WASHINGTON — By a single, tiebreaking vote, Senate Republicans on Tuesday approved President Donald Trump’s signature legislation, a major step toward passage of a bill that would expand tax cuts while cutting health care access to millions.

Just 50 Republicans supported the legislation, forcing Vice President JD Vance to cast the deciding vote.

GOP Sens. Rand Paul of Kentucky, Thom Tillis of North Carolina and Susan Collins of Maine joined all Democrats in the chamber in opposition to the bill.

The legislation, called the “One Big Beautiful Bill Act,” passed with the support of a key skeptic of its most controversial provisions: Republican Sen. Lisa Murkowski of Alaska, who persuaded Senate leadership to include several provisions uniquely beneficial to her state to secure her support.

The bill extends tax cuts and benefits first passed in 2017 under Trump that were set to expire later this year, while creating new eligibility requirements for food stamps and Medicaid, raising barriers to health care access that could result in 11.8 million Americans losing coverage by 2034, according to the nonpartisan Congressional Budget Office.

The House of Representatives will now have a second vote on a reconciled version of the bill. Should it pass, it will go to the president’s desk for his signature.

But the CBO estimates that the Senate version of the bill would add roughly $4 trillion to the national debt — $1 trillion more than the House version — over the next decade, and even more if Congress votes later on to remove several expiration dates built into the legislation.

The House Freedom Caucus, which was founded by several GOP lawmakers to advocate for fiscal discipline, had warned Senate Republicans on Monday to make major changes to the bill to “at least be in the ballpark of compliance with the agreed upon House budget framework.”

“It’s not what we agreed to,” the caucus wrote in a statement. “Republicans must do better.” The bloc did not immediately respond to the Senate vote.

Maya MacGuineas, president of the Committee for a Responsible Federal Budget, said in a statement that the Senate bill would add $600 billion to the deficit in 2027 alone and push deficits above 7% of gross domestic product.

“The level of blatant disregard we just witnessed for our nation’s fiscal condition and budget process is a failure of responsible governing,” MacGuineas said. “These are the very same lawmakers who for years have bemoaned the nation’s massive debt, voting to put another $4 trillion on the credit card.”

“The Senate took a bill that already borrowed way too much, and took it from bad to worse,” MacGuineas added.

Speaking with reporters after the vote, Murkowski said the choice was “agonizing,” but that she “had to look on balance, because the people in my state are the ones that I put first.

“We do not have a perfect bill by any stretch of the imagination. My hope is that the House is going to look at this and recognize that we’re not there yet,” she said.

Collins, who is up for reelection in Maine next year, said that she supported the bill’s provisions extending tax cuts and benefits.

“My vote against this bill stems primarily from the harmful impact it will have on Medicaid, affecting low-income families and rural healthcare providers like our hospitals and nursing homes,” she wrote on X. “The Medicaid program has been an important healthcare safety net for nearly 60 years that has helped people in difficult financial circumstances.”

Trump was at an event in Florida when the vote occurred, touring a detention facility for migrants set in the Everglades. The president’s megabill also includes a significant increase in funding for border security and defense.

“Oh, thank you,” Trump said amid applause when he was told the news of the vote. “I was also wondering how we’re doing, because I know this is prime time.”

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