Senate Republicans hauled President Donald Trump’s big tax breaks and spending cuts bill to passage Tuesday by the narrowest of margins, pushing past opposition from Democrats and their own GOP ranks after a turbulent overnight session. The outcome capped an unusually tense weekend of work at the Capitol, the president’s signature legislative priority teetering on the edge of approval or collapse. In the end that tally was 50-50, with Vice President JD Vance casting the tie-breaking vote. Three Republican senators — Thom Tillis of North Carolina, Susan Collins of Maine and Rand Paul of Kentucky — joined all Democrats in voting against it. The difficulty for Republicans, who have the majority in Congress, to wrestle the bill to this point is not expected to let up. The package now goes back to the House, where Speaker Mike Johnson of Louisiana had warned senators not to overhaul what his chamber had already approved. But the Senate did make changes, particularly to Medicaid, risking more problems ahead. House GOP leaders vowed to put it on Trump's desk by his July Fourth deadline. It's a pivotal moment for the president and his party, as they have been consumed by the 940-page “One Big Beautiful Bill Act,” as it was formally titled before Democrats filed an amendment to strip out the name, and invested their political capital in delivering on the GOP's sweep of power in Washington. What started as a routine but laborious day of amendment voting, in a process called vote-a-rama, spiraled into an all-night slog as Republican leaders bought time to shore up support. The droning roll calls in the chamber belied the frenzied action to steady the bill. Grim-faced scenes played out on and off the Senate floor, amid exhaustion. Senate Majority Leader John Thune of South Dakota worked around the clock desperately reaching for last-minute agreements between those in his party worried the bill's reductions to Medicaid will leave millions more people without care and his most conservative flank, which wanted even steeper cuts to hold down deficits ballooning with the tax cuts. The GOP leaders had no room to spare. Thune could lose no more than three Republican senators, and two — Tillis, who warned that millions of people will lose access to Medicaid health care, and Paul, who opposes raising the debt limit by $5 trillion — had already indicated opposition. Attention quickly turned to two other key senators, Lisa Murkowski of Alaska and Collins, who also raised concerns about health care cuts, as well as a loose coalition of four conservative GOP senators pushing for even steeper reductions. Murkowski in particular became the subject of GOP leaders' attention, as they sat beside her for talks. Then all eyes were on Paul after he returned from a visit to Thune’s office. An analysis from the nonpartisan Congressional Budget Office found 11.8 million more Americans would become uninsured by 2034 if the bill became law. The CBO said the package would increase the deficit by nearly $3.3 trillion over the decade. Pressure built from all sides. Billionaire Elon Musk said those who voted for the package should “hang their head in shame” and warned he would campaign against them. But Trump had also lashed out against the GOP holdouts including Tillis, who abruptly announced his own decision over the weekend not to seek reelection. Senators insist on changes Few Republicans appeared fully satisfied as the final package emerged, in either the House or the Senate. Collins fought to include $50 billion for a new rural hospital fund, among the GOP senators worried that the bill’s Medicaid provider cuts would be devastating and force them to close. While her amendment for the fund was rejected, the provision was inserted into the final bill. Still she voted no. The Maine senator said she’s happy the bolstered funding was added, but "my difficulties with the bill go far beyond that.” And Murkowski called the decision-making process “agonizing.” She secured provisions to spare Alaska and other states from some food stamp cuts, but her efforts to bolster Medicaid reimbursements fell short. She voted yes.