Washington D.C. — The United States House of Representatives on May 22, 2025, narrowly approved a comprehensive Republican-backed legislative package championed by President Donald Trump, often referred to by the President as “The One, Big, Beautiful Bill.” The measure, also described by critics as a “Deficit-Swelling Tax Bill,” represents a multitrillion-dollar economic package utilizing the budget reconciliation process.
Passed by a razor-thin vote of 215-214-1, the legislation now moves to the Senate for consideration. While encompassing broad economic measures, a significant portion of the bill is dedicated to substantial alterations of key national health programs, potentially impacting millions of Americans.
Key Health Program Revisions
The bill includes pivotal changes to Medicaid, the federal and state partnership program providing health coverage to eligible low-income adults, children, pregnant women, elderly adult’s and people with disabilities. Among the most impactful provisions are accelerated timelines for implementing work requirements for beneficiaries. Specifically, the bill imposes an 80-hours-a-month work requirement for certain adults who do not have dependent children or disabilities.
The House Energy and Commerce Committee’s contribution to the bill outlines further specific Medicaid provisions. These include implementing work and community engagement requirements on Medicaid expansion populations and introducing $35 copays for certain enrollees. Additionally, the legislation proposes reducing the duration of retroactive Medicaid and Children’s Health Insurance Program (CHIP) coverage from the current 90 days down to 30 days.
Potential Financial and Enrollment Impacts
Analysis from the Kaiser Family Foundation (KFF) suggests these proposed changes to Medicaid could result in substantial spending cuts, estimating a reduction of $625 billion over a decade. Furthermore, KFF reports indicate that the stricter eligibility criteria and requirements could lead to a significant drop in enrollment, potentially impacting over 10 million people who currently rely on the program for healthcare coverage.
Controversial Coverage Restrictions
The bill also contains provisions that have drawn significant controversy, particularly concerning reproductive health and gender-affirming care. It would prohibit Medicaid from covering non-abortion services provided by Planned Parenthood clinics. Moreover, the legislation limits coverage of gender-affirming care under Affordable Care Act (ACA) plans and explicitly bans Medicaid and CHIP coverage for this treatment for individuals of all ages.
Other Significant Provisions
Beyond Medicaid and the specified coverage restrictions, the sprawling bill addresses other areas of the healthcare landscape and broader economic policy. It includes measures to expand Health Savings Accounts (HSAs), tax-advantaged medical savings accounts available to taxpayers enrolled in high-deductible health plans.
The legislation also eliminates eligibility for Medicare and premium tax credits under the Affordable Care Act for undocumented immigrants and those holding temporary immigration status. Additionally, the bill proposes reforms for pharmacy benefit managers (PBMs), the third-party administrators of prescription drug programs, and modifies the exclusion for orphan drugs – those developed to treat rare diseases – under the federal drug price negotiation program.
Ways and Means Chairman Jason Smith commented on the bill’s passage, underscoring its significance as it transitions from the House to the Senate for the next stage of the legislative process. The Senate is expected to take up the measure in the coming weeks, where it faces an uncertain path and likely further debate and potential amendments.
