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What’s in the Senate's "One Big Beautiful Bill"

After several days of negotiations and votes on amendments, the Senate passed the One Big Beautiful Bill Act early Tuesday afternoon.

Where it stands: The legislation now heads back to the House, which is scheduled to take up the Senate version this week.

  • If the House can't pass the bill, both chambers will need to reconcile their differences, and they'll likely miss a July 4 target date for President Trump to sign the bill.

A key difference: The Senate bill removed the House provision to tie future Medicare physician payments to an inflation index

  • Instead, senators added a one-time 2.5% Medicare pay bump for physicians in 2026.
  • A temporary pay increase would provide some relief, but the CAP will continue to advocate for stabilization of the Medicare payment system through long-term reform.

The bill included Medicaid cuts of about $1 trillion, although senators did add a $50 billion fund for rural hospitals. 

  • Student loans: Similar to the House version, the Senate bill eliminates Grad PLUS loans and caps unsubsidized borrowing for professional degrees (eg, law, medicine) at $50,000 per year ($200,000 lifetime). The CAP remains concerned with this proposal.
    • The final Senate bill did not include the provisions that would prevent medical residencies from counting toward Public Service Loan Forgiveness or allow for interest-free loan deferment for four years during medical residency.

The big picture: Members of the House will need to decide whether to accept these and other changes, as lawmakers are under pressure to pass the bill by the deadline.

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