'Utter Betrayal': With Help From Vance, Senate GOP Votes to Decimate Medicaid to Fund Tax Cuts for Rich

With a tie-breaking vote from Vice President JD Vance, Senate Republicans on Tuesday narrowly passed budget legislation that includes the largest cuts to Medicaid and nutrition assistance in U.S. history and trillions of dollars in tax breaks that would disproportionately benefit the wealthiest Americans.

The Senate tally was 50-50 prior to Vance's intervention, with Democrats unanimously opposed and Sens. Rand Paul (R-Ky.), Thom Tillis (R-N.C.), and Susan Collins (R-Maine) crossing the aisle to vote against the bill, which now heads back to the Republican-controlled House of Representatives.

"JD Vance was the deciding vote to cut Medicaid across the country," Rep. Alexandria Ocasio-Cortez (D-N.Y.) wrote in response to the Senate vote. "An absolute and utter betrayal of working families."

The 887-page legislation includes more than $1 trillion in cuts to Medicaid and the Children's Health Insurance Program over the next decade—cuts that would result in nearly 12 million people losing health coverage. Analysts and advocates warn the proposed cuts would have cascading effects across the country, shuttering rural hospitals and devastating state budgets.

"Senate Republicans just voted to close nursing homes and hospitals around the country. These cuts will hit rural areas hardest, but nowhere is safe," said Alex Lawson, executive director of the progressive advocacy group Social Security Works. "Even if your local hospital doesn't close, it will have more patients and fewer staff due to the loss of Medicaid funding. Half of nursing homes will lose staff, and a quarter will close. All to give trillions in tax handouts to billionaires like Elon Musk and Jeff Bezos."

"In the end, billionaire political donors want a return on their investment, and Trump and Republicans are determined to give it to them with trillions in new handouts. The rest of us will suffer for it."

The measure also takes an ax to the Supplemental Nutrition Assistance Program (SNAP)—imperiling food aid for millions and potentially inflicting major damage to local economies across the U.S.—as well as clean energy programs, Planned Parenthood funding, and more.

Even with such seismic cuts, the Senate bill would still add more than $3 trillion to the deficit over the next 10 years due to the size of the measure's tax breaks, which would flow primarily to the rich and large corporations. Experts have said that, if enacted, the Republican legislation would spur the largest transfer of wealth from the poor to the rich in a single law in U.S. history.

"This abominable bill will make history—in appalling ways," said Amy Hanauer, executive director of the Institute on Taxation and Economic Policy. "Never before has legislation taken so much from struggling families to give so much to the richest. It makes the biggest cuts to food aid for hungry families, executes the largest cuts to healthcare ever, adds trillions to the national debt—all to give $114 billion to the richest 1% in a single year. It's no wonder that this bill is also extremely unpopular. Historians—and voters—will look back at this as a dark day in U.S. history."

The bill also contains a $150 billion boost for the Pentagon and tens of billions for Immigration and Customs Enforcement.

"This Republican bill is about caviar over kids, hedge funds over healthcare, and Mar-a-Lago over the middle class," said Sen. Ron Wyden (D-Ore.), the top Democrat on the Senate Finance Committee. "If this becomes law, only the ultrawealthy will make it through unscathed. Every other American will be hurt in one way or another, whether it's cancer patients losing their health coverage, kids going hungry, or families being forced to pay higher utility bills and insurance premiums."

"In the end, billionaire political donors want a return on their investment, and [President Donald] Trump and Republicans are determined to give it to them with trillions in new handouts," Wyden added. "The rest of us will suffer for it. The United States will be a weaker, sicker, and poorer country as a direct result of what the Republicans are doing."

House Republicans are expected to move quickly to pass the Senate-approved legislation before Trump's July 4 deadline, but the bill appears likely to face significant pushback—particularly from far-right members who believe the measure's spending cuts aren't sufficiently aggressive.

Punchbowl reported that the House Rules Committee is expected to meet Tuesday "to begin to prepare the bill for floor consideration."

"The full House is expected back in Washington Wednesday morning, giving the chamber two days to pass the package before" July 4, the outlet noted.

Senate Republican leaders locked in the bill's passage after winning the support of Sen. Lisa Murkowski (R-Alaska). The American Prospect's David Dayen reported that Murkowski "was able to secure a waiver from cost-sharing provisions that would for the first time force states to pay for part of" SNAP.

"In order to get that past the Senate parliamentarian, 10 states with the highest payment error rates had to be eligible for the five-year waiver, including big states like New York and Florida, and several blue states as well," Dayen explained. "The expanded SNAP waivers mean that in the short term, only certain states with average or even below-average payment error rates will have to pay into their SNAP program; already, the language provided that states with the lowest error rates wouldn't have to pay."

After voting for the bill, Murkowski suggested that Republicans in the House should change it—meaning it would have to pass the Senate again before reaching Trump's desk.

David Kass, executive director of Americans for Tax Fairness, said in a statement that "this fight is not over," pointing to the House Republicans who have "voiced concern about the massive cuts to Medicaid and SNAP, in addition to the trillions this bill adds to the national debt."

"Since the House last voted for the bill, the Senate has only made the bill more expensive and enacted more cuts to critical programs that their constituents rely on," said Kass. "The question is: Will House members stand up for their constituents, or blindly follow Trump and his elite backers?"