5 things to watch as the Senate takes up ‘One Big Beautiful Bill’

Modern Healthcare – Monday, June 2, 2025
By Michael Mcauliff

Now it’s the Senate’s turn to take on the One Big Beautiful Bill Act of 2025, and what Republicans demand during what promises to be a fractious process will determine if the tax-and-spending-cuts measure makes its way to President Donald Trump’s desk.

The bill, which passed the House by a single vote last month, aims to restore expiring tax cuts and enact some new ones at an estimated cost of nearly $4 trillion, while boosting spending on defense and immigration enforcement. It would be paid for, in part, by cuts elsewhere, with at least $800 billion extracted from the healthcare system. The Senate returns from a recess Monday and Congress aims to finish the bill by July 4.

1. The math and the process

There are several key factors that will determine whether the massive legislation sinks or swims as the Senate works its will. The most basic is how the Senate decides to proceed with the bill, and whether Majority Leader John Thune (R-S.D.) can keep all but three of his members on board in the narrowly divided upper chamber.

The bill is moving under expedited procedures known as budget reconciliation, which will allow the legislation to pass on a simple majority vote without the threat of a filibuster from the minority Democrats. Republicans hold a 53-47 edge and can win on a 50-50 vote with Vice President JD Vance breaking the tie in his constitutional capacity as president of the Senate.

Then there is the issue of how the bill gets to the floor. Under reconciliation rules, the Senate would be expected to have legislative committees markup their sections of the bill, just as the House did, then return them to the Budget Committee led by Chair Lindsey Graham (R-S.C.) and ranking member Jeff Merkley (D-Ore.).

Under that standard process, the Budget Committee would hold a final session to compile the bill and advance it to the Senate floor. Democrats are eager for this stage, which leaders such as Finance Committee ranking member Ron Wyden (D-Ore.) plan to use to highlight aspects of the measure Democrats see as damaging and unpopular.

The Senate does not have to do that, however. The more likely path is that Thune and Graham work with GOP senators in private to make changes that address concerns they’ve already raised. That would allow the majority to proceed in unity on an amended version of the House bill.

A final factor is what’s known as the “Byrd Bath,” named after late Sen. Robert Byrd (D-W. Va.), who set a Senate precedent that only provisions directly affecting expenditures and revenues can be included in a reconciliation bill. Through this mechanism, senators can raise objections to provisions that only have incidental impact on spending or taxes. The Senate parliamentarian has the authority to rule them invalid, and often does.

2. The nervous Republicans

Then there is the substance of the bill, and perhaps the biggest threat to its passage is the complaint several Republicans have expressed that it goes too far in specific areas, such as Medicaid.

Republicans Sens. Susan Collins (Maine), Lisa Murkowski (Alaska) and Josh Hawley (Mo.) have all raised concerns about cuts to Medicaid that are forecast to exceed $700 billion.

These GOP lawmakers have warned they do not want to see beneficiaries harmed, and voted for an unsuccessful amendment earlier in the process that would have spared Medicaid. Hawley has also said he is worried about how the bill cuts state provider taxes, which he said are important to his state’s Medicaid financing. Sen. Jerry Moran (R-Kan.) has also mentioned Medicaid cuts as a concern. The four together could sink the bill.

How committed they are to their stances remains to be seen. House Republicans who made similar noises about Medicaid cuts nearly all voted for the bill after pressure from Trump. Just one of them defecting could have killed the bill.

Some senators have issues unrelated to healthcare that also could prove crucial, including those who oppose language the House passed to strike clean energy funding that supports jobs and development in their states.

3. The hardliners

At least three Republican senators have gone on the record opposing the bill because it does not cut enough.

GOP Sens. Mike Lee (Utah), Dr. Rand Paul (Ky.) and Ron Johnson (Wis.) have said the bill should slash spending more deeply.

Johnson, in particular, has been highly vocal in demanding the measure cut $6 trillion to return federal spending to pre-COVID-19 pandemic levels. He told reporters before the Senate went on its Memorial Day break that he had at least four senators with him, which would be enough to nix the bill. Paul said he would consider voting for the legislation, but not if it includes a $4 trillion hike in the nation’s debt limit, which the House-passed measure does.

Paul was the only conservative to oppose the Senate’s passage of the budget resolution that set the stage for the One Big Beautiful Bill Act. Collins was the only other Republican who voted against it, for opposite reasons.

4. The Democrats’ delay tactics

While Democrats do not have the power to stop the bill if the Republicans remain united, they will do their best to drive wedges between their colleagues on the other side of the aisle in hopes of fomenting dissent.

Besides repeatedly highlighting the social costs of deep cuts to Medicaid and food assistance in “red” states, Minority Leader Chuck Schumer (D-N.Y.) has already begun focusing on other issues that matter to Republicans, including the clean energy funding.

While Democrats such as Wyden and Schumer may not get the opportunities to rail against the bill in committee, they will aim to emphasize issues polls show Republican voters don’t like.

There is one more step in the process when Democrats will get a chance to say their piece. That’s what’s known as the vote-a-rama. Under reconciliation rules, there is only a proscribed amount of time for debate because of the ban on filibusters, whereas Senate debates normally are not subject to time limits. But there are unlimited amendments allowed.

As they did when the Senate passed the budget resolution, Democrats can be expected to offer numerous carefully crafted provisions that more moderate Republicans may support. Wyden’s amendment to shield Medicaid in the budget resolution only failed by one vote.

5. The bottom line

Republican leaders need to keep the measure relatively close to what the House passed to have the best chance of sending Trump something to sign. House Speaker Mike Johnson (R-La.) has cautioned that a bill with major revisions will not make it through the House again.

Yet a number of Republicans, and all Democrats, will try hard to win significant changes. As it stands now, there are enough GOP senators on each side, either pushing for a more moderate or more stringent bill, to sink it. Hawley and some other senators have said it will be up to Trump to break through any logjams.

Access this article at its original source.