One Big Beautiful Bill Act (Senate passage, 50-50, tie broken by the Vice President)
House Bill, H.R. 1 (Senate passage)
What it did
H.R. 1, the One Big Beautiful Bill Act, is the 2025 reconciliation law sponsored by Rep. Jodey Arrington (R-TX). It cuts roughly $1 trillion from Medicaid and the Affordable Care Act marketplaces over ten years through work-reporting requirements, eligibility checks every six months, and limits on the provider taxes states use to fund their share of Medicaid.
It cuts SNAP by about $186 billion and shifts part of the cost of benefits onto states. The same bill extends the 2017 tax cuts, whose benefits go largely to the highest earners. The Congressional Budget Office (CBO) projected about 10 million more people uninsured by 2034 from the health provisions alone. The Senate passed its version on July 1, 2025 by 50-50, with Vice President Vance breaking the tie.
Three Republicans voted no: Sens. Susan Collins (R-ME), Rand Paul (R-KY), and Thom Tillis (R-NC). A yes vote sent the deeper Medicaid cuts back to the House for final passage. A no vote would have stopped the bill.
At the time of this vote, about 38 million American children were insured through Medicaid and CHIP, and the CBO's estimate of 10 million more uninsured by 2034 was on every senator's desk.
Result: Passed 50-50
At the time of this vote: Congressional Budget Office: 10,000,000+ more people uninsured by 2034 under the law's health provisions; ~38,000,000 US children insured through Medicaid and CHIP at the time of the vote
The humane vote: No (NAY)