Senate G.O.P. Gambles Its Legacy and Political Fate on Bill

Senate Republicans squeaked their sweeping tax and health policy bill over the finish line on Tuesday by the narrowest of margins, but the hard-fought legislative win came at considerable risk to their party’s political futures and fiscal legacy.

The measure, which still faces a tough road to final passage in the House, would make steep cuts to popular health and nutrition programs among other actions to help pay for roughly $4.5 trillion in tax cuts. It is projected to drive up the national debt considerably over the next 10 years despite vociferous protests to the contrary by President Trump and Republicans in Congress.

It took an extraordinary all-night session and some last-minute sweeteners for the final holdout for Republican leaders to drag the bill to passage, an effort that underscored the deep unease about the legislation. Senator Lisa Murkowski, the Alaska Republican who was a final holdout and backed it only after securing protections for her constituents from its most painful cuts, called the process “agonizing.”

Now, the G.O.P. must sell its widely criticized plan to a public that polls show is already skeptical of the legislation. And it will have to do so over the harsh condemnation of Democrats, who intend to make attacks on the measure a centerpiece of their 2026 campaign to retake the House and Senate.

The long-term fiscal consequences of the measure may be even more damaging. In the messy process of jamming the bill through the closely divided Senate, Republicans shattered a longstanding budgeting convention meant to curb Congress’s ability to enact policies that swell the deficit in the long term. With that guardrail busted, the nation’s already soaring debt is at risk of increasing exponentially over time, a dubious legacy for Republicans, who often call themselves the party of fiscal responsibility.

Some of the most lacerating criticism of the legislation came from within the Republican ranks, notably from Senator Thom Tillis, Republican of North Carolina. He had been warning his party for days that the bill was a political loser even before he abruptly announced on Sunday he would retire from the Senate next year after coming under political assault from Mr. Trump over his opposition to the bill.

Mr. Tillis said his research showed that the Medicaid cuts in the bill would wreak havoc in his state. In a biting floor speech that had to hit fellow Republicans where it hurt, he compared their promises that no deserving Medicaid recipient would lose coverage to a memorable Obama-era refrain that Republicans deployed to tremendous success against Democrats and relish to this day.

“The last time I saw a promise broken around health care,” Mr. Tillis said, “is when somebody said, ‘If you like your health care, you can keep it; if you like your doctor, you can keep it,’” Mr. Tillis said. “We found that wasn’t true.”

The pointed reference was, of course, to President Barack Obama’s pledge in 2009 that under his new health care plan, Americans would not experience any disruption in their coverage, a claim that did not pan out, contributing to big Democratic losses in the 2010 midterm elections.

Republicans made comments in this case that might come back to sting them. Vice President JD Vance dismissed as “immaterial” on Monday the Medicaid cuts that could reach millions of Americans when measured against the new security spending in the bill. Under fire at home for her support of the bill, Senator Joni Ernst, Republican of Iowa, answered constituent fears about potential loss of health care access by saying, “We are all going to die.”

As they pushed their legislation, top Republicans insisted that Medicaid would still be available to those who truly should be receiving it — that they were simply stomping out waste, fraud and abuse and knocking able-bodied Americans who could and should work out of the program.

“Medicaid was originally intended for children and poor families, children and people who were disabled and couldn’t work to provide health care,” said Senator Lindsey Graham, Republican of South Carolina and chairman of the Budget Committee. “Count me in for that.”

The rub for Republicans is that with generous federal support, many states have greatly extended the reach of their public health insurance programs deep into the ranks of Americans holding down jobs that do not provide health coverage. The states and their residents have come to rely on Medicaid as a stable source of health care. History has shown that once voters obtain government aid under a program, they are not happy to see those benefits threatened, particularly if they are told that it is being done to underwrite tax cuts for affluent Americans.

Republicans also came under fire from within their ranks over the bill’s expected impact on the national debt. Senator Rand Paul, Republican of Kentucky, has for weeks taken aim at his G.O.P. colleagues for abandoning their professed anti-deficit ideology by promoting legislation that spills barrels of red ink while raising the federal debt limit by $5 trillion.

Mr. Paul warned colleagues who like to consider themselves deficit hawks that they would have no one to point fingers at when the bill comes due if the measure becomes law and the projections are realized.

“Republicans now own the debt, and Republicans now own the spending,” Mr. Paul said. “There is no more blaming — ‘Oh, it’s Biden’s fault.’ The deficit is fully, completely owned by Republicans.”

Top Republicans dispute the claims that their measure will drive up the deficit and say that the growth produced by the legislation will offset any revenue losses, a prediction that has proved to be overly optimistic under past Republican-only tax cuts.

“We want to grow the economy,” Senator John Barrasso of Wyoming, the No. 2 Senate Republican, said of his party’s legislation, in an appearance on Fox News. “They want to grow the government,” he said of the Democrats.

The Senate Republican projections of the fiscal impact of their legislation were enhanced by a bit of dexterous accounting that allowed them to unilaterally treat the cost of extending the tax breaks as zero in a maneuver that Democrats said perverted special Senate budget rules and undermined the filibuster.

Democrats said that approach would come back to haunt Republicans when Democrats regain control of Congress and use the same tactic to push through legislation Republicans oppose without the threat of a filibuster.

To try to soften the political impact of the health care changes, Republicans pushed off most of the start dates of the program cuts and new work requirements for Medicaid recipients past the 2026 midterm elections.

But Democrats intend to pound home the looming consequences of the cuts, and they may get some help from Senator Josh Hawley, Republican of Missouri. Though he voted for the legislation, Mr. Hawley said he was so opposed to the Medicaid provisions that he intended to spend the next two years trying to get them overturned.

It is worth noting that Democrats were crushed in the 2010 midterms even though the botched rollout out of the Affordable Care Act was years away as Republicans capitalized on voter anxiety about the coming health care changes.

Mr. Tillis reminded his colleagues of that fact and the impact on his own political career in North Carolina and Washington.

“That made me the second Republican speaker of the House since the Civil War, ladies and gentlemen, because we betrayed the promise to the American people,” he said about becoming head of the House in his home state after the tumult surrounding the Affordable Care Act. “Three years later, it actually made me a U.S. senator.”

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