaid because they don’t have a job that gives them health care and they cannot afford to buy it on the exchange,” Hawley said. “They don’t want to be, but it’s their only option. And I just think it’s wrong to take away health care coverage from those folks. Now if they’re not working, then sure, they should be.”

Senate Republican Policy Committee Chair Shelley Moore Capito, R-W.Va., said she had a “lengthy discussion” with her home state’s hospital association earlier in the day.

“This has a lot of impacts and we want to make sure we have a lot of rural hospitals. That’s why this rural hospital fund idea is developing,” Capito said. “I don’t think anything is set yet but that is an issue. I think Medicaid, we need to preserve it for the people it’s intended for and get rid of the people who don’t deserve it and don’t qualify and are bilking the system.”

Capito said she hadn’t yet formed an opinion on the rural hospital fund since there isn’t yet a formal proposal written down.

Public lands

In one major development, the Senate parliamentarian ruled Monday that a controversial provision championed by Senate Energy and Natural Resources Chairman Mike Lee to mandate the sale of at least 2 million acres of public lands in 11 Western states did not comply with the chamber’s rules for reconciliation.

Lee, a Utah Republican, has said the provision would free up land to build new housing. But Democrats and some Republicans from the affected states strongly opposed it.

Lee said on social media Monday evening that he was working to rewrite the proposal to comply with reconciliation rules. A spokesperson for his office did not return a message seeking comment Tuesday morning.

SNAP cost-sharing under debate

In another turn of events, Senate Agriculture Chairman John Boozman, R-Ark., earlier Tuesday had announced the panel successfully reworked a provision that would transfer some of the cost of the Supplemental Nutrition Assistance Program to state governments.

But a spokesperson for the panel said later that the parliamentarian actually has not yet made a ruling. The spokesperson said “we’ve gotten some clarification from leadership and it’s steering in the direction it would be compliant but not official.”

Boozman earlier had said his proposal would improve SNAP. “Our commonsense approach encourages states to adopt better practices, reduce error rates, be better stewards of taxpayer dollars, and prioritize the resources for those who truly need it,” Boozman wrote in a statement.

The new language, if accepted, would give states the option of selecting fiscal year 2025 or 2026 as the year that the federal government uses to determine its payment error rate for SNAP, which will then impact how much of the cost the state has to cover starting in fiscal year 2028. Afterward, a state’s payment error rate will be calculated using the last three fiscal years.

Any state with an error rate higher than 6% will have to cover a certain percentage of the cost of the nutrition program for lower income households.

Rushing toward deadline

The internal debates among lawmakers about how to rewrite major pieces of the tax and spending cuts package have led to a rushed feeling among Republican leaders, who have repeatedly promised to approve the final bill before the Fourth of July — an exceedingly tight timeline.

Speaker Mike Johnson, R-La., said during a press conference shortly after a closed-door House GOP conference meeting Tuesday that he’s hopeful the final bill that comes out of the Senate won’t make too many changes to what the House approved earlier this year.

“I remain very optimistic that there’s not going to be a wide chasm between the two products — what the Senate produces and what we produce,” Johnson said. “We all know what the touchpoints are and the areas of greatest concern.”

Republicans, he said, know they need to focus on preserving a fragile compromise on the state and local tax deduction, or SALT, that helps offset the cost of living in some higher-tax states like California, New Jersey and New York.

A deal Johnson brokered with GOP lawmakers in the SALT Caucus has been significantly rewritten in the Senate, but is expected to move back toward the House version, though not entirely.

Johnson also mentioned GOP efforts to roll back certain clean-energy provisions that Democrats approved and President Joe Biden signed into law in their signature climate change, health care and tax package, called the Inflation Reduction Act, or IRA, in 2022.

“We’ve got to get the SALT negotiation number right. We’ve got to make sure the IRA subsidies are handled in an appropriate manner,” Johnson said. “Look, you’ve got a number of provisions.”

Johnson said he expects the Senate to vote on its final bill by Friday or Saturday and that he’s told House lawmakers to “keep your schedules flexible” on being in Washington, D.C., for a final House vote. 

Trump goads Republicans

President Donald Trump sought to spur quick approval of a final bill, posting on social media that GOP lawmakers should get the package to him as soon as possible.

“To my friends in the Senate, lock yourself in a room if you must, don’t go home, and GET THE DEAL DONE THIS WEEK. Work with the House so they can pick it up, and pass it, IMMEDIATELY,” Trump wrote Tuesday. “NO ONE GOES ON VACATION UNTIL IT’S DONE. Everyone, most importantly the American People, will be much better off thanks to our work together. MAKE AMERICA GREAT AGAIN!”

Oklahoma Sen. Markwayne Mullin said there are concerns among his fellow Republicans about all of the provisions that must be removed or significantly reworked to meet the complex rules for moving a reconciliation bill through that chamber.

“Every time something comes out that we’re using as a pay for, it takes the deficit reduction down. And they’ve taken out nearly $300 billion so far. We’ve got to make that up,” Mullin said after leaving the closed-door House GOP meeting. “The Senate can’t come in below the House version as far as deficit reduction. So that makes it difficult.”

Mullin, who has been acting as his chamber’s top negotiator with SALT Republicans in the House, told reporters he expects the deduction for state and local taxes to remain at the $40,000 level negotiated in the House. But said the Senate will likely rewrite the $500,000 income ceiling to qualify for the tax deduction.

“I think 40 is a number we’re going to land on,” Mullin said. “It’s the income threshold that’s in negotiations.”

Sen. Kevin Cramer of North Dakota said “most of us would like to make it zero.”

“I hate the idea of $40,000 but if that’s what it takes to pass the bill, I probably could do it. I would like to maybe find some other tweaks to it, somehow, like changing the income levels,” he said.

Treasury Secretary Scott Bessent told reporters he expects a resolution on SALT in the next 24 to 48 hours.

“I had a very successful lunch meeting with the senators. I think that we are on track,” Bessent said.

The ‘red line’ in the House

New York Republican Rep. Mike Lawler told reporters following the closed-door meeting that Senate leaders shouldn’t assume whatever they pass will be accepted by the House.

“I’ve been very clear about where my red line is. So, you know, we’ll let this process play out,” Lawler said. “I think the Senate should recognize the only number that matters is 218, and 50 plus 1. That’s it. And how do you get there?”

Republicans hold 53 seats in the Senate, so leadership cannot lose more than four votes and still approve the package, given that Democrats are universally opposed.

In the House, GOP leaders have 220 seats and need nearly every one of their members to support whatever the Senate sends back across the Capitol for it to make it to the president’s desk before their self-imposed deadline.

In addition to the SALT tax compromise, Lawler said he has concerns about how the Senate has changed other provisions, including those addressing Medicaid, the state-federal health program for lower income people.

“Yeah, there are a number of concerns about decisions that they’re making,” Lawler said. “And obviously, the bill on their side is not final, so we’ll see where it goes.”

Missouri Republican Rep. Jason Smith, chairman of the Ways and Means Committee that crafted the tax provisions in the reconciliation bill, stood by the House’s version of the Opportunity Zone Tax Incentives. The House version extends the incentive from the 2017 Tax Cuts and Jobs Act for a year, while the Senate’s version makes it permanent.

The Opportunity Zone Tax Incentive was pushed by South Carolina Sen. Tim Scott during the first Trump administration, which aimed to create tax cuts for businesses and real estate to invest in low-income communities, but it had mixed results.

“The tax bill that we’re going to deliver is gonna deliver for working families, small businesses and farmers,” Smith said.

Thumbs down from one House Republican

House Freedom Caucus Chairman Andy Harris, R-Md., posted on social media that he doesn’t support how the Senate has changed the bill and that he would seek to block it from becoming law. 

“The currently proposed Senate version of the One Big Beautiful Bill weakens key House priorities—it doesn’t do enough to eliminate waste, fraud, and abuse in Medicaid, it backtracks on Green New Scam elimination included in the House bill, and it greatly increases the deficit – taking us even further from a balanced budget.

“If the Senate tries to jam the House with this version, I won’t vote ‘present.’ I’ll vote NO.”

Rattlesnakes and the Senate

West Virginia Republican Sen. Jim Justice told reporters that it’s important for the Senate to take its time in its changes to the reconciliation package and that GOP lawmakers need to be patient.

“If you’re walking through the woods and you look right over there at that wall and there’s a rattlesnake all curled up there and everything, what do you do?” Justice asked. “Most people just jump and take off runnin’, well … rattlesnakes run in pairs and if you just jump left or right or behind, that one can hurt you right there.”

Rattlesnakes are typically solitary creatures, but new research has shown that rattlesnakes are more social than previously thought.

Justice said the best course of action when dealing with a rattlesnake, or two, is to stand still for a moment.

“Look to the left, look to the right, look behind you, and then decide which way you’re going,” he said. “That’s what I think we need to do (in the Senate).”

Tami Jackson of the Wisconsin Board for People with Developmental Disabilities describes how unpaid family caregivers could be affected by proposed Medicaid cuts in the Republican budget reconciliation package in Washington, D.C. Janet Zander of the Greater Wisconsin Agency on Aging Resources, seated at right, also spoke. (Photo by Erik Gunn/Wisconsin Examiner)

Among the many people whose health care could be in jeopardy from possible Medicaid cuts, one group may be even less visible than the rest.

“Medicaid is the primary thing that supports family caregivers,” said Tami Jackson, policy analyst for the Wisconsin Board for People with Development Disabilities (BPDD), in a presentation to social workers Thursday in Dodgeville. 

The person under the caregiver’s care could be living at home, but will probably still require long-term support of some kind — support covered by Medicaid, Jackson said. Medicare provides coverage only for a limited time, such as when a person has come home after being hospitalized.

Private long-term care insurance plans “are unaffordable and they have not been workable for many years,” she added. “So Medicaid is it — and we happen to have a lot of people who need long-term care.”

Jackson and Janet Zander of the Greater Wisconsin Agency on Aging Resources met with Iowa County social workers in Dodgeville Thursday to explain the likely effect of Medicaid cuts that are part of the budget reconciliation bill that has passed the U.S. House and is now in the Senate.

The GOP majorities of both houses want to pass the legislation so they can extend tax cuts enacted in 2017, when President Donald Trump was in his first term. Those tax cuts have been found to heavily benefit wealthy Americans. Without action they will expire at the end of 2025.

Cutting Medicaid, hiking other costs

Medicaid is the single largest source of federal funds in the state budget — about $9 billion a year.

Under the U.S. House version of the budget reconciliation bill, the Wisconsin Department of Health Services (DHS) has projected between 71,000 and 111,000 Wisconsinites would lose Medicaid coverage, including more than 3,800 people with disabilities and 2,400 older adults. The state’s federal Medicaid revenues would be cut by $501 million to $663 million.

The Medicaid cuts on the scale of those in current iterations of the bill “are too large to not cause states to have to cut many things in their state budget,” Jackson said.

The bill’s Medicaid cuts as well as changes it would make to the Affordable Care Act’s health insurance marketplace — including ending subsidies that have made marketplace plans more affordable for lower-income people — would increase the number of uninsured Americans by 16 million in the next decade, according to the Congressional Budget Office.

“Whether you’re a caregiver, whether you’re on Medicaid, whether you’re working for somebody who’s on Medicaid,” everyone will be affected by 16 million more uninsured people, Zander said.

With more uncompensated care for hospitals and providers, she predicted that the cost for other payers will increase.

“We’re going to see premiums for any kind of [health] insurance skyrocket — the employer’s portion, the employee’s portion,” Zander said.

Reduced Medicaid care, more unpaid care

Family caregivers feel Medicaid’s impact in several ways. For many people who are elderly or have disabilities it enables them to get paid, professional care at home. If that care is cut back, that means more work for the unpaid family member.

“Those paid caregivers — they’re paid for by Medicaid dollars and there aren’t enough of them. There haven’t been enough of them for years,” Jackson said.

 If Medicaid cutbacks reduce the pay for those caregivers, the workforce that is already underpaid is likely to be even harder to find — making access to paid care even more difficult, she added, to the point where “it’s either the unpaid caregiver or nothing.”

Family caregivers who take on more unpaid care responsibilities may have to cut back on their own paid jobs.

“The amount of people who are reducing, limiting [work hours or] leaving the workforce because there isn’t a stable, paid caregiving workforce to provide what they need is huge,” Jackson said.

A BPDD survey found that for unpaid family caregivers in Wisconsin providing or coordinating care or filling in for missing care workers took 80% of their time. Two-thirds said caregiving had a negative impact on their family finances and 50% said they left jobs or reduced hours to provide care because there were no care workers to hire.

Unpaid caregivers who leave the workforce not only lose income but reduce the earnings that contribute to their Social Security retirement, Jackson said.

Kristin Voss, a Madison public school teacher for 24 years, had to retire to help manage and care for her 23-year-old daughter. Her daughter has epilepsy, autism and an intellectual disability and “functions at about anywhere from 6 to 12 years old,” Voss said in a panel discussion that was part of Thursday’s presentation.

Until her daughter was 21, she was entitled to public education, where she got “tons of support” including in her transition period that started when she was 18, Voss said. At 21, those supports were no longer available, however.

Her daughter enrolled in the state’s self-directed long-term care program called IRIS. The program includes a caseworker, but Voss also has responsibility as her daughter’s family caregiver, helping to manage day-to-day changes in her daughter’s placement and activities.

“I don’t mind doing these things, but there’s things that I don’t always know about and I’m not always prepared for,” Voss said. “And so, no, I couldn’t do this and be a public school teacher.”

Instead, she has put together a collection of part-time positions that give her flexibility that she needs — although none of them have health insurance, Voss said.

Unpaid caregivers ‘untangling the mess’

Some unpaid caregivers who leave the workforce may also turn to Medicaid for their health coverage because they can’t afford health insurance or work at a job that doesn’t provide insurance.

“About 4 million people nationally are unpaid caregivers who are in Medicaid themselves,” Jackson said.

Among the changes proposed for Medicaid is a requirement for participants in the program to prove every six months that they are still eligible for the program, instead of once a year, the current standard. Another change proposed is to add a work requirement for certain Medicaid participants.

Both of those changes will mean more paperwork. “Unpaid caregivers are the folks that are keeping people who are in Medicaid programs already,” Jackson said — by filling out the forms that are required to prove the person is still eligible.  

“Often these processes are so complex,” Jackson said. And when something goes wrong, because of an error in an eligibility form or a billing mistake, family caregivers “are the people who are untangling the mess.”

The current version of the bill in the Senate gives caregivers an exemption from the work requirement — but Jackson said the definition has raised concerns.

The current proposal limits the exemption to people who are caring for a person under the age of 14. National advocates have said that “really narrows that caregiver exemption and doesn’t quite fit with the reality that most unpaid caregivers are providing care for people with disabilities and older adults,” Jackson said.

Including exemptions in the proposed work requirement provisions also doesn’t necessarily reduce the paperwork.

“You either have to prove you’re meeting the work requirements, or you have to prove that you’re exempt for those requirements,” Jackson said. “And if you’re a caregiver who’s in Medicaid, you have to do that for yourself and probably the person you’re supporting.”