Washington, DC (BN24) – A sweeping budget bill championed by President Donald Trump could strip health insurance from nearly 12 million Americans and add $3.3 trillion to the national debt, according to new projections from the Congressional Budget Office.
The nonpartisan analysis is the most comprehensive accounting yet of the potential fallout from Trump’s “One Big Beautiful Bill Act,” which narrowly cleared a procedural hurdle in the Senate late Saturday after hours of tense negotiations and party infighting.
The CBO projected that the legislation would slash about $1 trillion in health care funding, primarily through deep cuts to Medicaid, the program serving low-income, disabled, and elderly Americans. Those reductions, paired with new work requirements and restrictions on state taxes to finance Medicaid, would leave millions without coverage over the next decade.
Republican leaders have defended the measure as a necessary overhaul to curb waste and expand tax relief. But critics warn the trade-offs would be catastrophic.
“This is tax cuts for the wealthiest to end up cutting health care, plain and simple,” said Democratic Sen. Mark Warner of Virginia in an interview Sunday.
The bill advanced by a 51-49 vote after two Republican senators—Thom Tillis of North Carolina and Rand Paul of Kentucky—joined all Democrats in opposition. Paul objected to provisions raising the debt ceiling, while Tillis said the Medicaid cuts would devastate his state. Hours later, Tillis announced he would not seek re-election.
Senate rules required a marathon 16-hour reading of the nearly 1,000-page bill over the weekend. Lawmakers now have 20 more hours allocated for debate, and Democratic leaders have pledged to use every minute to delay passage.
Republicans hold a narrow 53-seat majority, leaving them little room for additional defections. Vice President JD Vance could cast a tie-breaking vote if needed, underscoring the razor-thin margin.
President Trump, who has set a July 4 deadline to deliver the legislation to his desk, hailed the initial Senate vote as a “great victory” and urged Republicans to remain unified.
“The White House said failure to pass it would be the ‘ultimate betrayal,’” Trump told reporters Saturday.
While the legislation retains core campaign promises—including new tax cuts on overtime pay and tips and extending the 2017 Republican tax reductions—it relies on controversial spending cuts to offset the cost.
Under the plan, most Americans would see tax relief next year, though wealthier households would receive the largest benefits as a share of their incomes, according to the nonpartisan Tax Policy Center.
The bill imposes work requirements on most adults to qualify for Medicaid and reduces the taxes states can levy on health providers, a key source of funding for the program. In response to concerns from rural-state Republicans, Senate negotiators boosted a rural hospital relief fund from $15 billion to $25 billion in the latest draft.
Food assistance would also be restricted, with parents of children 14 and older required to show proof of employment to access benefits. Additional provisions would shift some federal costs for Medicaid to states beginning in 2028.
Sen. Markwayne Mullin, an Oklahoma Republican, defended the bill on NBC Sunday, saying it aims to curb “fraud, waste and abuse” in federal programs.
“We don’t pay people in this country to be lazy,” Mullin said. “We want to give them an opportunity. And when they’re going through a hard time, we want to give them a helping hand.”
If the Senate passes the measure, it would return to the House for final approval before heading to the president’s desk.
BBC
