U.S. Sen. Susan Collins voted Tuesday against President Donald Trump’s One Big Beautiful Bill Act featuring tax breaks coupled with spending cuts that affect Medicaid and other safety net programs, but her fellow Republicans passed the proposal anyway.
Collins, who is up for reelection as one of the top Democratic targets in 2026, had cast a key vote over the weekend to advance the measure to final votes but said that move was not an endorsement of the roughly 900-page megabill that needs to go back to the House for approval before reaching Trump ahead of the Republican’s desired July 4 deadline.
Despite opposition from the Maine senator and two other Republicans, U.S. Sens. Rand Paul of Kentucky and Thom Tillis of North Carolina, party leaders clinched 50 votes on Tuesday, allowing Vice President JD Vance to cast the tie-breaking vote. It followed a lengthy “vote-a-rama” on a flurry of amendments from both Democrats and Republicans, with GOP disagreements over other issues such as phasing out clean energy credits and a revised state and local tax deduction.
Democrats and interest groups put pressure on Collins, the Senate Appropriations Committee chair, ahead of the vote. She did not share how she would vote until the final roll call but had offered amendments to the package that seeks to extend Trump’s 2017 tax cuts, including an effort to raise the top rate on those earning at least $25 million annually to create a $50 billion fund to help rural hospitals withstand a loss of Medicaid funds.
The Senate defeated Collins’ proposal, but members later agreed to create the $50 billion fund in addition to a carveout that won over U.S. Sen. Lisa Murkowski, R-Alaska, by temporarily exempting her state from taking on more SNAP costs under the food benefit program.
Collins expressed appreciation for the rural hospital fund in a statement after Tuesday’s vote but said it was “not sufficient to offset the other changes in the Medicaid system.”
“While I continue to support the tax relief I voted for in 2017, I could not support these Medicaid changes and other issues,” Collins said.
Senate Republicans could only afford to lose three members to pass the plan, with the caucus scrambling to revise sections after the chamber’s parliamentarian ruled certain parts did not conform to rules on budget bills, including a proposed cap on a Medicaid provider tax, a provision allowing the sale of public lands. The parliamentarian allowed language blocking Planned Parenthood’s eligibility for Medicaid funding.
The Senate version of Trump’s big bill, which includes Medicaid work requirements that Collins left open the door to supporting in recent months, would make nearly 12 million people become uninsured by 2034 — including tens of thousands of the nearly 400,000 Mainers on the state’s version of Medicaid — and add nearly $3.3 trillion to the nation’s debt over that next decade, per the Congressional Budget Office.
That led to opposition from a mix of fiscal hawks and Republicans representing rural areas. Tillis said Sunday he will not seek reelection amid criticism from Trump and blasted the megabill as breaking Trump’s promise of not interfering with Medicaid benefits.
The bill’s effect on rural hospitals framed much of the debate in Maine. Two recent studies found that its Medicaid cuts would put the Calais, Presque Isle, Caribou and Ellsworth hospitals in danger of closing. The powerful Maine Hospital Association, which has the congressional delegation’s ear, said every iteration of the bill would financially hurt members.
Democratic groups at the state and national levels did not give Collins credit for ultimately opposing the bill, emphasizing her key role in advancing it over the weekend.
“Make no mistake: Susan Collins made the deliberate choice to advance this bill, and she’ll be held accountable for it in 2026,” Maine Democratic Party spokesperson Tommy Garcia said.
U.S. Sen. Angus King, an independent who caucuses with Democrats, voted against the bill. He decried its effects on health care and food stamp programs in a Sunday night floor speech and reportedly shouted “shame on you guys” at GOP colleagues while leaving the Senate Tuesday.
The nonpartisan Congressional Budget Office and other studies found higher-income Americans would benefit the most from the megabill, but Trump and his allies pointed to a boost in the $500 child tax credit to $2,500 through 2028 and adding $4,000 to the standard deduction for taxpayers 65 years and older.
The megabill also includes Trump’s “no taxes on tips” pledge that was the lone provision popular among Mainers in a recent poll that found less than a third of the state’s residents wanted Congress to pass the sweeping bill.