Senate Republicans are deeply divided over President Trump’s “big, beautiful bill,” which the House passed by a single vote last week, setting up a battle in the upper chamber between moderates and conservatives that is likely to drag on well into July.
GOP senators are vowing to rewrite the bill, but they’re still weeks away from putting together a package that can muster the 51 votes it needs to pass, according to GOP senators and aides.
The more senators change the legislation, the more difficult it will be to pass again through the House — where Republicans control a slim 220-to-212-seat majority. Identical legislation must be approved by both chambers before it can go to Trump for his signature.
Centrist GOP Sens. Susan Collins (Maine), Lisa Murkowski (Alaska) and Thom Tillis (N.C.) are facing off against conservatives such as Sens. Ron Johnson (R-Wis.), Rick Scott (R-Fla.) and Mike Lee (R-Utah) over potential cuts to Medicaid benefits, the phase-out of renewable energy incentives and other deficit-reduction measures that conservatives say don’t go far enough.
The Medicaid cuts also divide conservatives, with Sen. Josh Hawley (R-Mo.) warning they could be bad policy and politically suicidal.
It has all left observers skeptical the debate in the Senate will end in June.
“I would be shocked if it did not go past July 4,” said a Senate Republican aide. “There are going to be a lot more twists and turns in this road, but we’re going to get it done.”
Looming over the debate is the memory of what happened in 2017, Trump’s first year in office, to a House-passed bill to repeal the Affordable Care Act.
The repeal measure narrowly passed the House in May of that year only to fall apart on the Senate floor when Collins, Murkowski and the late Sen. John McCain (R-Ariz.) voted no.
Two of those players, Collins and Murkowski, will have a big say over the fate of Trump’s big, beautiful bill this summer.
Collins is worried about the bill’s impact on rural hospitals, and Murkowski is conscious of potential benefit cuts to tribes in Alaska.
American Hospital Association President Rick Pollack warns the House-passed bill will impact patients “especially in rural and underserved areas” and could lead to longer wait times to receive care and more crowded emergency departments.
The House-passed legislation includes an exemption for American Indian and Alaska Natives from Medicaid work requirements, according to the National Indian Health Board.
But that exemption and others could be under scrutiny as conservatives look for additional ways to save money.
“I’ve been focusing on spending, spending, spending, spending,” said Johnson, the Wisconsin senator who previously criticized the House bill for delaying implementation of Medicaid work requirements.
“Somebody’s got to be the dad who says, ‘I know you all want to go to Disney World, but we can’t afford it.’ I guess I’m going to be that guy,” Johnson said.
Meanwhile, Tillis is warning that an abrupt termination of renewable energy incentives will hit domestic companies like a bomb blast. He’s keeping close track of the billions of dollars of low-carbon energy investments in North Carolina.
Tillis argues that investors are still reluctant to back oil pipeline projects in the United States because former President Biden suddenly killed the Keystone XL Pipeline after coming to office in 2021.
And Murkowski is sympathetic to that argument. She signed on to a letter with Tillis earlier this year warning that “wholesale repeal, or the termination of individual credits, would create uncertainty, jeopardizing capital allocation, long-term project planning.”
Ron Bonjean, a Republican strategist and former Senate leadership aide, says Collins, Murkowski and Tillis probably have more leverage than their conservative colleagues in shaping the bill.
A big reason for that is that both Collins and Tillis are top Democratic targets for 2026. Their successful reelections would go a long way in ensuring Republicans keep control of the Senate for years to come.
With their reelections potentially riding on how the bill impacts their constituents, Collins and Tillis are likely to drive a hard bargain, whether on Medicaid reforms or green energy incentives.
“These senators have been around for a long time, and they’ve been involved in other serious pieces of legislation and know how to take negotiating positions,” he said.
Bonjean said these GOP senators are less likely to succumb to pressure from Trump than their House counterparts, who voted for the bill last week after the president dropped the f-bomb in a private meeting and told them to get in line.
Also in the mix are Hawley, a populist conservative concerned that higher copays for medical services will hit working-class Missourians, and Sen. Jerry Moran (R-Kan.), a mainstream pragmatic Republican who is worried about rural hospitals going out of business.
They both have warned colleagues they will not vote for Medicaid reforms that cut benefits or imperil the financial health of rural hospitals.
Conservatives led by Scott, a former health care CEO, argue that Medicaid has drifted from its original purpose of covering poor kids and disabled adults and spends far too much money on “able-bodied” adults.
He and other conservatives argue the renewable energy incentives enacted under Biden should be repealed entirely.
“We should completely eliminate the Green New Deal. That’s No. 1,” he said. “No. 2 is Medicaid ought to go back and do what it was set up to do. It was set up to take care of poor children and the chronically ill, and that’s what the focus should be.”
Lee, the senator from Utah, said the House bill needs to do more to limit “the extent to which persons unlawfully present in the United States could receive federal benefits, including Medicaid.”
He said House negotiators “inexplicably made a bunch of that stuff available, still, to persons unlawfully present in the United States — that’s a problem.”
GOP senators are also divided over whether to let stand the compromise Speaker Mike Johnson (R-La.) negotiated with blue-state House Republicans from New York, New Jersey and California to raise the cap on state and local tax (SALT) deductions.
“The SALT thing’s going to come up. It’s going to be an issue,” Lee said.
Other GOP senators say, however, they want to leave Johnson’s deal with House colleagues on SALT alone because they don’t want to hurt the bill’s chances of passing the lower chamber again after the Senate makes its changes.
Johnson urged GOP senators at a meeting earlier this month to tread carefully on rewriting the House bill or otherwise risk derailing it.
Another point of disagreement is whether to score the extension of the expiring 2017 Trump tax cuts as a continuation of current policy, which would allow them to be enacted permanently but would also add trillions of dollars to the debt beyond 2034.
Sen. Bill Cassidy (R-La.) says he’s keeping a close eye on interest rates and doesn’t want the bill to make the nation’s debt situation even worse.
He and Sen. Todd Young (R-Ind.) have raised concerns about scoring the extension of the 2017 tax cuts as a matter of current policy if the bill doesn’t find a way to somehow offset the future impact on the deficit.
Cassidy noted in a Senate floor speech last month that “current policy has never been used as [a] baseline involving this much money in a reconciliation bill” and warned that it “establishes a dangerous precedent.”
He said he wants to make sure in the Senate debate over the bill “that we are truly addressing the national debt.”
The stakes of the debate in the Senate are high. If Congress does not approve some kind of extension of the 2017 tax cuts, taxes will rise on U.S. households in 2026.
Treasury Department Secretary Scott Bessent has also warned Congress it will need to raise the debt ceiling in July if the government is to meet its fiduciary obligations.
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