Two high-profile Republicans, Sen. Lisa Murkowski of Alaska and Sen. Susan Collins of Maine, notably voted against his confirmation. Republican Sen. Mitch McConnell, the longest-serving Senate party leader, who announced Thursday he will not be seeking re-election in 2026, voted in favor of Patel's nomination, which came as a surprise to many.

Patel is expected to be confirmed unless more than three Republican senators defy Trump's will and vote against him.