The Senate has passed the Republican megabill by a vote of 51-50, with Republican Senators Thom Tillis of North Carolina, Susan Collins of Maine, and Rand Paul of Kentucky — opposed. The bill’s latest text became public less than an hour before the vote. 

The House Rules Committee has already begun to debate the bill before putting it on the floor for a full vote.  If the House changes anything in the bill it just received from the Senate, once it passes the House it will have to be returned to the Senate for another vote, exposing it to all of the procedural tactics Senator Dems just used to slow the bill down and try to kill it.  

It is commonly held that the longer a bill hangs out in the ether without being disposed of (one way or another) by lawmakers the more problems will develop as people READ the bill and as long as lobbyists and others continue to pressure lawmakers to think a certain way. There is every reason to believe the President will immediately land on any House lawmaker willing to state (for the record either before the vote or during) that they will vote no. For all of these reasons and more, I think the House will now try to move at warp speed, and whip any Republican member that gets out of line.

Over the last 24 hours all eyes were on Alaska Senator Lisa Murkowski who stated for the record that she knew people across the country ‘would not benefit’ from passage of the bill (with a tone in her voice that told everyone she was measuring her words carefully) however the sweeteners that were added to the Senate bill for Alaska that ultimately got Murkowski to ‘yes’ were apparently too good to pass up.  Had Murkowski voted down the bill, it would have failed in the Senate.  There’s an article from The Bulwark (below) on the Senator from Alaska.

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Here’s some great information from the Congressional Progressive Caucus Coalition:

Now the bill heads back to the House, where a handful of Republicans have claimed they could vote the bill down. Whether they’ll make good on those claims remains to be seen. After all, numerous House Republicans had major qualms with the House version of the megabill but went on to support it without getting everything they wanted—and that was when the stakes were arguably lower. They’re now three days from their self-imposed deadline to get the bill to the President’s desk. 

All that being said: until the House votes, this is not a done deal. 

Senate Republicans used a so-called wraparound amendment to make a host of last-minute changes to the megabill to win holdouts’ votes. Those changes include: 

• Delayed Supplemental Nutrition Assistance Program (SNAP) cuts for certain states. In an effort to appease senators from Alaska, the bill will delay a provision shifting SNAP costs to states for the first time, but only for states with sufficiently high “payment error rates.” This will likely apply to Alaska, DC, Florida, Georgia, Maryland, Massachusetts, New Jersey, New Mexico, New York, and Oregon. This will create a perverse incentive for states to pursue more errors to delay cuts. 
• Bandaid for rural hospitals. The bill’s Medicaid cuts are expected to be devastating to rural hospitals, many of which may close if the bill becomes law. The bill now includes $50 billion in an effort to soften the blow for those hospitals. 

Below I’ll summarize some of the most important things to know about the Republican megabill as it stands now, notable impacts on specific issues and communities, and—should the bill become law—key dates in the months and years ahead. This summary is not exhaustive.

I know a lot of folks who read this have spent the last several days monitoring many hours of Senate debate and amendments, so I’ll start with a hat tip to all those working tirelessly to analyze this gargantuan legislation and inform the public about its impacts. I see you. 

This bill will give more to the richest Americans and corporations, while taking from those who have the least. Yale’s Budget Lab found that the bill will result in the bottom 40% of American households losing income, while the top 0.1% gain an extra $118,000. These giveaways to the ultra-wealthy, corporations, and Big Oil are coupled with billions of dollars for the already-bloated Pentagon budget and the Trump immigration agenda, which is tearing families and communities apart. 

All of this is paid for by taking health care and food assistance from millions: nearly 20 million people are expected to lose their health care under this bill. These coverage losses will result in higher out-of-pocket costs, more medical debt, and more evictions as families struggle to keep up with the cost of health care. Folks who cannot cover those costs will go without needed prescriptions and forego appointments, like prenatal care.  

• New work reporting requirements under Medicaid. This new red tape alone would kick millions off their health insurance—without actually promoting employment. Most Medicaid enrollees already work, and most within the minority who do not are caring for family members, have a disability, or attend school. People who lose coverage due to work reporting requirements suffer long-term consequences: Arkansas data shows that half struggle to pay off medical debt and nearly two-thirds delay taking medications. 
• New paperwork requirements to “re-prove” Medicaid eligibility. This added red tape results in people who are Medicaid-eligible losing insurance due to paperwork errors or processing delays. 
• Hurting states’ ability to fund Medicaid programs. A new cap on Medicaid provider taxes could force states to slash Medicaid payment rates for health care providers—which, in turn, may force some providers to close. One study found more than 300 rural hospitals could cut back on the care they offer or close entirely due to this bill. 
• Killing tax credits that lower families’ health care costs. The bill lets tax credits that help families afford their insurance premiums expire, raising their costs. For example, older Americans will pay an extra $1,200 annually, on average, for their current health care plans under this bill. 
• Enacting a backdoor abortion ban. The bill bars Medicaid payments to Planned Parenthood, where 4-in-10 Medicaid recipients have received care, for one year. This would risk the closure of almost 200 health centers across 24 states, jeopardizing access to care for more than 1.1 million patients. 

• New work reporting requirements for people who receive food assistance through SNAP—including for older Americans and parents of children as young as 13-years-old. Similar to Medicaid reporting requirements, this new red tape would have little effect on the number of people working, but would hurt working families, including children. 
• Forcing states to cut back on or end food assistance. The bill pushes SNAP benefit costs onto states for the first time since the program’s creation during the Great Depression. This is expected to force states to cut back on the assistance hungry Americans can receive, narrow SNAP eligibility, or end their food aid programs entirely.
• Preventing food assistance from keeping up with rising costs. In 2021, at Congress’ direction under a law then-President Trump signed, the Biden administration updated the grocery budget the Agriculture Department uses to determine the monthly SNAP allotment for the first time in 15 years. The change meant, on average, an extra $12-$16 per person per month for SNAP households. Republican members of Congress strongly criticized this increase, and this bill would forestall similar updates in the future. 

• New out-of-pocket costs under Medicaid. This bill would let states charge low-income Americans up to $35 per health care service. Research shows that people seek care less when they’re subject to out-of-pocket costs, and that such costs correlate with worse patient health.
• Making energy bills more expensive. The bill ends or restricts several tax credits for clean energy, electric cars, and home efficiency improvements, raising Americans’ energy costs. 
• Cutting funding for the Consumer Financial Protection Bureau (CFPB). This watchdog agency has returned $20 billion to defrauded Americans and investigated consumer complaints against companies. Without adequate resources, CFPB cannot recoup Americans’ costs when companies rip them off. 
• Raising student borrowers’ costs. By limiting options for students to repay their loans, this bill could force the average borrower to pay thousands of dollars more each year.

• Kicking about 2.6 million U.S. citizen kids off the child tax credit. The bill would deny the child tax credit—an essential tool for combatting child poverty—to U.S. citizen kids whose parents do not have Social Security Numbers. In addition, children who do not have Social Security Numbers would continue to be excluded from the credit. 
• Cutting off access to food assistance and school meals. SNAP cuts in the bill are expected to impact 16 million kids. Kids who lose even some of their SNAP benefits become more likely to skip medical care as their families try to make ends meet. Many could also lose access to school meals. 

• Cutting off immigrants’ access to basic needs. The bill excludes refugees, asylees, human trafficking and domestic violence victims, and other non-exempt immigrants from Medicaid, Medicare, the Children’s Health Insurance Program (CHIP), and SNAP.
• Handing ICE billions to imprison immigrants and take parents from their children. This bill includes $45 billion to construct immigrant jails—a 365% increase to ICE’s detention budget, rendering ICE’s detention budget 50% larger than that of the U.S. federal prison system. 
• Taxing remittances. The bill slaps a 3.5% tax on money that immigrants in the U.S. send abroad. A remittance tax could worsen economic insecurity in those countries and prompt more migration to the U.S. People with Social Security Numbers may claim credits to offset the remittance tax. 

The tables below highlight important dates to know as policies from the Republican megabill take effect, should this bill become law. These lists are not exhaustive.

These tables also highlight timing gimmicks within the bill to shield its GOP backers from accountability and limit benefits for ordinary Americans. Major cuts take effect after the 2026 midterms, delaying their full impact until after lawmakers face re-election. Meanwhile, tax breaks for the wealthy last longer—such as a permanent estate tax exemption—while provisions like the tipped income deduction expire as the Trump administration ends.