The proposal would salvage some clean-energy tax credits and phase out others more slowly, making up some of the cost by imposing deeper cuts to Medicaid than the House-passed bill would.

Without changes to the GOP's "big, beautiful bill," Sen. Josh Hawley fears "there’s going to be a lot of rural hospitals in Missouri that close."

The legislation keeps some House provisions, like new Medicaid rules, while making significant changes in other areas, including Medicare and the state and local tax deduction.