Crunch Time: Who Gets Cut & Who Gets Counted in the One Big Beautiful Bill
By Doug Steiger
Crunch Time: Who Gets Cut & Who Gets Counted in the One Big Beautiful Bill
By Doug Steiger, Child Welfare Wonk Senior Contributor
The Senate is considering a reconciliation bill that would upend the negotiated balance that the House barely cleared 215-214.
Complex ongoing negotiations with implications for Medicaid and other child and family programs will determine whether Senate Republicans pass a bill that can also pass the House.
Ticking in the background is the debt limit clock; the bill would lift the debt ceiling, which we will breach without action at some point in August. Here’s what to watch.
One Big Beautiful Bill 2.0
The emerging Senate bill has important differences from the House bill. These include: larger Medicaid cuts, in particular through stricter limits on “provider taxes1,” a key funding source for Medicaid programs.
The Senate version also makes more people subject to Medicaid work requirements, in particular parents of children over 14.
These savings align with longstanding GOP goals for structural changes to Medicaid. They also free up funds for bigger tax cuts, and a slower phase-out of clean energy tax credits that split GOP Senators along regional rather than political lines.
The Senate version also applies SNAP work requirements to fewer families.
BUT, the bill drops the exemption to work requirements for young people who have aged out of foster care.
In a bill of this size, changes like this can easily slip through unnoticed.
Provisions– like the exclusion of the House’s SALT2 deduction increase and a slower phase-out of clean energy tax credits are active points of negotiation.
They play along complex regional lines that add further tensions to the pathway to a majority vote. With talks ongoing, the final shape of the bill remains in flux.
What’s still being negotiated
There are 53 Senate Republicans. At least 50 have to vote for the bill.
Finding those votes involves balancing the desire of some conservatives to reduce Medicaid and SNAP spending with the concerns those cuts raise with other Senators.
It also requires finding the right mix of tax provisions, given different priorities among the provisions affecting industries, investors, and families.
Who counts in the Senate and why
With just a few votes to spare, Senate Republicans must reconcile competing priorities—tax cuts, structural safety net reforms, and debt and deficit reduction.
None of this maps neatly; it reflects complex realities back home. These are the players shaping what makes it into the final bill—and what gets cut to get there.
Senate and Committee Leaders
Majority Leader John Thune (R-SD), responsible for lining up the votes for final passage.
Finance Committee Chairman Mike Crapo (R-ID), who oversees the tax and Medicaid provisions.
Agriculture Committee Chairman John Boozman (R-AR), who oversees the SNAP provisions.
Conservative Medicaid Defenders
Senators Josh Hawley (R-MO) and Jim Justice (R-WV), who convey their support for Medicaid in MAGA framing about impacts on working class voters and rural hospitals
Senator Justice has also expressed concern about the impact of SNAP cuts in his state.
Centrist Medicaid Defenders
Senators Lisa Murkowski (R-AK) and Susan Collins (R-ME), concerned about the impact on their states, such as on rural hospital finances.
Deficit & Debt Detractors
Senator Johnson (R-WI), seeking deeper spending cuts than the bill contains.
Senator Paul (R-KY), opposed to the provision increasing the debt ceiling, which is necessary to avoid a separate debt ceiling negotiation with Democrats.
Who counts in the House
Once the Senate passes its version of the bill, the House will be pressured to pass it “as is” so that the President can quickly sign it.
However, there are House Republicans committed to the increased SALT deduction the Senate has dropped.
If they hold firm, they could prevent the Senate version from passing the House.
House conservatives remain committed to substantial Medicaid and SNAP cuts. If Senate negotiations result in smaller cuts, they could insist on changes too.
Yet House moderates could object to the deeper cuts the House conservatives are seeking. At each stage, negotiation is fraught and multi-dimensional.
It’ll probably come down to the President
President Trump’s power over Republicans will likely force a bill through, deciding whose concerns count and whose get cut.
What counts in the clutch
In the short term, the action is in the Senate, particularly with those Senators listed above.
Congressional Republicans are under significant pressure to pass something, which makes broad opposition less impactful.
The messenger matters as much as the message– and what breaks through are constituent-specific consequences. In a message-saturated environment members tune out “vote yes” and “vote no” outreach.
What gets attention is clear, localized impacts, especially when they scale across a district or state. That’s why niche policy like the SALT deduction makes national noise.
It is possible the bill could be voted down, even more than once. Sometimes, the pressure of a failed vote is what forces recalcitrant members to accept difficult compromises.
In the coming days, what rises to Members inboxes will help determine what makes the bill, and what hits the cutting room floor.
