Senate Passes Devastating Medicaid Cuts, House Fight Looms
Vice President JD Vance cast the tie-breaking vote as the Senate passed the “One Big Beautiful Bill” (or substitute your description of the bill) 50-50 after a 27-hour marathon of voting. While the most extreme Scott amendment was ultimately defeated, the base bill’s devastating wealth transfer from healthcare to tax cuts for the wealthy now moves to the House, where the real fight begins.
In the pre-dawn hours of Tuesday morning, the U.S. Senate completed one of the most consequential votes in recent American history—not just for what it passed, but for what it revealed about who matters in American democracy. After 27 hours of marathon voting, Republicans achieved their goal of the largest wealth redistribution in recent memory: cutting more than $793 billion from Medicaid to fund tax cuts for the wealthy.
The vote came down to a 50-50 tie broken by Vice President Vance, with only three Republicans joining all Democrats in opposition: Susan Collins of Maine, Thom Tillis of North Carolina, and Rand Paul of Kentucky. The absence of the ultra-extreme Scott amendment—which would have completely eliminated Medicaid expansion funding starting in 2031—represents the only silver lining in an otherwise devastating outcome for American healthcare.
The Democratic Paradox That Defined the Vote
As the final vote was called, the stark mathematics of American democracy became clear: 100 senators cast votes that will determine the healthcare fate of over 20 million Americans who gained coverage through Medicaid expansion. Each senator enjoys premium government healthcare through the Federal Employees Health Benefits Program, where taxpayers cover 72–75% of their costs, yet they voted on whether millions of working families will maintain access to basic medical care.
The irony runs deeper when considering that some of the senators who pushed the most aggressive amendments reportedly hold significant personal wealth. A senator representing millions of working families who depend on Medicaid casts the same single vote as colleagues whose financial security insulates them from the healthcare anxieties faced by their constituents. Each senator’s decision affects more lives than most of them will ever personally meet. The founders designed the Senate to be deliberative, but they likely never imagined the disconnect between representatives’ personal circumstances and the life-or-death consequences of their votes for ordinary Americans.
Behind every statistic about Medicaid cuts lies a human story that plays out in every state across America. Tommy—a working American—spent his life juggling two jobs, one at a local grocery store and another as a painter in an Idaho ski town, earning between $40,000 and $45,000 annually. He fell into the coverage gap that traps millions: making too much to qualify for traditional Medicaid but unable to afford private insurance premiums. When Tommy developed a persistent cough, he couldn’t afford the $300–$500 urgent care visit that would have provided the antibiotics to treat what became bilateral pneumonia and sepsis. He died during an emergency airlift to a hospital 80 miles away from a completely preventable illness. Tommy’s story is representative of countless real families across America, and the Senate bill will create millions more such tragedies.
What the Senate Actually Passed
The legislation that squeaked through represents a systematic wealth transfer disguised as fiscal responsibility. The base reconciliation bill cuts $793 billion from Medicaid over 10 years, including $58 billion specifically from rural hospitals, while potentially eliminating healthcare coverage for millions of Americans. Meanwhile, it protects tax cuts averaging $79,000 annually for the top 1% of earners, provides an average $12,000 annual increase for wealthy households, permanently extends Trump-era tax cuts for the wealthy, and adds $2.8 trillion to the national debt to fund these cuts.
The Congressional Budget Office analysis reveals the true nature of this wealth transfer: the poorest Americans on average lose $1,600 annually while the wealthiest Americans gain $12,000. Every dollar in tax cuts for wealthy Americans comes directly from healthcare cuts for poorer Americans.
The rural hospital crisis spans every region of America, with more than 700 rural hospitals—one-third of all rural hospitals nationwide—at immediate risk of closure due to financial problems. The Senate’s response creates $58 billion in cuts specifically targeting rural hospitals over 10 years while offering an inadequate $25 billion rural fund over 5 years that expires in 2032. Professional healthcare analysts estimate that preventing rural hospital closures would require at least $6 billion annually, yet the Senate chose to cut rather than preserve this critical infrastructure.
The geographic inequality embedded in the legislation punishes states for expanding healthcare access while rewarding those that denied coverage to their residents. The 39 expansion states plus DC face a triple penalty: state-directed payments to hospitals are limited to 100% of Medicare rates, provider taxes are reduced from 6% to 3.5% by 2032, and they become subject to new work requirements and enhanced verification systems. Meanwhile, the 11 non-expansion states can pay hospitals 110% of Medicare rates, maintain existing provider tax rates, and face no work requirements.
McConnell’s “They’ll Get Over It” Prophecy
When Senate Republican leader Mitch McConnell dismissed constituent concerns about Medicaid cuts with, “I know a lot of us are hearing from people back home about Medicaid. But they’ll get over it,” he revealed the underlying philosophy driving this legislation. His expectation that constituents will simply “get over” losing healthcare access takes on particularly troubling meaning when applied to families facing preventable deaths caused by lack of insurance.
McConnell’s comment perfectly encapsulates what critics see as the Republican calculation: inflict maximum pain on working Americans quickly, assume they’ll forget by the next election, and use the savings to fund tax cuts for wealthy donors who won’t forget their largesse. But families don’t “get over” preventable deaths caused by lack of healthcare access.
The Senate’s priorities became crystal clear when they voted 22–78 to defeat Senator Susan Collins’ amendment that would have created a new 39.6% top marginal tax rate for individuals earning above $25 million and couples above $50 million. The revenue would have doubled the inadequate rural hospital relief fund from $25 billion to $50 billion. Even this modest proposal—asking the ultra-wealthy to help save rural hospitals serving their own states—was too much for the Senate majority.
Remarkably, 18 Republican senators voted for this measure to tax the ultra-wealthy, including former GOP Leader Mitch McConnell himself, showing that even within the Republican caucus, there is recognition that the current approach creates unsustainable inequities.
Nebraska’s Response and the House Battle
The legislation now faces significant challenges in the House, where the real fight for America’s healthcare future begins. Nebraska’s response illustrates the broader national divide. After Republican U.S. Sens. Deb Fischer and Pete Ricketts of Nebraska helped send the bill back to the House by the narrowest of margins, Democrats and advocacy groups shifted their attention to Nebraska’s House Republicans.
The bill’s steep cuts to federal nutrition aid and the government insurance program that covers about 346,000 Nebraskans raised alarm among advocates, who warned that proposed SNAP cuts would shift millions in federal costs onto the state, while Medicaid cuts could cost more than 100,000 Nebraskans their health coverage and force six hospitals in rural parts of the state to close.
Jeremy Nordquist, president of the Nebraska Hospital Association, said the bill “doubles down on long-term Medicaid cuts that will undermine our rural hospitals and healthcare services across Nebraska.” He called on Nebraska’s House members—GOP Reps. Mike Flood, Don Bacon, and Adrian Smith—to “stand firm and send the bill back to the Senate with the provisions that support rural hospitals and preserve access to care for all Nebraskans.”
At least six House Republicans have already threatened to oppose the Senate bill because of changes to the House-passed legislation, and Representative Thomas Massie is viewed as likely to vote no because the package adds more than $3 trillion to the debt. House Republicans from expansion states face an impossible political calculation. Representatives from states like Ohio, Michigan, Pennsylvania, and Nebraska—where voters approved Medicaid—must explain to constituents why they’re voting to slash healthcare funding for working families while delivering tax cuts to millionaires.
The Path Forward
The Senate vote, while devastating, creates new opportunities for advocacy as the bill moves to the House. As you consider this legislation, please remember that constituents in your district will be evaluating these choices when they cast their votes next year. Healthcare stakeholders must mobilize immediately. Hospital systems, Hospital and all Healthcare Associations, and healthcare workers should issue statements and contact House members about hospital closures and job losses. Every district has stories like Tommy’s—working Americans who depend on Medicaid for healthcare access. These personal stories carry enormous weight with House members facing reelection.
A Fox News poll found that only 38% of voters favor the One Big Beautiful Bill while 59% oppose it. House Republicans need to hear that this legislation is politically toxic in their districts. The focus should be on Republicans from expansion states who represent competitive districts, particularly in Ohio, Michigan, Pennsylvania, Wisconsin, Arizona, and North Carolina.
The message framework is straightforward: Why are you asking working families in your district to lose healthcare so millionaires can get tax cuts? Explain to a painter earning $40,000 why his healthcare matters less than a senator’s tax savings.
The Moment of Truth Continues
While the Senate vote was devastating, it wasn’t the end of the story. The House represents the last chance to stop this wealth transfer from working families to wealthy donors. The political dynamics are different in the House, where members face voters every two years and represent smaller, more responsive districts.
The fundamental choice remains the same: preserve healthcare access for millions of vulnerable Americans or eliminate healthcare for the poor to fund tax cuts for millionaire politicians. The Senate made their choice. Now it’s up to the House—and ultimately the American people—to decide whether McConnell’s prediction that Americans will “get over” losing their healthcare proves correct.
The wealth transfer is advancing, but it’s not inevitable. The House fight represents the final opportunity to choose healthcare access over tax cuts for the wealthy, working families over wealthy donors, and human dignity over political calculation.
The time for action is now. Contact your House representative. Make your voice heard. Because when politicians with premium government healthcare tell working Americans they’ll “get over” losing access to basic medical care, the only response should be overwhelming political resistance that proves them wrong.
Key Statistics
$793+ billion in Medicaid cuts over 10 years
$58 billion cut from rural hospitals specifically
700+ rural hospitals at immediate closure risk
72–75% government healthcare subsidy for senators
22–78 vote defeating Collins amendment to tax the ultra-wealthy
38% public support vs. 59% opposition (Fox News poll, June 2025)
Contact Information
Find your House Representative: house.gov/representatives/find-your-representative
Capitol Switchboard: (202) 224-3121
Share your story: Use #HealthcareOverHedgeFunds #WorkingFamiliesFirst #StopTheWealthTransfer
Key Message
"I’m calling to urge [Representative Name] to vote against the Senate’s healthcare cuts. Working families in [District] shouldn’t lose healthcare so millionaires can get tax cuts."
