Three Republican senators — Thom Tillis of North Carolina, Susan Collins of Maine and Rand Paul of Kentucky — joined all Democrats in voting against it.
"In the end we got the job done," Senate Majority Leader John Thune of South Dakota said afterward.
The difficulty for Republicans, who have the majority in Congress, to wrestle the bill to this point is not expected to let up. The package now goes back to the House, where Speaker Mike Johnson of Louisiana had warned senators not to overhaul what his chamber had already approved. But the Senate did make changes, particularly to Medicaid, risking more problems ahead. House GOP leaders vowed to put it on Trump's desk by his July Fourth deadline.
It's a pivotal moment for the president and his party, as they have been consumed by the 940-page "One Big Beautiful Bill Act," as it was formally titled before Democrats filed an amendment to strip out the name, and invested their political capital in delivering on the GOP's sweep of power in Washington.
Trump acknowledged it's "very complicated stuff," as he departed the White House for Florida.
“I don’t want to go too crazy with cuts," he said. "I don’t like cuts.”
Senators work around the clock
What started as a routine but laborious day of amendment voting, in a process called vote-a-rama, spiraled into an all-night slog as Republican leaders bought time to shore up support.
The droning roll calls in the chamber belied the frenzied action to steady the bill. Grim-faced scenes played out on and off the Senate floor, amid exhaustion.
Thune worked around the clock desperately reaching for last-minute agreements between those in his party worried the bill's reductions to Medicaid will leave millions more people without care and his most conservative flank, which wanted even steeper cuts to hold down deficits ballooning with the tax cuts.
The GOP leaders had no room to spare. Thune could lose no more than three Republican senators, and two — Tillis, who warned that millions of people will lose access to Medicaid health care, and Paul, who opposes raising the debt limit by $5 trillion — had already indicated opposition.
Attention quickly turned to two other key senators, Lisa Murkowski of Alaska and Collins, who also raised concerns about health care cuts, as well as a loose coalition of four conservative GOP senators pushing for even steeper reductions.
Murkowski in particular became the subject of GOP leaders' attention, as they sat beside her for talks. Then all eyes were on Paul after he returned from a visit to Thune’s office.
Senate Democratic Leader Chuck Schumer of New York said Republicans "are in shambles because they know the bill is so unpopular."
An analysis from the nonpartisan Congressional Budget Office found 11.8 million more Americans would become uninsured by 2034 if the bill became law. The CBO said the package would increase the deficit by nearly $3.3 trillion over the decade.
Pressure built from all sides. Billionaire Elon Musk said those who voted for the package should "hang their head in shame" and warned he would campaign against them. But Trump had also lashed out against the GOP holdouts including Tillis, who abruptly announced his own decision over the weekend not to seek reelection.
Senators insist on changes
Few Republicans appeared fully satisfied as the final package emerged, in either the House or the Senate.
Collins fought to include $50 billion for a new rural hospital fund, among the GOP senators worried that the bill’s Medicaid provider cuts would be devastating and force them to close.
While her amendment for the fund was rejected, the provision was inserted into the final bill. Still she voted no.
The Maine senator said she’s happy the bolstered funding was added, but "my difficulties with the bill go far beyond that.”
And Murkowski called the decision-making process “agonizing.”
She secured provisions to spare Alaska and other states from some food stamp cuts, but her efforts to bolster Medicaid reimbursements fell short. She voted yes.
What's in the big bill
All told, the Senate bill includes $4.5 trillion in tax cuts, according to the latest CBO analysis, making permanent Trump's 2017 rates, which would expire at the end of the year if Congress fails to act, while adding the new ones he campaigned on, including no taxes on tips.
The Senate package would roll back billions of dollars in green energy tax credits, which Democrats warn will wipe out wind and solar investments nationwide. It would impose $1.2 trillion in cuts, largely to Medicaid and food stamps, by imposing work requirements on able-bodied people, including some parents and older Americans, making sign-up eligibility more stringent and changing federal reimbursements to states.
Additionally, the bill would provide a $350 billion infusion for border and national security, including for deportations, some of it paid for with new fees charged to immigrants.
“The big not so beautiful bill has passed,” Paul said.
Democrats fight all day and night
Unable to stop the march toward passage, the Democrats tried to drag out the process, including with a weekend reading of the full bill.
Sen. Patty Murray of Washington, the ranking Democrat on the Appropriations Committee, raised particular concern about the accounting method being used by the Republicans, which says the tax breaks from Trump's first term are now “current policy” and the cost of extending them should not be counted toward deficits.
She said that kind of “magic math” won't fly with Americans trying to balance their own household books.
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Associated Press writers Joey Cappelletti, Darlene Superville, Seung Min Kim and Kevin Freking contributed to this report.
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