The so-called "One, Big Beautiful Bill" passed on July 1 on a 51-50 vote after three Republicans defected, requiring Vice President JD Vance to break the tie in a dramatic flourish and send the bill back to the House for final approval but where the outcome remains uncertain.

Senate Parliamentarian Elizabeth MacDonough ruled that a provision in the One Big Beautiful Bill blocking illegal immigrants from receiving Medicaid benefits had to be removed. Senate Republicans are moving the legislation through the upper chamber using the budget reconciliation process,

State officials estimate 310,000 Pennsylvanians will lose Medicaid coverage and anticipate strain at health facilities caused by federal budget cuts.

Vice President JD Vance said cuts to Medicaid and budget impacts in the Senate tax bill don't compare to the importance of ICE spending.

U.S. Rep. Andy Barr, who represents Kentucky's 6th District including Lexington, championed President Trump's Big Beautiful Bill and secured votes to get it passed.