After a tense Saturday night of backroom negotiations, Senate Republicans struck a last-minute deal to keep President Trump’s sweeping budget reconciliation bill alive, securing the support of key conservative holdouts by agreeing to deeper Medicaid spending cuts.
Senate Majority Leader John Thune (R-S.D.) and Vice President J.D. Vance brokered the agreement with a small group of conservative senators who had been withholding their votes over concerns the bill didn’t go far enough in slashing federal health care spending. The breakthrough, finalized in Thune’s Capitol office late Saturday, was pivotal to flipping the votes of Sens. Ron Johnson (R-Wis.), Rick Scott (R-Fla.), Mike Lee (R-Utah), and Cynthia Lummis (R-Wyo.) — all of whom had threatened to block the bill from advancing.
The legislation — a sprawling 940-page package that boosts funding for border security, immigration enforcement, and the military while rolling back a range of taxes — advanced on a razor-thin 51–49 procedural vote after a more than three-hour delay on the Senate floor.
A Fragile Deal Held Together by Medicaid Cuts
At the center of the deal was a conservative demand to further limit federal Medicaid spending, particularly targeting the Affordable Care Act’s expansion that allowed states to cover more low-income adults. According to a preliminary analysis by the Congressional Budget Office, the revised language would reduce Medicaid spending by approximately $930 billion over the next decade.
“We want to stop Blue State governors from taking advantage of Red States,” said Sen. Rick Scott, who led the charge. “Paying for health care for illegal immigrants with federal tax dollars is going to end.”
Conservatives pressed for a reduction in the federal government’s enhanced 90% Medicaid match rate for newly eligible enrollees under the ACA — a key incentive for states to expand coverage in the first place.
Sen. Johnson, who initially opposed the bill, said the leadership agreed to allow a vote on an amendment that could put a cap on future Medicaid enrollments under the ACA expansion. “At a certain point we just don’t allow single working-age, able-bodied childless adults to sign onto ObamaCare expansion and get that 9-1 match,” Johnson said.
The proposal would delay implementation of the cap, giving states time to adapt, but its inclusion is already triggering backlash among more centrist Republicans.
Centrist Republicans Voice Alarm
Sen. Josh Hawley (R-Mo.) warned that more aggressive Medicaid cuts could alienate the GOP from working-class voters — a core constituency Trump has sought to court. Hawley, who secured carveouts for Missouri hospitals in earlier negotiations, called the cuts “a mistake.”
“If you want to be a working-class party, you’ve got to deliver to working-class people,” Hawley said. “You cannot take away health care from working people.”
Similarly, Sen. Susan Collins (R-Maine), who has long voiced concerns about Medicaid reductions, cautioned that her procedural vote Saturday should not be interpreted as support for the final package. “I still have deep reservations about the direction this bill is taking on health care,” Collins said.
And House Speaker Mike Johnson (R-La.) had previously declared in May that any proposal to directly reduce the enhanced Medicaid match rate was “off the table.” Whether he holds that line remains to be seen.
Trump’s Involvement and the Road Ahead
The bill’s survival now hinges in large part on President Trump’s ability to rally skeptical lawmakers behind the revised package. According to multiple senators, Trump met personally with the holdouts in a bid to unify the party.
“Trump is willing to do what needs to be done to put this nation on a path of eventually balancing our budget,” Sen. Johnson said after Saturday’s vote.
The Senate now enters up to 20 hours of formal debate, followed by a marathon “vote-a-rama” during which dozens of amendments could be offered. A final vote on the reconciliation bill is expected by Monday.
But even with Trump’s backing and Saturday’s momentum, the path forward remains uncertain — particularly as the bill heads toward a divided House GOP conference, where resistance to Medicaid cuts could derail it again.
In short:
The Senate advanced a GOP budget bill with a 51–49 vote after hours of gridlock.
Conservatives flipped their votes in exchange for deeper Medicaid cuts, saving the bill.
The revised bill includes a $930 billion Medicaid reduction over 10 years.
Centrists warn the cuts could backfire politically — especially with working-class voters.
