Debt, healthcare fears loom as Trump’s 'Big Beautiful Bill' moves to final vote

US President Donald Trump’s sweeping budget proposal, dubbed the 'Big Beautiful Bill', is heading toward a decisive vote in the House of Representatives, following weeks of heated debate over its broader economic implications.

The bill, which consolidates a range of Trump’s flagship policy promises, proposes major tax cuts, expanded infrastructure spending, and new social benefit schemes. But it has faced delays in Congress, with critics warning that the plan could significantly deepen the national debt and strain public healthcare systems.

House Republicans voted before dawn on Thursday to advance Trump's tax and spending cuts package after GOP leaders worked almost around the clock trying to persuade sceptical holdouts as they race to send the bill to his desk by the Fourth of July deadline.

Trump, who had hosted lawmakers at the White House earlier, lashed out at the delay. Once the gavel struck, 219-213, the bill advanced to a last round of debates toward a final vote, which is expected later Thursday morning.

“Our way is to plow through and get it done,” House Speaker Mike Johnson said, emerging in the middle of the night from a series of closed-door meetings. “We will meet our July 4th deadline.” The idea of quickly convening to for a vote on the more than 800-page bill after it passed the day before in the Senate was a risky gambit, one designed to meet Trump's demand for a holiday finish. Republicans have struggled mightily with the bill nearly every step of the way, often succeeding by the narrowest of margins — just one vote. Their slim 220-212 majority leaves little room for defections.

Several Republicans are balking at being asked to rubber-stamp the Senate version less than 24 hours after passage. A number of moderate Republicans from competitive districts have objected to the Senate bill's cuts to Medicaid, while conservatives have lambasted the legislation as straying from their fiscal goals.

“What are the Republicans waiting for??? What are you trying to prove???” Trump railed in a post-midnight vote. He also warned starkly of political fallout from the delay “COSTING YOU VOTES!!!” It fell to Johnson and his team to convince them that the time for negotiations is over. They needed assistance from Trump to close the deal, and lawmakers headed to the White House for a two-hour session Wednesday to talk to the president about their concerns. Trump also worked the phones.

“The president's message was, We're on a roll,'” said Rep. Ralph Norman, R-SC “He wants to see this.” Republicans are relying on their majority hold of Congress to push the package over a wall of unified Democratic opposition. No Democrats voted for bill in the Senate and none were expected to do so in the House.

“Hell no!” said House Democratic Leader Hakeem Jeffries, flanked by fellow Democrats outside the Capitol.

In an early warning sign of Republican resistance, during a first procedural vote that also stalled out as GOP leadership waited for lawmakers who were delayed coming back to Washington and conducted closed-door negotiations with holdouts.

By nightfall, as pizzas and other dinners were arriving at the Capitol, the next steps were uncertain.

Trump pushes Republicans to do the right thing The bill would extend and make permanent various individual and business tax breaks from Trump's first term, plus temporarily add new ones he promised during the 2024 campaign. This includes allowing workers to deduct tips and overtime pay, and a USD 6,000 deduction for most older adults earning less than USD 75,000 a year.

In all, the legislation contains about USD 4.5 trillion in tax cuts over 10 years.

The bill also provides about USD 350 billion for defense and Trump's immigration crackdown. Republicans partially pay for it all through less spending on Medicaid and food assistance. The Congressional Budget Office projects the bill will add about USD 3.3 trillion to the federal debt over the coming decade.

The House passed its version of the bill in May by a single vote, despite worries about spending cuts and the overall price tag. Now it's being asked to give final passage to a version that, in many respects, exacerbates those concerns. The Senate bill's projected impact on the nation's debt, for example, is significantly higher.

“Lets go Republicans and everyone else,” Trump said in a late evening post.

The high price of opposing Trump's bill Johnson is intent on meeting Trump's timeline and betting that hesitant Republicans won't cross the president because of the heavy political price they would have to pay.

They need only look to Sen. Thom Tillis, R-N.C., who announced his intention to vote against the legislation over the weekend. Soon, the president was calling for a primary challenger to the senator and criticising him on social media. Tillis quickly announced he would not seek a third term.

One House Republican who has staked out opposition to the bill, Rep. Thomas Massie of Kentucky, is being targeted by Trump's well-funded political operation.

Democrats Target vulnerable Republicans to join them in opposition Flanked by nearly every member of his caucus, Democratic Leader Jeffries of New York delivered a pointed message: With all Democrats voting “no,” they only need to flip four Republicans to prevent the bill from passing.

Jeffries invoked the “courage” of the late Sen. John McCain giving a thumbs-down to the GOP effort to “repeal and replace” the Affordable Care Act, and singled out Republicans from districts expected to be highly competitive in 2026, including two from Pennsylvania.

“Why would Rob Bresnahan vote for this bill? Why would Scott Perry vote for this bill?” Jeffries asked.

Democrats have described the bill in dire terms, warning that Medicaid cuts would result in lives lost and food stamp cuts would be “literally ripping the food out of the mouths of children, veterans and seniors,” Jeffries said Monday.

Republicans say they are trying to right-size the safety net programs for the population they were initially designed to serve, mainly pregnant women, the disabled and children, and root out what they describe as waste, fraud and abuse.

The package includes new 80-hour-a-month work requirements for many adults receiving Medicaid and applies existing work requirements in the Supplemental Nutrition Assistance Program, or SNAP, to more beneficiaries. States will also pick up more of the cost for food benefits.

The driving force behind the bill, however, is the tax cuts. Many expire at the end of this year if Congress doesn't act.

The Tax Policy Centre, which provides nonpartisan analysis of tax and budget policy, projected the bill would result next year in a USD 150 tax break for the lowest quintile of Americans, a USD 1,750 tax cut for the middle quintile and a USD 10,950 tax cut for the top quintile. That's compared with what they would face if the 2017 tax cuts expired.