Trump's 'One Big Beautiful Bill' before the House of Representatives—and Medicaid

US president Donald Trump wants to sign the over 900-page-long Bill into law before the 4 July holiday begins.

He has repeatedly urged Republicans, who have a slender majority in both the US Senate and the House of Representatives, not to break ranks and vote against the Bill and instead to get on board. At least three Republican senators did vote against the Bill, requiring vice president J.D. Vance to break the tie with his casting vote. The Bill was passed by 51 votes for it and 50 against.

The US president has asked House Republicans to unite and ignore the "grandstanders" in the party and send "this bill to my desk… we are on schedule — let's keep it going, and be done before you and your family go on a July 4th vacation," he wrote on Truth Social. "To my GOP friends in the House: Stay UNITED, have fun, and Vote 'YAY,” he concluded.

Trump loyalists claim that the Bill will curb waste and fraud and that the funds can then be diverted to defence and other uses.

Critics like Elon Musk object to the Bill empowering the executive — essentially, the POTUS — to vastly increase budget deficits and borrow money up to a humongous USD 4 trillion. The increased debt burden, critics believe, is a recipe for disaster and the government would collapse in future.

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Democrats object to cuts in social security spending, including Medicaid for the poorest Americans as well.

Since cuts and restrictions on Medicaid are at the heart of the conversation around the Bill, here is an explainer on what it is:

What is Medicaid?

The health insurance programme for low-income Americans that provides coverage for more than 70 million people was created in 1965 under President Lyndon Johnson, following the passage of the Social Security Amendments.

The law established Medicare, which provides health insurance coverage for Americans aged 65 and older, and Medicaid, which serves low-income people. Medicaid is financed jointly by state and federal governments

The Affordable Care Act enabled states to expand Medicaid eligibility to include non-elderly adults whose income was up to 138 per cent of the federal poverty level — a national average income of $ 44,367 for a family of four this year. 40 states and Washington DC have so far adopted the expansion, 90 per cent of which is funded by the federal government.

Both the House and Senate versions of the Bill would reduce funding for the programme by hundreds of billions of dollars, according to the Congressional Budget Office (CBO). Nearly 12 million adults could lose health insurance because of the proposed cuts in the Senate’s revised bill over the next decade, the CBO estimated in a report released on Saturday, 28 June 2025.

It doesn't take a genius to know when you're being lied to. Donald Trump has claimed on multiple occasions that his 'Big, Beautiful Bill' does not cut Medicaid.

To the American people: right now, Donald Trump is lying to you. 17 million people will lose their health care. pic.twitter.com/bua3KwQkRy

— Team AOC (@TeamAOC) July 2, 2025

The White House has rejected the CBO’s findings, insisting that the cuts to the programme will only reduce fraud and waste.

How many people are enrolled in Medicaid?

A report in Time magazine quoted the Pew Research Center’s finding that Medicaid enrolment stood at around 20 per cent of the total US population and has for the last several years.

Some 71.3 million low-income people in the U.S. were enrolled in the programme in March 2025, more than half of whom were adults. The figure has clearly declined from the 100 million people enrolled in 2023, following the end of the continuous enrolment introduced due to the Covid pandemic.

The proportion of people enrolled in the programme varies significantly between states. More than 30 per cent of residents in Louisiana and New Mexico are covered by Medicaid, compared to just 12 per cent in Wyoming and North Dakota.

Who is eligible for Medicaid?

The federal government sets broad eligibility requirements. It also requires states to cover some groups when they fall below certain income levels, including pregnant women, families with children, disabled people and most children in foster care.

Since the programme is state-administered, Medicaid eligibility varies from state to state. While some immigrants are eligible for coverage in states such as New Jersey or New York, one of the provisions in the Senate version of the Bill seeks to cut federal funding to states that purportedly use Medicaid to provide healthcare to undocumented immigrants.

Illegals don't get Medicaid. The only way you get Medicaid is if you've qualified as a legal immigrant and you have to be in the country 5 years. pic.twitter.com/hqci7YY44u

— Hypocrisy Now. (@Hypocrisy_45) July 1, 2025

Are Medicaid recipients required to work?

Current regulations in most states do not require Medicaid recipients to work.

In Georgia, however, applicants are required to prove that they completed at least 80 hours of work or volunteer services to receive coverage. Because of this verification system, a ProPublica report found that Georgia enrolled only some 7,500 residents out of the estimated 250,000 eligible residents.

Attempts to implement work requirements in Arkansas were struck down by a federal court in 2019.

A federal judge blocked similar requirements in Kentucky from taking effect. Idaho, Kentucky, and Indiana have adopted legislation to impose work requirements this year.

Work requirements are being considered on a federal level in Trump’s ‘One Big Beautiful Bill’. The package would require Medicaid recipients from ages 19 to 64 to verify that they work at least 80 hours a month, or are training for a new job, studying or volunteering. People’s work status would be checked twice a year.

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