The bill faced opposition from three GOP senators—Thom Tillis, Susan Collins, and Rand Paul—and all Democrats.

After a contentious overnight session and vote-a-rama, the bill, which includes $4.5 trillion in tax cuts, $1.2 trillion in cuts to Medicaid and food stamps, and a $5 trillion debt ceiling increase, now returns to the House.

Changes to Medicaid risk further complications as Speaker Mike Johnson warned against significant deviations.

The Congressional Budget Office estimates the bill could leave 11.8 million more Americans uninsured by 2034 and increase the deficit by $3.3 trillion over a decade. Key GOP concerns included Medicaid cuts and the debt ceiling hike, while Democrats criticized the bill’s unpopularity and fiscal impact.