President Donald Trump has achieved the biggest legislative win of his presidency after most MAGA Republicans fell into line to pass his sweeping domestic policy bill.
But doctors and patients have warned of a return to “COVID-style healthcare chaos” as an estimated 12 million Americans could end up losing health insurance due to cuts in Medicaid.
After a marathon voting session, hours of negotiations and a series of raging overnight Truth Social posts, the “one big beautiful bill” passed 218-214 on Thursday after Speaker Mike Johnson was able to convince enough Republicans to vote for it.
Two Republicans voted no: Thomas Massie of Kentucky and Brian Fitzpatrick of Pennsylvania.
The bill is a significant victory for Trump, as it extends the tax cuts passed during his first administration, boosts funding for border security and gives temporary tax deductions to tipped workers and those on overtime.
However, it also reduces food assistance for the poor, increases the debt limit by $5 trillion, and includes work requirements for Medicaid while restricting state fees on health care providers that are used to pay for Medicaid.
“Elon Musk and I agree with each other. The GOP tax scam is a disgusting abomination,” said Democrat House leader Hakeem Jeffries, who spent nearly nine hours on his feet in the chamber trying to delay the vote.
Critics have also warned that the bill will be a political powder keg for Republicans ahead of next year’s midterm elections, putting pressure on the health system and hurting vulnerable families.
“This is going to mirror COVID times,” Tennessee doctor Laura Andreson told the Daily Beast.
“As people become uninsured, health providers will become the emergency room because people will no longer have a primary carer. Our ERs will be brimming over with patients that haven’t had their routine health care, and that’s going to increase wait times for everyone.”
Conservative Republicans had earlier threatened to tank the Senate version of the mega-bill because it did not match their goals for the legislation after changes were made to the bill passed in the House by one vote last month.
They slammed Trump’s 4th of July deadline as artificial and said the House should take more time to make changes to the bill to get them to “yes.”
Johnson insisted it would be “impossible” to make every member happy with the process as he worked to get enough votes. Four holdouts would have been enough to kill the bill.
The president was working the phones and meeting with House members in person at the White House on Wednesday in an effort to get more Republicans to say “yes.”
But by the early hours of Thursday morning, with fiscally conservative Republicans still holding out, Trump’s patience was clearly wearing thin.
“What are the Republicans waiting for??? What are you trying to prove???” he wrote. “MAGA IS NOT HAPPY, AND IT’S COSTING YOU VOTES!!!”
A few hours later, some of the defectors had changed their minds, although it is not clear what shifted, as Johnson insisted that no promises were made to secure votes.
The legislation eventually passed at shortly after 2:30pm on Thursday.
The bill shifts some of the funding for the Supplemental Nutrition Assistance Program (SNAP) back to states. It also includes work requirements that able-bodied adults under age 65 would have to work 80 hours per month, with exceptions for those with children under 10.
According to the latest projection from the Congressional Budget Office, the national debt is expected to rise by $3.3 trillion over the next decade, with revenues falling by $4.5 trillion while spending is cut by $1.2 trillion.
That analysis also found 11.8 million more Americans would become uninsured by 2034 if the bill passed, raising concerns for some more moderate members.
The Medicaid changes, in which able-bodied adults under 65 would also be required to work 80 hours per month, with exceptions for those with children under 14, have already proved contentious.
In Iowa, where Trump was traveling later on Thursday for a “Salute to America” celebration, former nurse Shelley Werger, who is disabled, relies on Medicare, while four of her adopted children have special needs and rely on Medicaid.
“I’m very scared,” she told the Daily Beast. “It’s hard enough in our country to get ahead, and it feels like they are taking away the last strings.”
Medicaid is a crucial lifeline for Michiganders everywhere. Let’s hear from more Michiganders whose health, wealth, and lives are at threat.🧵⬇️ https://t.co/pY9v4rCTuW
— Governor Gretchen Whitmer (@GovWhitmer) July 2, 2025
In the election battleground of Michigan, Democratic Governor Gretchen Whitmer posted numerous examples of people in her state who would also be affected.
One was a mother who feared her 16-year-old son with cystic fibrosis would die without prescription coverage. Another was a woman who feared “my disability would go unchecked.”
But speaking before the vote, Johnson said Americans said the changes would put “fairness back in the system.”
“We’re going to make sure that Americans who do need and deserve these critical programs won’t have to compete against people who can work but choose not to do so,” he said. “That’s not right.”
Before the House vote, the bill ended up passing in the Senate on Tuesday by 51 to 50, with Vice President J.D. Vance casting the tie-breaking vote.
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