A sweeping budget measure backed by President Donald Trump is facing growing resistance in the U.S. Senate, as new estimates show it could strip health insurance from nearly 12 million Americans and add $3.3 trillion to the national debt.
The non-partisan Congressional Budget Office released its assessment just as the Senate narrowly advanced the bill in a 51–49 vote late Saturday. Two Republicans, Senators Thom Tillis of North Carolina and Rand Paul of Kentucky, broke ranks to join Democrats in opposition. Tillis, who announced he will not seek reelection, cited deep healthcare cuts as his reason for voting no.
The legislation, officially titled the One Big Beautiful Bill Act, proposes $1 trillion in healthcare spending reductions, including sweeping changes to Medicaid eligibility and funding. It also introduces work requirements for adult beneficiaries and reduces the taxes states can collect from healthcare providers — a key revenue source for many Medicaid programs.
Republicans argue the bill delivers long-promised tax relief, including deductions on Social Security benefits and the elimination of taxes on overtime and tips. The Tax Policy Center estimates over 80% of Americans would receive tax cuts, with the wealthiest households benefiting most.
To cover the cost of those breaks, the bill shifts financial burdens to states beginning in 2028 and enacts limits on federal food assistance. Democrats have strongly opposed the changes, warning they would harm millions of low-income and rural families.
Vice President JD Vance holds the tie-breaking vote, meaning Republicans can afford no more than three defections. With debate time still ongoing and Democrats using procedural tactics to delay a final vote, the bill’s fate remains uncertain.
Trump has called passage before July 4 a top priority, framing it as a loyalty test for lawmakers. The White House warned that failure to advance the measure would be “the ultimate betrayal.”
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