Senate Republicans unveil the intricate bargaining process leading to the approval of Trump's colossal $3.3 trillion legislation spearhead
The One Big Beautiful Bill Act: A Landmark Legislation with Controversial Healthcare Cuts
On July 4, 2025, President Trump signed into law the One Big Beautiful Bill Act (OBBB), a sweeping piece of legislation that has far-reaching implications for taxation, immigration, healthcare, and other priorities. The bill, passed through a special budget reconciliation process in the Senate, has been met with both praise and criticism for its controversial and substantial cuts to social programs.
The OBBB, also known as the "big, beautiful bill," includes provisions for border security, defense, energy, and aims to extend or make permanent many of the 2017 Tax Cuts and Jobs Act. However, it is the bill's healthcare provisions that have sparked the most debate.
The OBBB cuts over $1 trillion from health programs, primarily Medicaid. This reduction is estimated to result in 10 million people losing health insurance coverage. The bill also modifies Medicaid eligibility by enforcing stricter work reporting requirements and blocking services to undocumented immigrants, effectively reducing coverage for many low-income populations. Additionally, it cuts at least $120 billion from the Supplemental Nutrition Assistance Program (SNAP), reducing food aid for low-income families.
The law also speeds up Medicare’s hospital trust fund insolvency timeline and will trigger automatic spending cuts totaling about $500 billion from 2026 to 2034.
In terms of its passage, the key factor was using the budget reconciliation process, which allows legislation related to budget and spending to pass the Senate with a simple majority vote, bypassing the 60-vote filibuster threshold typically required for most bills. This special process facilitated the passage of the bill despite its controversial and substantial cuts to social programs.
The bill also introduces challenging work reporting requirements starting January 1, 2027, under which many Medicaid expansion adults risk losing coverage unless they report at least 80 hours per month of work, school, or community engagement activities, with potential lockouts from ACA marketplace subsidies for noncompliance.
Despite its cuts, the bill includes new funding for rural healthcare, establishing the Rural Health Transformation Program to improve healthcare access and sustainability in rural areas.
This bill represents the largest rollback of federal healthcare support in U.S. history with major implications for millions of Americans' health coverage and welfare. The journey to pass the bill began over a year and a half ago, with Senate Republicans discussing their agenda in a policy retreat. The bill was a product of months of behind-the-scenes work by Senate Republicans, with key negotiations taking place late at night to secure the support of Senators like Lisa Murkowski. However, a Republican family feud in the Senate over the nature of cuts to Medicaid, particularly aimed at the provider tax rate, delayed the bill's passage. A $50 billion rural hospital fund was created to smooth over the disagreement, but some lawmakers vowed to ensure that the changes to the provider would never take effect.
Senators like Josh Hawley expressed dissatisfaction with the Medicaid provisions in the bill, while fiscal hawks like Ron Johnson and Rick Scott wanted deeper cuts to Medicaid. On the other hand, Senators like Cynthia Lummis advocated for amendments to save money and reduce mandatory spending. The real, nitty-gritty work on the bill began in January, where concepts were taken and fleshed out into legislation. An amendment was offered to address the fiscal hawks' concerns, but it never came to the floor. In the end, only three Republicans, Sens. Rand Paul, Collins, and Tillis, voted against the bill.
Sen. Thom Tillis emphasizes that the bill averted a nationwide tax hike as a key selling point. The bill's passage was also marked by a marathon vote-a-rama, with Sen. Chuck Schumer forcing the reading of the entire bill and a marathon vote-a-rama during its passage.
The economy, according to Sen. Tillis, was able to withstand COVID due to the bill's passage. The OBBB represents a significant shift in U.S. policy and is likely to have lasting impacts on the nation's healthcare system and social welfare programs.
- The One Big Beautiful Bill Act, with its controversial healthcare cuts, has sparked debates in both the general news and policy-and-legislation arenas, causing divisiveness in politics.
- The OBBB has far-reaching effects on the economy, as the bill's healthcare provisions, which include $1 trillion in cuts to health programs like Medicaid and SNAP, may lead to job losses and increased financial strain for many low-income individuals.
- The passage of the OBBB has coincided with a period of controversy in the political landscape, as the controversial healthcare cuts have pitted Republicans against each other, leading to delays in the bill's passage and ongoing debates on its implications for healthcare and social welfare policies.
