Sen. Susan Collins on Tuesday voted against President Donald Trump’s sweeping domestic policy bill that would cut $1 trillion in health care and food assistance while strengthening border security and extending tax cuts that disproportionately benefit wealthy Americans.

Collins was one of three Republicans to join Senate Democrats and vote against the proposal, which included a $5 trillion increase to the debt limit. But her opposition was not enough to stop the bill. It led to a 50-50 tie, which was broken by Vice President JD Vance.

The bill now goes back to the House of Representatives, which passed a different version by a single vote last month.

In a written statement, Collins said she opposed the bill mostly because of the health care cuts, although she expressed support for work requirements that critics say will cause people to lose Medicaid simply because of the additional paperwork. She also criticized parts of the bill that would cut clean energy tax credits and eliminate incentives for heat pumps, which have proved popular in Maine.

“I strongly support extending the tax relief for families and small businesses,” Collins said. “My vote against this bill stems primarily from the harmful impact it will have on Medicaid, affecting low-income families and rural health care providers like our hospitals and nursing homes.”

Collins’ support for the bill was in doubt Tuesday morning after the Senate voted against her amendment to increase taxes on the ultra-wealthy and use the revenue to build up an emergency fund for rural hospitals expected to lose billions of dollars in Medicaid funding, including $5.9 billion to Maine over the next decade.

About one in every four Mainers — or roughly 400,000 people — rely on MaineCare, the state’s Medicaid program.

The Senate eventually did amend the bill to include $25 billion in additional funding to help rural hospitals, which was consistent with Collins’ amendment and brought the total to $50 billion. It was well short of her original request of $100 billion and did not lead Collins to support the bill.

Collins, who is the only New England Republican in Congress, is up for reelection next year. And Democrats pounced on her decision to vote in support of a procedural motion to advance the bill over the weekend, despite concerns that it could force rural hospitals to reduce services or close altogether. The procedural motion passed by a 51-49 vote, setting up the marathon floor debate and final vote vote Tuesday.

“Instead of using the power and seniority she likes to campaign on to protect Mainers from life-threatening cuts to Medicaid, SNAP, and other essential programs – Collins hung Mainers out to dry, leveraging her power to enable the passage of a bill that will devastate Maine,” Maine Democratic Party spokesperson Tommy Garcia said in a written statement. “Make no mistake: Susan Collins made the deliberate choice to advance this bill, and she’ll be held accountable for it in 2026.”

Trump’s so-called “One Big Beautiful Bill Act” seeks to extend his 2017 tax cuts, which predominantly benefited the wealthy and are set to expire at the end of the year, while increasing spending on national and border security and slashing safety net programs. The bill would cut about $1 trillion from Medicaid and food assistance, and is expected to add $3.3 trillion to the national debt, according to the nonpartisan Congressional Budget Office.

Collins and fellow moderate Sen. Lisa Murkowski of Alaska were among Republicans being closely watched in the Senate. Murkowski, who does not face voters again until 2028, voted in support of the bill, after winning carve-outs for her home state.

Sens. Rand Paul of Kentucky and Thom Tillis of North Carolina also voted against the bill. Tillis announced he would not seek reelection after being criticized by Trump on social media.

Collins made her case on the Senate floor late Monday during a so-called vote-a-rama, where Democrats forced votes on a series of amendments, including several efforts to eliminate cuts to Medicaid, which would cause an estimated 11.8 million Americans to lose their health insurance, including 60,000 Mainers.

Collins said her amendment would have doubled the $25 billion included in the bill to help rural hospitals cope with the Medicaid cuts and expand the list of eligible providers to include community health centers, nursing homes, ambulance services, skilled nursing facilities and others. The increase would have been funded by allowing Trump’s tax cuts to expire on the wealthiest Americans — families earning more than $50 million and individuals earning more than $25 million.

“Rural providers – especially rural hospitals and nursing homes – are under great financial strain right now, with many having recently closed and others at risk of closing,” Collins said. “When these facilities shut their doors, the people they serve are often left without access to health care. This amendment would help keep them open and caring for those who live in these rural communities.”

The Senate rejected the amendment by a 78-22 vote shortly after midnight. It was supported by 18 Republicans, including Murkowski . U.S. Sen. Angus King, a Maine independent who caucuses with the Democrats, also supported the amendment.

Murkowski was also under intense pressure from Senate leadership, who sweetened the deal by providing additional concessions for her home state, including exempting Alaska from having to pay a greater share of benefits provided under the Supplemental Nutrition Assistance Program.

Collins and Murkowski were the only Republicans to support an amendment from Democratic Sen. Patty Murray of Washington that sought to eliminate a provision that would prohibit Planned Parenthood from receiving Medicaid funding for health care services provided to low-income women. The amendment failed, 51-49.

King, meanwhile, firmly opposed the bill, saying during a press conference last week that it was “the worst, most regressive and most harmful piece of legislation I have ever seen,” and that he had “no choice whatsoever but to vote ‘no’ on this bill.”

He reiterated his opposition in a floor speech over the weekend. He called on the Senate to kill the bill and draft a new one that maintains tax breaks for working families, while allowing those breaks to expire for people earning more than $400,000, which would have eliminated the need for cuts to the safety net, including food assistance.

King said the bill could lead to the closures of up to five hospitals in Maine.

“All this damage to give a tax break to guys making a million bucks,” King said. “It is a shame. And it’s embarrassing to even be debating this bill.”

Republicans are hoping to meet a self-imposed deadline of sending the bill to Trump’s desk by Friday.

If approved, the budget would have to go back to the House for reconciliation. The House passed its own version of the bill on June 22, with both Rep. Jared Golden, D-2nd District, and Rep. Chellie Pingree, D-1st District, opposed.