Senate Advances Trump Budget Bill Amid Medicaid Cuts, Rural Hospital Concerns

The Senate narrowly voted 51-49 to advance President Donald Trump's "Big Beautiful Bill," a key legislative effort that extends his 2017 tax cuts and raises the debt ceiling by $5 trillion, while implementing cuts to Medicaid which have raised concerns about impacts on rural health care. Senator Susan Collins (R-ME) supported moving the bill forward but expressed reservations and plans to file amendments, particularly seeking more funding for rural hospitals, with her current stance leaning against the bill if it is not substantially changed. Opposition from some Republicans, including Sen. Thom Tillis who voted against advancing the bill and announced he will not seek re-election, highlights intra-party tensions; Democrats uniformly opposed the measure, citing its Medicaid cuts and fiscal recklessness. Critics, including Maine representatives and health care advocates, warn the bill risks closing rural hospitals, increasing health care deserts, and causing significant job losses, while supporters praise it as a path to tax relief and economic growth. The legislation also includes increased deductions for State and Local Taxes (SALT), tips, and overtime, but pays for these through lowering Medicaid eligibility and provider taxes, fueling debate over its long-term social and economic consequences. With President Trump setting a July 4 deadline for final passage, the Senate is expected to continue debating amendments before a final vote, after which the bill would return to the House and then the White House for enactment.