As President Donald Trump’s signature tax cuts and spending bill makes its way through Congress, one of Florida’s two U.S. senators has emerged as a key figure in the legislative talks.

Over the weekend, Rick Scott announced he would offer a key amendment to Trump’s One Big Beautiful Bill Act. Scott is proposing a major change to Medicaid — the joint federal and state program that insures children, people with disabilities and poor people — in the states that have expanded the program under the Affordable Care Act. (Florida is not one of those states.)

“This would be the nail in the coffin for the Affordable Care Act’s Medicaid expansion if it passes,” said Joan Alker, the co-founder of the Center for Children and Families and a research professor at Georgetown University.

The Affordable Care Act gave states the option to expand Medicaid to adults up to 138% of the federal poverty level — currently about $44,300 in income for a family of four. More than 40 states have taken advantage.

The federal government pays for 90% of the Medicaid coverage for the 20 million or so Americans covered under the Affordable Care Act expansion, a much higher reimbursement rate than is given under traditional Medicaid. (In 2013, as Florida governor, half a decade before he was elected to the Senate, Scott supported expanding Medicaid. At the time, the federal government was offering to pay 100% of the cost. Scott later reversed course.)

Under Scott’s proposal, the states that have expanded Medicaid would no longer be eligible for that 90% reimbursement from the federal government for covering non-disabled adults who have no children.

“When blue states abuse Medicaid to give handouts to able-bodied, childless, working-age adults, they’re jeopardizing this critical program for those who need it the most,” Scott posted to X Monday. “The Big Beautiful Bill is our chance to protect Medicaid for those in need.”

Taking effect in 2031, Scott’s proposal would save the government hundreds of billions of dollars, his office said — and likely cost thousands their health care. Those covered by Medicaid before 2031 would remain eligible.

Scott has said the proposal would discourage states from using federal money to pay for health care for people who are in the country illegally. Those who lack legal status are already ineligible for federal health care benefits. However, some states, such as California, have state programs that offer coverage to people in the country illegally.

By proposing the amendment, Scott is inserting himself into a high-stakes policy and political debate. Trump is hoping to make good on many of his 2024 promises through the Big Beautiful Bill, a version of which has already passed the House. He’s given congressional Republicans a July 4 deadline to pass the bill.

It’s not clear that Republicans will meet the president’s timeline. The House and the Senate would have to agree on identical versions of the bill by then, a daunting prospect. Republicans control the House and Senate, but only narrowly.

Polls show the bill, which most notably extends the tax cuts supported by Trump at the cost of trillions of dollars, is unpopular. Critics note that Republicans are arguing that Medicaid spending is out of control while pushing for an expensive extension of Trump’s signature tax cuts.

Republicans who oppose Trump’s bill are likely to hear about it from the president. After Sen. Thom Tillis of North Carolina voted against advancing the bill over the weekend, Trump blasted a missive on social media promising to run a primary opponent against Tillis. Later that day, Tillis announced he would not seek reelection.

But Trump also warned Republicans not to cut too many federal programs, acknowledging the potential political cost of doing so.

“You still have to get reelected,” Trump wrote. “Don’t go too crazy!”

Scott’s vote could prove crucial. Florida’s senior senator, an early backer of Trump, has long supported the president’s agenda in Congress. But over the weekend, there were hints that Scott’s vote for the Senate version of the Big Beautiful Bill is dependent on his Medicaid amendment passing. On Saturday night, Scott was one of the last three Republicans to vote to advance the bill.

When asked whether he would support the bill without the amendment, Scott told reporters he was confident the amendment would pass.

Even without Scott’s amendment, the Senate version of the bill cuts Medicaid more than the House version. It’s not clear whether those cuts will be politically palatable in the House.

But Scott expressed confidence about the Senate bill’s prospects.

“I don’t think it’s going to lose support in the House,” Scott told reporters.

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