The US House of Representatives approved the Senate version of Trump’s “Big Beautiful Bill” on July 3 in a narrow 218-214 vote, clearing the way for it to be signed into law by US President Donald Trump.
The bill will be sent to Trump’s desk for him to sign by a self-imposed 5 pm July 4 deadline.
Two Republicans broke ranks to join all Democrats in opposition. GOP leaders worked through the night, and Trump personally pressured several holdouts to secure the final votes needed to send the legislation to his desk.
The legislation includes an estimated $4.5 trillion in tax cuts over the next decade, extending and expanding Trump’s previous term tax provisions from 2017.
However, it pays for these tax breaks in part by cutting $1 trillion from Medicaid, the joint federal-state insurance program that serves more than 75 million low-income Americans. The deep cuts to Medicaid were of the most contentious elements of the bill among Democratic senators and a small group of Republicans.
Spanning approximately 887 pages, the legislation features a wide range of “provisions” planned over the next ten years.
In addition to the deep cuts to Medicaid, it includes other sweeping tax cuts such as eliminating taxes on tips and overtime pay, as well as generous tax breaks for corporations and high-income earners. However, the administration argues the tax cuts will benefit the working class.
Other items include a rollback of solar energy tax credits and increased funding for national defense and deportation efforts.
Notably, despite claims by Trump, the bill does not eliminate taxes on Social Security benefits.
Related: Massive Healthcare Cuts Targeting NIH and Medicaid Included in Trump’s 2026 ‘Skinny Budget’ Proposal
According to the Congressional Budget Office (CBO), a non-partisan think-tank, the Medicaid reduction alone could result in nearly 11.8 million people not having insurance by 2034. This includes an estimated 1.4 million individuals without verified citizenship, nationality or satisfactory immigration status who would lose coverage under state-only funded programs by 2034.
Big Beautiful Bill Provisions
The bill delivers what the administration calls the “largest tax cut in US history for middle- and working-class Americans.”
Key provisions include eliminating taxes on tips, overtime pay and Social Security benefits, as well as expanding the child tax credit and offering a tax break on car loans for American-made vehicles.
The administration says the bill protects Medicaid “for American citizens who need it — like pregnant women, children, seniors, people with disabilities and low-income families,” while “eliminating waste, fraud and abuse.”
The bill reinforces Trump’s aggressive border security agenda, allocating funds to deport up to 1 million undocumented immigrants annually, complete construction of the border wall and expand personnel with 10,000 additional ICE officers, 5,000 new Customs agents and 3,000 new Border Patrol agents.
It also includes funding for Trump’s “Golden Dome” missile defense shield, restocks America’s arsenal, delivers the largest Coast Guard upgrade since WWII and improves the country’s “military readiness.”
From Senate to Trump’s Desk
The approval of the “Big Beautiful Bill” marks a major milestone in Trump’s return to the White House and underscores the influence the Republican Party now holds in a right-leaning Congress.
On July 1, 2025, the US Senate passed the bill in a dramatic 51-50 vote.
Vice President JD Vance cast the tie-breaking vote, propelling the bill forward despite concerns over its projected economic and human impact.
According to AP News, what began as a routine, though grueling, day of amendment votes — known as a ‘vote-a-rama’ — quickly turned into an all-night marathon as Republican leaders scrambled to secure enough support for the bill.
To comply with reconciliation rules and ease political pressure, Republicans portrayed the bill as generating a $500 billion surplus, achieved by treating the extension of existing tax cuts as having no cost.
Democrats and financial analysts sharply criticized this as an “accounting gimmick,” warning it could set a troubling precedent for future budget calculations.
The Democrats also blasted the bill in a statement from the House Budget Committee Democrats, titled “Trump’s Big Bill Steals from the Poor to Give to the Ultra-Rich.” They argue the bill would strip healthcare from 16-17 million Americans, gut food assistance and worsen income inequality to finance tax breaks favoring the ultra-rich.
Critics say the bill highlights a broader failure by both parties. Despite repeated promises, lawmakers have consistently failed to reform the US healthcare system, leaving millions uninsured or underinsured.
Efforts to expand access or control costs have routinely stalled amid partisan gridlock, bureaucratic inertia and pressure from industry stakeholders. Until Congress breaks this pattern, deep cuts like those in the current bill will continue to shift burdens onto vulnerable populations.
Health policy experts warn that the consequences of Trump’s new bill could be severe, particularly for rural hospitals, which rely heavily on Medicaid reimbursements.
The bill includes a $50 billion rural health stabilization fund, but hospital associations argue that this falls far short of what’s needed. More than 150 rural hospitals have already closed since 2010, and the American Hospital Association (AHA) projects nearly $70 billion in losses across the healthcare system under the new law.
Reactions
House Minority Leader Hakeem Jeffries, D-NY, delivered his party’s final opposition to the bill with a record-breaking “magic minute” speech, an uncapped address traditionally reserved for party leaders.
Speaking for eight hours and 44 minutes, Jeffries condemned the bill, saying, “Shame on the people who decided to launch that kind of all-out assault on the health and the well-being of everyday Americans.”
AHA president and CEO Rick Pollack said the group was “very disappointed” by the passage of the bill.
“The real-life consequences of these nearly $1 trillion in Medicaid cuts — the largest ever proposed by Congress — will result in irreparable harm to our health care system, reducing access to care for all Americans and severely undermining the ability of hospitals and health systems to care for our most vulnerable patients.”
After the official passing of the bill, Pollack said, “No matter how often repeated, the magnitude of these reductions — and the number of individuals who will lose health coverage — cannot be simply dismissed as waste, fraud and abuse.”
“The faces of Medicaid include our children, our disabled, our seniors, our veterans, our neighbors and friends. The real-life consequences of these reductions will negatively impact access to care for all Americans.”
A Budget Lab report from Yale University reveals that the wealthiest 20% of Americans would receive an average annual benefit of $6,055, meanwhile the poorest households would lose roughly $700, underscoring how the bill reallocates resources upward while squeezing the most vulnerable.
The analysis also found that the budget bill would add $3 trillion to the debt over the 2025-2034 period (0.84% of GDP over this time frame) and $12.1 trillion from 2025-2055 (0.71% of GDP over this time period).
Critics have called the bill a massive redistribution of wealth to the top 1%, while downshifting costs onto low-income communities, people with disabilities and children in what is being called “taking from the poor and giving to the rich.”
Senator Susan Collins (R-ME), one of three Republicans to vote against the measure, cited the devastating effect the cuts would have on her constituents. Meanwhile, fiscal conservatives have expressed concern over the $3.3 trillion increase to the federal deficit projected by the CBO and the Budget Lab report.
As Trump prepares to sign the bill, attention now turns to how the policy will be implemented, and whether the political backlash will shape the upcoming 2026 midterm elections.
“This bill moves us in the wrong direction,” said American Medical Association (AMA) president Bobby Mukkamala, MD, in a statement. “It will make it harder to access care and make patients sicker. It will make it more likely that acute, treatable illnesses will turn into life-threatening or costly chronic conditions. That is disappointing, maddening and unacceptable.”
Join or login to leave a comment
JOIN LOGIN