Medicaid

June 26 (UPI) — The U.S. Supreme Court ruled Thursday that Planned Parenthood South Atlantic, the nonprofit’s arm that covers South Carolina, can’t sue the state over its closing off of the nonprofit’s Medicaid funding because it provides abortions.

“The U.S. Supreme Court has affirmed our right to exclude abortion providers from receiving taxpayer dollars,” wrote Gov. Henry McMaster, R-S.C., in an X post Thursday.

“Seven years ago, we took a stand to protect the sanctity of life and defend South Carolina’s authority and values,” he added, “and today, we are finally victorious.”

The 6-3 decision followed the court’s ideological makeup, with the three liberal judges in dissent while the six conservative judges ruled in support.

The court’s syllabus noted 42 U.S. Code Section 1983, which allows private parties to file suit against state officials who violate their Constitutional rights. However, in the opinion of the Court, which was delivered by Justice Neil Gorsuch, he wrote that “federal statutes do not automatically confer [Section 1983]-enforceable ‘rights.'”

“This is especially true of spending-power statutes like Medicaid, where ‘the typical remedy’ for violations is federal funding termination, not private suits,” he continued.

“No court has addressed whether that Medicare provision creates [Section 1983] rights,” he later wrote.

Justice Ketanji Brown Jackson wrote the dissent, and she also referred to Section 1983.

“South Carolina asks us to hollow out that provision so that the State can evade liability for violating the rights of its Medicaid recipients to choose their own doctors,” Jackson stated. “The Court abides South Carolina’s request. I would not.”

South Carolina had announced in July of 2018 that Planned Parenthood could no longer participate in the state’s Medicaid program, under a state law that prohibits the use of its own public funding for abortions.

The order further affected patients in that it had the effect of also blocking Planned Parenthood patients from receiving services such as breast exams, sexually transmitted diseases and contraception.

Planned Parenthood South Atlantic announced on its social media platform Thursday that, “Today, the U.S. Supreme Court decided that people using Medicaid in South Carolina no longer have the freedom to choose Planned Parenthood South Atlantic as their sexual and reproductive health care provider.”

“If you are a patient using Medicaid, keep your appointment,” the post continued. “We’re still here to provide you with the low or no cost care you deserve.”

The post concluded with “We’re in this with you, and we aren’t going anywhere.”

WASHINGTON — The Supreme Court ruled Thursday that states may exclude Planned Parenthood clinics from providing medical screenings and other healthcare for women on Medicaid.

The court’s conservative majority reversed the longstanding rule that said Medicaid patients may obtain medical care from any qualified provider.

In a 6-3 vote, the justices ruled the Medicaid Act does not give patients an “individual right” to the provider of their choice.

The dispute has turned on abortion. Medicaid is funded by the federal government and the states. For decades, conservative states have argued their funds should not be used in Planned Parenthood clinics because some of those clinics perform abortions.

But until now, the federal government and the courts had said that Medicaid patients can go to any qualified provider for healthcare.

In dissent, Justice Ketanji Brown Jackson said the decision “will deprive Medicaid recipients in South Carolina of their only meaningful way of enforcing a right that Congress has expressly granted to them. And, more concretely, it will strip those South Carolinians — and countless other Medicaid recipients around the country — of a deeply personal freedom: the ability to decide who treats us at our most vulnerable.” Justices Sonia Sotomayor and Elena Kagan agreed.

Planned Parenthood clinics provide cancer screenings, birth control medical screenings, pregnancy testing, contraception and other healthcare services.

Congress pays most of the state’s costs for Medicaid, and it says “any individual eligible for medical assistance” may receive care from any provider who is “qualified to perform the service.”

Lupe Rodríguez, executive director of National Latina Institute for Reproductive Justice, called the decision “an attack on our healthcare and our freedom to make our own decisions about our bodies and lives. By allowing states to block Medicaid patients from getting care at Planned Parenthood health centers, the Court has chosen politics over people and cruelty over compassion.”

Three years ago, the Supreme Court overturned Roe vs. Wade and ruled states may prohibit nearly all abortions.

Nonetheless, South Carolina continued its legal fight to prevent Medicaid patients from receiving care at Planned Parenthood’s clinics in Charleston and Columbia.

Former Gov. Henry McMaster, who issued the ban on Planned Parenthood in 2018, said he did so to protect “his state’s sovereign interests.”

Critics of the move said the state has a severe shortage of doctors and medical personnel who treat low-income patients on Medicaid.

WASHINGTON — Senate Republicans on Monday proposed deeper Medicaid cuts, including new work requirements for parents of teens, as a way to offset the costs of making President Trump’s tax breaks more permanent in draft legislation unveiled for his “Big Beautiful Bill.”

The proposals from Republicans keep in place the current $10,000 deduction of state and local taxes, called SALT, drawing quick blowback from GOP lawmakers from New York and other high-tax states, who fought for a $40,000 cap in the House-passed bill. Senators insisted negotiations continue.

The Senate draft also enhances Trump’s proposed new tax break for seniors, with a bigger $6,000 deduction for low- to moderate-income senior households earning no more than $75,000 a year for singles, $150,000 for couples.

All told, the text unveiled by the Senate Finance Committee’s Republicans provides the most comprehensive look yet at changes the GOP senators want to make to the 1,000-page package approved by House Republicans last month. GOP leaders are pushing to fast-track the bill for a vote by Trump’s Fourth of July deadline.

Sen. Mike Crapo (R-Idaho), the chairman, said the proposal would prevent a tax hike and achieve “significant savings” by slashing green energy funds “and targeting waste, fraud and abuse.”

It comes as Americans broadly support levels of funding for popular safety net programs, according to the poll from the Associated Press-NORC Center for Public Affairs Research. Many Americans see Medicaid and food assistance programs as underfunded.

What’s in the “Big Beautiful Bill” so far

Trump’s “Big Beautiful Bill” is the centerpiece of his domestic policy agenda, a hodgepodge of GOP priorities that Republicans are trying to swiftly pass over unified opposition from Democrats — a tall order for the slow-moving Senate.

Fundamental to the package is the extension of some $4.5 trillion in tax breaks approved during his first term, in 2017, that are expiring this year if Congress fails to act. There are also new ones, including no taxes on tips, as well as more than $1 trillion in program cuts.

After the House passed its version, the nonpartisan Congressional Budget Office estimated the bill would add $2.4 trillion to the nation’s deficits over the decade, and leave 10.9 million more people without health insurance, due largely to the proposed new work requirements and other changes.

The biggest tax breaks, some $12,000 a year, would go to the wealthiest households, CBO said, while the poorest would see a tax hike of roughly $1,600. Middle-income households would see tax breaks of $500 to $1,000 a year, CBO said.

Both the House and Senate packages are eyeing a massive $350-billion buildup of Homeland Security and Pentagon funds, including some $175 billion for Trump’s mass deportation efforts, such as the hiring of 10,000 more officers for Immigration and Customs Enforcement, or ICE.

This comes as protests over deporting migrants have erupted nationwide — including the stunning handcuffing of Sen. Alex Padilla last week in Los Angeles — and as deficit hawks such as Kentucky Sen. Rand Paul are questioning the vast spending on Homeland Security.

Senate Democratic Leader Charles E. Schumer warned that the Senate GOP’s draft “cuts to Medicaid are deeper and more devastating than even the Republican House’s disaster of a bill.”

Trade-offs in bill risk GOP support

As the package now moves to the Senate, the changes to Medicaid, SALT and green energy programs are part of a series of trade-offs GOP leaders are making as they try to push the package to passage with their slim majorities, with almost no votes to spare.

But criticism of the Senate’s version came quickly after House Speaker Mike Johnson warned senators of making substantial changes.

“We have been crystal clear that the SALT deal we negotiated in good faith with the Speaker and the White House must remain in the final bill,” the co-chairs of the House SALT caucus, Reps. Young Kim (R-Calif.) and Andrew Garbarino (R-N.Y.), said in a joint statement Monday.

Republican Rep. Nicole Malliotakis of New York posted on X that the $10,000 cap in the Senate bill was not only insulting, but a “slap in the face to the Republican districts that delivered our majority and trifecta” with the White House.

Medicaid and green energy cuts

Some of the largest cost savings in the package come from the GOP plan to impose new work requirements on able-bodied single adults, ages 18 to 64 and without dependents, who receive Medicaid, the health care program used by 80 million Americans.

While the House first proposed the new Medicaid work requirement, it exempted parents with dependents. The Senate’s version broadens the requirement to include parents of children older than 14, as part of their effort to combat waste in the program and push personal responsibility.

Already, the Republicans had proposed expanding work requirements in the Supplemental Nutrition Assistance Program, known as SNAP, to include older Americans up to age 64 and parents of school-age children older than 10. The House had imposed the requirement on parents of children older than 7.

People would need to work 80 hours a month or be engaged in a community service program to qualify.

One Republican, Missouri Sen. Josh Hawley, has joined a few others pushing to save Medicaid from steep cuts — including to the so-called provider tax that almost all states levy on hospitals as a way to help fund their programs.

The Senate plan proposes phasing down that provider tax, which is now up to 6%. Starting in 2027, the Senate looks to gradually lower that threshold until it reaches 3.5% in 2031, with exceptions for nursing homes and intermediate care facilities.

Hawley slammed the Senate bill’s changes on the provider tax. “This needs a lot of work. It’s really concerning and I’m really surprised by it,” he said. “Rural hospitals are going to be in bad shape.”

The Senate also keeps in place the House’s proposed new $35-per-service co-pay imposed on some Medicaid patients who earn more than the poverty line, which is about $32,000 a year for a family of four, with exceptions for some primary, prenatal, pediatric and emergency room care.

And Senate Republicans are seeking a slower phaseout of some Biden-era green energy tax breaks to allow continued develop of wind, solar and other projects that the most conservative Republicans in Congress want to end more quickly. Tax breaks for electric vehicles would be immediately eliminated.

Conservative Republicans say the cuts overall don’t go far enough, and they oppose the bill’s provision to raise the national debt limit by $5 trillion to allow more borrowing to pay the bills.

“We’ve got a ways to go on this one,” said Sen. Ron Johnson (R-Wis.).

Mascaro and Freking write for the Associated Press. AP writers Mary Clare Jalonick and Matthew Daly contributed to this report.

It took Crystal Strickland years to qualify for Medicaid, which she needs for a heart condition.

Strickland, who’s unable to work due to her condition, chafed when she learned that the U.S. House has passed a bill that would impose a work requirement for many able-bodied people to get health insurance coverage through the low-cost, government-run plan for lower-income people.

“What sense does that make?” she asked. “What about the people who can’t work but can’t afford a doctor?”

The measure is part of the version of President Trump’s “Big Beautiful” bill that cleared the House last month and is now up for consideration in the Senate. Trump is seeking to have it passed by July 4.

The bill as it stands would cut taxes and government spending — and also upend portions of the nation’s social safety net.

For proponents, the ideas behind the work requirement are simple: Crack down on fraud and stand on the principle that taxpayer-provided health coverage isn’t for those who can work but aren’t. The measure includes exceptions for those who are under 19 or over 64, those with disabilities, pregnant women, main caregivers for young children, people recently released from prisons or jails — or during certain emergencies. It would apply only to adults who receive Medicaid through expansions that 40 states chose to undertake as part of the 2010 health insurance overhaul.

Many details of how the changes would work would be developed later, leaving several unknowns and causing anxiety among recipients who worry that their illnesses might not be enough to exempt them.

Advocates and sick and disabled enrollees worry — based largely on their past experience — that even those who might be exempted from work requirements under the law could still lose benefits because of increased or hard-to-meet paperwork mandates.

Benefits can be difficult to navigate even without a work requirement

Strickland, a 44-year-old former server, cook and construction worker who lives in Fairmont, North Carolina, said she could not afford to go to a doctor for years because she wasn’t able to work. She finally received a letter this month saying she would receive Medicaid coverage, she said.

“It’s already kind of tough to get on Medicaid,” said Strickland, who has lived in a tent and times and subsisted on nonperishable food thrown out by stores. “If they make it harder to get on, they’re not going to be helping.”

Steve Furman is concerned that his 43-year-old son, who has autism, could lose coverage.

The bill the House adopted would require Medicaid enrollees to show that they work, volunteer or go to school at least 80 hours a month to continue to qualify.

A disability exception would likely apply to Furman’s son, who previously worked in an eyeglasses plant in Illinois for 15 years despite behavioral issues that may have gotten him fired elsewhere.

Furman said government bureaucracies are already impossible for his son to navigate, even with help.

It took him a year to help get his son onto Arizona’s Medicaid system when they moved to Scottsdale in 2022, and it took time to set up food benefits. But he and his wife, who are retired, say they don’t have the means to support his son fully.

“Should I expect the government to take care of him?” he asked. “I don’t know, but I do expect them to have humanity.”

There’s broad reliance on Medicaid for health coverage

About 71 million adults are enrolled in Medicaid now. And most of them — around 92% — are working, caregiving, attending school or disabled. Earlier estimates of the budget bill from the Congressional Budget Office found that about 5 million people stand to lose coverage.

A KFF tracking poll conducted in May found that the enrollees come from across the political spectrum. About one-fourth are Republicans; roughly one-third are Democrats.

The poll found that about 7 in 10 adults are worried that federal spending reductions on Medicaid will lead to more uninsured people and would strain health care providers in their area. About half said they were worried reductions would hurt the ability of them or their family to get and pay for health care.

Amaya Diana, an analyst at KFF, points to work requirements launched in Arkansas and Georgia as keeping people off Medicaid without increasing employment.

Amber Bellazaire, a policy analyst at the Michigan League for Public Policy, said the process to verify that Medicaid enrollees meet the work requirements could be a key reason people would be denied or lose eligibility.

“Massive coverage losses just due to an administrative burden rather than ineligibility is a significant concern,” she said.

One KFF poll respondent, Virginia Bell, a retiree in Starkville, Mississippi, said she’s seen sick family members struggle to get onto Medicaid, including one who died recently without coverage.

She said she doesn’t mind a work requirement for those who are able — but worries about how that would be sorted out. “It’s kind of hard to determine who needs it and who doesn’t need it,” she said.

Some people don’t if they might lose coverage with a work requirement

Lexy Mealing, 54 of Westbury, New York, who was first diagnosed with breast cancer in 2021 and underwent a double mastectomy and reconstruction surgeries, said she fears she may lose the medical benefits she has come to rely on, though people with “serious or complex” medical conditions could be granted exceptions.

She now works about 15 hours a week in “gig” jobs but isn’t sure she can work more as she deals with the physical and mental toll of the cancer.

Mealing, who used to work as a medical receptionist in a pediatric neurosurgeon’s office before her diagnosis and now volunteers for the American Cancer Society, went on Medicaid after going on short-term disability.

“I can’t even imagine going through treatments right now and surgeries and the uncertainty of just not being able to work and not have health insurance,” she said.

Felix White, who has Type I diabetes, first qualified for Medicaid after losing his job as a computer programmer several years ago.

The Oreland, Pennsylvania, man has been looking for a job, but finds that at 61, it’s hard to land one.

Medicaid, meanwhile, pays for a continuous glucose monitor and insulin and funded foot surgeries last year, including one that kept him in the hospital for 12 days.

“There’s no way I could have afforded that,” he said. “I would have lost my foot and probably died.”

Mulvihill writes for the Associated Press. AP writer Susan Haigh in Hartford, Conn., contributed to this report.

WASHINGTON — The clamorous end to President Trump’s alliance with Elon Musk is increasing pressure on the White House over its signature legislation known as the “One Big Beautiful Bill Act” — a bill under intense scrutiny in the Senate that Musk wants killed over its price tag, but that Trump views as critical to the success of his presidency.

The bill faces strong headwinds among senators across the Republican spectrum, including fiscal conservatives who say it authorizes unsustainable spending, as well as moderates who fear the consequences of offsetting costly tax breaks in the bill with steep cuts to Medicaid.

Sen. Ron Johnson, a Republican from Wisconsin among those seeking to decrease spending in the bill, told NPR this week that it has “no chance of passing” the Senate in its current form.

“It’s easy to be the parent that says, ‘We’re going to go to Disney World.’ It’s hard to be the parent that says, ‘yeah, but we can’t afford it,” Johnson told reporters on Capitol Hill Friday. “To get to yes, I need a commitment to return to a reasonable pre-pandemic level of spending.”

Trump’s relationship with Musk, the world’s richest man and the largest Republican donor during the 2024 presidential campaign, shattered on Thursday in an exchange of public insults between the two men. After leaving his role in the administration last week, where he was assigned to cut federal spending and government waste, Musk sounded off on the bill as an “abomination” that would cause the national debt to soar.

Trump responded by suggesting Musk opposed the legislation because it includes cuts to energy tax credits that have benefited Tesla, Musk’s electric vehicle company. The billionaire entrepreneur may also be angry, Trump mused, because his recommendation to head NASA was rejected — an important position for SpaceX, another Musk business.

Those comments set off an online tirade from Musk that claimed credit for Trump’s election victory and accused the president of links with Jeffrey Epstein, a notorious child sex offender.

“Without me, Trump would have lost the election, Dems would control the House and the Republicans would be 51-49 in the Senate,” Musk wrote on X, his social media platform. “Such ingratitude.”

Musk contributed over $280 million to Trump and other Republicans during the 2024 presidential campaign. But his tenure in the White House has come at a steep cost. Tesla’s profits plummeted 71% over the first three months of the year, with reputation rankings showing a similarly precipitous drop amongst consumers. In Thursday alone, as his feud with Trump escalated, Tesla’s stock price dropped 14%.

“I’m not even thinking about Elon,” Trump told CNN’s Dana Bash in a phone interview on Friday. “He’s got a problem. The poor guy’s got a problem.”

Musk was also quieter on Friday, focusing his social media activity on his companies, a sign that both men see mutual destruction in the fallout from their feud.

But the source of their feud — the bill — remains on thin ice.

The nonpartisan Congressional Budget Office estimates the bill could add $2.4 trillion to annual deficits over the next decade and result in 10.9 million people losing their health insurance, prompting GOP senators like Shelley Moore Capito, of West Virginia, where 28% of the state population is enrolled in Medicaid, to express concern.

But Senate Majority Leader John Thune, Republican of South Dakota, told reporters that the caucus is open to exploring cuts to another popular health program — Medicare, for Americans 65 and older — if it results in lowering the overall costs of the bill.

“The focus, as you know, has been on addressing waste, fraud, abuse within Medicaid and, but right now, we’re open to suggestions that people have them about other areas where there is, you know, clearly, waste, fraud and abuse that can be rooted out in any government program,” Thune said in a news conference.

Asked whether Medicare cuts are on the table, Thune replied, “I think anything we can do that’s waste, fraud and abuse are open to discussions.”

House Speaker Mike Johnson, a Republican from Louisiana, defended the bill against Musk’s attacks on Friday and said his calls to kill the bill were a “surprise.”

“I don’t argue with Elon on how to build rockets,” Johnson said. “I wish he wouldn’t argue with me about how to craft legislation.”

Johnson has said his goal is to have the legislation passed into law by Independence Day, before lawmakers start traveling home for a series of long summer recesses.

But there are other reasons for the deadline. The Treasury Department anticipates the country could risk default unless Congress raises the debt ceiling by August. And tax cuts passed in 2017, under the first Trump administration, are set to expire at the end of this year, leading Republicans to warn of a 68% tax increase if the bill fails.

WASHINGTON — President Trump wants his “big, beautiful” bill of tax breaks and spending cuts on his desk to be signed into law by the Fourth of July, and he’s pushing the slow-rolling Senate to make it happen sooner rather than later.

Trump met with Senate Majority Leader John Thune at the White House early this week and has been dialing senators for one-on-one chats, using both the carrot and stick to nudge, badger and encourage them to act. But it’s still a long road ahead for the 1,000-page-plus package.

“His question to me was, How do you think the bill’s going to go in the Senate?” Sen. Josh Hawley (R-Mo.) said about his call with Trump. “Do you think there’s going to be problems?”

It’s a potentially tumultuous three-week sprint for senators preparing to put their own imprint on the massive Republican package that cleared the House late last month by a single vote. The senators have been meeting for weeks behind closed doors, including as they returned to Washington late Monday, to revise the package ahead of what is expected to be a similarly narrow vote in the Senate.

“Passing THE ONE, BIG, BEAUTIFUL BILL is a Historic Opportunity to turn our Country around,” Trump posted on social media. He urged them Monday “to work as fast as they can to get this Bill to MY DESK before the Fourth of JULY.”

Thune, like House Speaker Mike Johnson, has few votes to spare from the Senate’s slim, 53-seat GOP majority. Democrats are waging an all-out political assault on GOP proposals to cut Medicaid, food stamps and green energy investments to help pay for more than $4.5 trillion in tax cuts — with many lawmakers being hammered at boisterous town halls back home.

“It’d be nice if we could have everybody on board to do it, but, you know, individual members are going to stake out their positions,” Thune said Tuesday.

“But in the end, we have to succeed. Failure’s not an option. We’ve got to get to 51. So we’ll figure out the path forward to do that over the next couple of weeks.”

At its core, the package seeks to extend the tax cuts approved in 2017, during Trump’s first term at the White House, and add new ones the president campaigned on, including no taxes on tips and others. It also includes a massive build-up of $350 billion for border security, deportations and national security.

To defray the lost tax revenue to the government and avoid piling onto the nation’s $36-trillion debt load, Republicans want to reduce federal spending by imposing work requirements for some Americans who rely on government safety net services. Estimates are 8.6 million people would no longer have healthcare and nearly 4 million would lose Supplemental Nutritional Assistance Program benefits.

The package also would raise the nation’s debt limit by $4 trillion to allow more borrowing to pay the bills.

Senate Democratic Leader Chuck Schumer said Trump’s bill “is ugly to its very core.”

Schumer said Tuesday it’s a “lie” that the cuts won’t hurt Americans. “Behind the smoke and mirrors lies a cruel and draconian truth: tax breaks for the ultra-wealthy paid for by gutting healthcare for millions of Americans,” said the New York senator.

The nonpartisan Congressional Budget Office is expected to soon provide an overall analysis of the package’s impacts on the government balance sheets, particular its rising annual deficits. But Republicans are ready to blast those findings from the congressional scorekeeper as flawed.

Trump on Tuesday switched to tougher tactics, deriding the holdout Republican senators to get on board.

The president laid into Kentucky Sen. Rand Paul, the libertarian-leaning deficit hawk who has made a career of arguing against government spending. Paul wants the package’s $4-trillion increase to the debt ceiling out of the bill.

“Rand votes NO on everything, but never has any practical or constructive ideas. His ideas are actually crazy (losers!).” Trump posted.

The July 4 deadline is not only aspirational for the president, it’s all but mandatory for his Treasury Department. Treasury Secretary Scott Bessent has warned Congress that the nation will run out of money to pay its bills if the debt ceiling, now at $36 trillion, is not lifted by mid-July or early August to allow more borrowing. Bessent has also been meeting behind closed doors with senators and GOP leadership.

Thune acknowledged Tuesday that lifting the debt ceiling is not up for debate.

“It’s got to be done,” the South Dakota senator said.

The road ahead is also a test for Thune, who, like Johnson, is a newer leader in Congress and among the many Republicans adjusting their own priorities with Trump’s return to the White House.

While Johnson has warned against massive changes to the package, Thune faces demands from his senators for adjustments.

To make most of the tax cuts permanent — particularly the business tax breaks that are the Senate priorities — senators may shave some of Trump’s proposed new tax breaks on automobile loans or overtime pay, which are policies less prized by some senators.

There are also discussions about altering the $40,000 cap that the House proposed for state and local deductions, known as SALT, which are important to lawmakers in high-tax New York, California and other states, but less so among GOP senators.

“We’re having all those discussions,” said Sen. Thom Tillis (R-N.C.), another key voice in the debate.

Hawley is among a group of senators, including Maine’s Susan Collins and Alaska’s Lisa Murkowski, who have raised concerns about the Medicaid changes that could boot people from health insurance.

A potential copay of up to $35 for Medicaid services that was part of the House package, as well as a termination of a provider tax that many states rely on to help fund rural hospitals, have also raised concerns.

“The best way to not be accused of cutting Medicaid is to not cut Medicaid,” Hawley said.

Collins said she is reviewing the details.

There’s also a House provision that would allow the auction of spectrum bandwidth that some senators oppose.

Mascaro and Jalonick write for the Associated Press. AP writer Matt Brown contributed to this report.

A Medicaid bill pushed by Republicans proposes significant cuts to the health insurance programme for lower-income Americans. But United States President Donald Trump has claimed the legislation would change Medicaid in ways that only combat “waste, fraud and abuse”, a phrase he repeated seven times over a couple of minutes.

“We’re not doing any cutting of anything meaningful,” the Republican president said. “The only thing we’re cutting is waste, fraud and abuse. … We’re not changing Medicaid, and we’re not changing Medicare, and we’re not changing Social Security.”

The House of Representatives passed the bill on Thursday, and it now moves to the Senate, where it could be changed. The House version doesn’t directly target Social Security or Medicare. But it changes Medicaid, including in ways that align with Republican priorities.

Congress’s nonpartisan Congressional Budget Office has projected that at least 8.6 million people will lose coverage because of the changes.

“Relatively little of the bill is clearly related to trying to reduce fraud or error,” said Leighton Ku, director of George Washington University’s Center for Health Policy Research. “There are some minor provisions about things like looking for dead people who are enrolled or checking addresses. But the major provisions are not fraud, waste or error by any means. They’re things that reflect policy preferences of the Republican architects.”

Robin Rudowitz, vice president and director of the Program on Medicaid and the Uninsured at the health policy research group KFF, agreed that the scope of the bill’s changes go further than Trump said. “The magnitude of the federal spending reductions and resulting coverage loss go well beyond rooting out fraud and abuse,” she said.

The bill’s key provisions could be removed before the final votes and enactment while others may be added.

The White House did not respond to an inquiry for this fact check.

How the federal government defines waste, fraud and abuse

The Centers for Medicare and Medicaid Services, the federal agency that runs Medicaid, offers official definitions for these three terms:

• Fraud: “When someone knowingly deceives, conceals, or misrepresents to obtain money or property from any health care benefit program. Medicare or Medicaid fraud is considered a criminal act.”
• Waste: “Overusing services or other practices that directly or indirectly result in unnecessary costs to any health care benefit program. Examples of waste are conducting excessive office visits, prescribing more medications than necessary, and ordering excessive laboratory tests.”
• Abuse: “When health care providers or suppliers perform actions that directly or indirectly result in unnecessary costs to any health care benefit program. Abuse includes any practice that doesn’t provide patients with medically necessary services or meet professionally recognised standards,” such as overbilling or misusing billing codes.

Some bill provisions can be described as targeting waste, fraud and abuse

One provision in the bill requires states to confirm recipients’ Medicaid eligibility at least every six months rather than every year under current law. Another would set stricter requirements for verifying enrollees’ addresses and other information.

Such efforts could save expenditures on ineligible people and could be classified as a waste-prevention measure.

Other provisions are more ideological than focused on waste, fraud and abuse

Several of the bill’s highest-profile provisions are driven more by ideology – differences in how expansive the programme should be and what types of people should benefit.

One of these provisions involves people in the US without documentation.

Because it’s already against the law to spend federal Medicaid funds on undocumented people, the bill takes a different approach: It seeks to make it harder for states to exclusively rely on state funds to cover immigrants in the US. Currently, 14 states and the District of Columbia cover children regardless of their immigration status, and seven states plus Washington, DC, cover at least some adults living in the US without documents too.

For these states, the bill reduces the federal government’s share of Medicaid payments from 90 percent to 80 percent.

In other words, if a state wants to keep covering undocumented people, it will face a cut in the federal reimbursement rate for the coverage of US citizens, not just immigrants in the country without documents. Budgetary pressures in these states could mean that some citizens also lose some of their benefits or all of their Medicaid coverage.

Another provision involves work requirements. The bill would require individuals aged 19 to 64 receiving Medicaid under the Affordable Care Act expansion, which was passed during former President Barack Obama’s Democratic administration, to be working or participating in qualifying activities (such as having a disability, being a caretaker for family members or attending school) for at least 80 hours per month.

Research has found that the vast majority of people who would be required to work under similar requirements are already employed or have a qualifying exemption — yet many get thrown off Medicaid because they fail to keep up with the mandatory paperwork.

“Work requirements are not about waste, fraud, and abuse. They are fundamentally changing the rules of who is eligible for the programme, and they are adding an immense set of bureaucratic obstacles and red tape for eligible people to keep coverage,” said Benjamin D Sommers, a professor of healthcare economics and medicine at Harvard University’s TH Chan School of Public Health and Harvard Medical School.

A KFF analysis in March found that fraud occurs in Medicare and Medicaid mostly by providers. “There are checks on fraud, waste, and abuse at both the federal and the state levels,” KFF wrote.

Another bill provision bans Medicaid funds spent on nonprofit organisations primarily engaged in family planning or reproductive services, which would affect Planned Parenthood and other organisations that provide abortions.

Finally, at least two provisions focus on saving money. One would require, for the first time, that states impose $35 copays for many types of care. The other would limit retroactive coverage after applying for Medicaid to one month before application, down from 90 days. These provisions don’t specify how they’d root out waste, fraud and abuse.

“The ‘Medicaid savings’ in this bill are primarily from reducing programme enrolment,” Sommers said.

Our ruling

Trump said the House bill is “not changing Medicaid,” only cutting “waste, fraud and abuse”.

The legislation includes provisions that could improve the detection of beneficiaries who aren’t eligible for coverage.

But other provisions would change Medicaid to align with Trump’s ideology and Republican priorities. The bill would incentivise states to stop using their own funds to cover undocumented people in the US; it requires people to work or do other approved activities to secure benefits; and it bans Medicaid payments to nonprofits such as Planned Parenthood, which provide abortions among other services.

Other changes aim to cut expenses, including the imposition of copays and a shorter window for retroactive coverage. Those provisions don’t specify how they’d cut waste, fraud or abuse.

We rate the statement false.

WASHINGTON — Landmark legislation that would rewrite the tax code and levy steep cuts to programs providing healthcare and food stamps to the poor passed the House early Thursday, a development that was celebrated by President Trump despite the bill facing an uncertain future among Senate Republicans.

The measure, titled the “One Big Beautiful Bill Act,” would boost funding for border security and the Defense Department, eliminate taxes on tips and overtime, provide a new tax deduction to seniors and renew the 2017 tax cuts passed during the first Trump administration. To pay for those new funding commitments, the bill proposes eliminating green energy tax benefits passed under President Biden, as well as an estimated $1 trillion in cuts to Medicaid and the Supplemental Nutrition Assistance Program.

Even still, the bill would add so much money to the debt that Congress may be forced to execute cuts across the board, including hundreds of billions to Medicare, in a process known as sequestration, according to the nonpartisan Congressional Budget Office.

The House vote fell along party lines. By opposing the bill, the Trump administration said that Democrats were supporting the largest tax increase on middle-class Americans in decades, a reference to the upcoming expiration of Trump’s 2017 tax cuts at the end of the year.

Democrats, on the other hand, have accused Republicans of voting for the deepest cuts to healthcare in modern times. By creating new barriers to Medicaid coverage through the introduction of work hour requirements, as well as increasing premiums under the Affordable Care Act, the CBO and other nonpartisan organizations estimate up to 14 million Americans could lose their insurance coverage.

Those drastic changes to the healthcare landscape have given pause to several Republican senators.

Sen. Susan Collins of Maine has said she is “very wary of cutting Medicaid.” Sen. Josh Hawley of Missouri said he “can’t support” substantial cuts to Medicaid benefits. And after the vote on Thursday, Sen. Roger Marshall of Kansas said that material changes should be expected to the House bill.

“We need to go back through that bill with a fine tooth comb and make it better,” Marshall said in an interview with Newsmax. “I think there’s opportunities in Medicaid to make that bill better, to make sure that we strengthen it, that we preserve it for those who need it most.”

Any Senate rollback of cuts to the Medicaid program could face resistance from the House Freedom Caucus during the reconciliation process. Members of that group, which proclaims a commitment to fiscal conservatism, have called for even deeper cuts to the Medicaid program.

Rep. Andy Harris of Maryland, chair of the House Freedom Caucus, voted “present” early Thursday morning, preserving negotiating leverage as the bill makes its way across Capitol Hill.

“I voted to move the bill along in the process for the president,” Harris wrote on social media. “There is still a lot of work to be done in deficit reduction and ending waste, fraud, and abuse in the Medicaid program.”

The vote came hours after Trump met with GOP holdouts at the White House. As late as Wednesday afternoon, before meeting with the president, several of those lawmakers were casting doubt on the prospects of the bill’s passage this week, ahead of a Memorial Day deadline set by House Speaker Mike Johnson, a Louisiana Republican.

Republican Sen. Lindsey Graham of South Carolina was dismissive of the Freedom Caucus on Thursday, telling CNN that the cuts they are pushing for would barely make a dent in the national debt.

“You had your chance,” Graham said to the caucus. “Some of these cuts are not real. We’re talking about over a decade — you know, if you do $1.5 trillion, that’s like a percent and a half. So let’s don’t get high on our horse here that we’ve somehow made some major advancement of reducing spending, because we didn’t.”

Sen. Kevin Cramer of North Dakota also mocked the caucus, calling it “rich” for its members to lecture Senate Republicans on fiscal conservatism, “and end up with not that conservative a bill.” The CBO estimates the House legislation would result in a $3.8-trillion increase to the deficit.

If passed, the new work requirements to Medicaid would kick in at the end of 2026, right after the midterm elections. Green energy tax credits would phase out for any project that is not already under construction 60 days after the law comes into force.

The cap on the state and local tax deduction, known as SALT, will increase to $40,000 from $10,000, phasing out for individuals and households making more than $500,000. And while the president campaigned on a promise to eliminate taxes on Social Security, a parliamentary rule precluded Republicans from including a full cut. Instead, the bill proposes an enhanced tax deduction for senior citizens of up to $4,000.

On Truth Social, the president’s social media platform, Trump wrote that the bill is “arguably the most significant piece of Legislation that will ever be signed in the History of our Country!”

“There is no time to waste,” he added. Johnson, the speaker, has set a goal of sending the bill to the president’s desk by Independence Day.

Trump’s press secretary, Karoline Leavitt, said the president’s team was “suiting up” for negotiations with the Senate now that the bill has passed the House. “We will see how it goes,” she said.

“The ‘One Big Beautiful Bill’ is named the ‘One Big Beautiful Bill’ for a reason, because it is a one big beautiful bill that encompasses just about everything this president could want for the American public. It delivers on so many of his core campaign promises. So surely we want to see those campaign promises signed into law,” Leavitt said. “He’s expecting them to get busy on this bill and send it to his desk as soon as possible.”

The two House Republicans who voted against the bill, Thomas Massie of Kentucky and Warren Davidson of Ohio, should face primary challenges for their defiance of the president’s directive, Leavitt added.

“What’s the alternative, I would ask those members of Congress. Did they want to see a tax hike? Did they want to see our country go bankrupt? That’s the alternative by them trying to vote no,” she said. “The president believes that the Republican Party needs to be unified.”

WASHINGTON — How can Congress cut Medicaid without explicitly cutting Medicaid?

That has been a years-long dilemma facing fiscal conservatives in the Republican Party who have sought cuts to the country’s deficit-driving social safety net programs, including Medicaid, Social Security and Medicare, without generating political fallout from the tens of millions of Americans who will suffer the consequences.

Now, GOP lawmakers have settled on a strategy, outlined in legislation expected to pass the House in the coming days amid ongoing negotiations over the package that President Trump is calling his “Big Beautiful Bill.”

Rather than lowering the income eligibility limit for coverage — an old policy proposal that would cut off Americans at the higher end of the eligibility range — Trump’s bill will instead require applicants to provide proof of their work hours and apply for specific exceptions, creating new barriers for individuals to maintain insurance.

House passage of the bill is far from assured, and the Senate will still have its say. But if it does become law, the policy would affect more than 71 million of the poorest Americans, more of whom live in California than any other state.

Barriers to entry are the point

If everyone eligible under the new work requirements were to apply for and receive Medicaid coverage, the cost savings to the government would be minimal. But the barriers themselves are the point, making it more likely that people with a right to Medicaid won’t ultimately receive it, experts said.

“If you want to make a substantial cut to the program, how do you do that in a systematic way?” said Matt Bruenig, founder of People’s Policy Project and a former lawyer at the National Labor Relations Board.

“With the work requirements, the number of people who seem to be actually ineligible because of it is quite small — so if it actually is perfectly administrated, you’re not going to see a whole lot of savings,” Bruenig said. “But if it’s not well administrated and it creates all these problems, then you could see significant savings.”

Existing government programs, such as Social Security, unemployment and supplemental nutrition assistance for women, infants and children, determine eligibility for those benefits based on an individual’s income. But creating a new set of criteria for Medicaid based on hours worked will require a new reporting system that is not outlined in the bill.

“We have all these systems that are based around making sure people have the earnings that they can report to all these agencies, but you don’t really report hours in any context,” Bruenig added. “Monthly hours — that’s just not a thing. And it’s not clear how that’s going to work, at all.”

Who counts as ‘waste, fraud and abuse’?

Trump and members of the House Freedom Caucus, a group of Republican fiscal hawks, have argued for a strict hourly work requirement to eliminate “waste, fraud and abuse” in Medicaid by cutting off unproductive individuals from government benefits.

But exemptions suggested in the draft legislation — parents caring for young children or elderly parents, individuals dealing with health issues, those between jobs — reflect the range of reasons why Medicaid recipients may fall below the proposed hourly requirement. And each time an exception arises, individuals will have to refile, increasing the likelihood they will simply let their coverage lapse.

It also will force working individuals who would otherwise be eligible — such as Americans working gig jobs for DoorDash or Uber, for example — to account for hours worked transiting between jobs that don’t generate receipts.

“They just are not finding very much at all,” said John Schmitt, a senior research fellow at the Center for Economic and Policy Research and a senior economist at the Economic Policy Institute, when asked whether ineligible individuals are routinely receiving Medicaid.

“The real problems are not with individuals taking advantage of Medicaid,” Schmitt added. “It is with healthcare providers taking advantage of Medicaid, in the sense of the way they bill and provide services to people. And that is not going to be changed in any way, whatsoever, by imposing a work requirement.”

The Congressional Budget Office said it is these Medicaid recipients who will either fall behind or grow fed up with the paperwork, resulting in 7.6 million losing coverage under the plan and saving the federal government roughly $800 billion.

California will be hit hardest

The effects of Medicaid cuts will be felt nationwide, but most pointedly in states that expanded Medicaid coverage under the Affordable Care Act. On that score, Democratic states such as California lead the way.

A state assessment published Sunday found the GOP bill would “cause serious harm to California’s health care system,” possibly resulting in up to 3.4 million residents losing coverage.

No state has more workers on Medicaid than California, where 18% of its workforce receives benefits from the program, according to a study from the Center for Economic and Policy Research.

“Millions will lose coverage, hospitals will close, and safety nets could collapse under the weight,” Gov. Gavin Newsom said in a statement. “We must sound the alarm because the stakes couldn’t be higher.”

But the political stakes are high for Republicans as well.

Stephen K. Bannon, a former campaign aide and White House strategist to Trump, warned in recent days that the party has “gotta be careful” with Medicaid, given its widespread use among low-income GOP voters.

“A lot of MAGAs are on Medicaid, I’m telling you,” Bannon said on his podcast. “If you don’t think so, you are dead wrong.”

Trump, for his part, seems of two minds on the matter. Cuts to Medicaid, as well as to food stamp programs and green energy tax benefits, will be required to get the bill passed with support from the Freedom Caucus, which says the renewal of tax cuts initially passed in the first Trump administration must be offset with savings elsewhere.

“Here’s what I want on Medicaid: We’re not touching anything,” Trump said Tuesday, taking questions from reporters on Capitol Hill. “All I want is one thing. Three words. We don’t want any waste, fraud or abuse. Very simple — waste, fraud, abuse.”

But in a private meeting with GOP lawmakers, his guidance was sharper. “Don’t f— around with Medicaid,” the president reportedly said.

What else you should be reading

The must-read: White House pushes for quick approval of ‘big, beautiful bill,’ but key hurdles remain
The deep dive: Villaraigosa blasts Harris and Becerra for not speaking out about Biden’s decline
The L.A. Times Special: Congressional leaders call for streamlined visa process ahead of World Cup, L.A. Olympics

More to come,
Michael Wilner
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WASHINGTON — House Republicans are pushing to vote on their multitrillion-dollar tax breaks package as soon as Wednesday, grinding out last-minute deal-making to shore up wavering GOP support and deliver on President Trump’s top legislative priority.

Trump himself had instructed the Republican majority to quit arguing and get it done, his own political influence on the line. But GOP leaders worked late into the night to convince skeptical Republicans who have problems on several fronts, including worries that it will pile onto the nation’s $36-trillion debt.

A fresh analysis from the Congressional Budget Office said the tax provisions would increase the federal deficit by $3.8 trillion over the decade, while the changes to Medicaid, food stamps and other services would tally $1 trillion in reduced spending. The lowest-income households in the U.S. would see their resources drop, while the highest ones would see a boost, the CBO said.

Republicans hunkered down at the Capitol through the night for one last committee hearing processing changes to the package. Democrats immediately motioned to adjourn, but the vote failed on party lines.

“President Trump’s ‘one, big, beautiful bill’ is going to require one, big, beautiful vote,” said Speaker Mike Johnson (R-La.). “We are going to get this done.”

It’s a make-or-break moment for the president and his party in Congress, who have invested much of their political capital during the crucial first few months of Trump’s return to the White House on this package. If the House Republicans fall in line with the president, overcoming unified Democratic objections, the package would next go to the Senate.

The package comes at a daunting time as the U.S. economy faces uncertainty. Democratic Leader Hakeem Jeffries said Republicans are trying to “quickly jam this unpopular legislation through the House because they know that the longer they wait, the more will come to light about this cruel and unconscionable bill.”

At its core, the sprawling 1,000-plus-page bill is centered on extending the tax breaks approved during Trump’s first term in 2017, while adding new ones he campaigned on during the 2024 presidential campaign.

To make up for some of the lost revenue, the Republicans are focused on spending cuts to federal safety net programs and a massive rollback of green energy tax breaks from the Biden-era Inflation Reduction Act.

Additionally, the package tacks on $350 billion in new spending — with about $150 billion going to the Pentagon, including for the president’s new “ Golden Dome” defense shield, and the rest for Trump’s mass deportation and border security agenda.

The package title carries Trump’s own words, the “One Big Beautiful Bill Act.”

As Trump promised voters on the tax front, the package proposes there would be no taxes on tips for certain workers, including those in some service industries; automobile loan interest; or some overtime pay.

There would also be an increase to the standard income tax deduction, to $32,000 for joint filers, and a boost to the child tax credit to $2,500. There would be an enhanced deduction, of $4,000, for seniors of certain income levels, to help defray taxes on Social Security income.

To cut spending, the package would impose new work requirements for many people who receive health care through Medicaid, with able-bodied adults without dependents needing to fulfill 80 hours a month on a job or in other community activities.

Similarly, those who receive food stamps through the Supplemental Nutritional Assistance Program, known as SNAP, would also face new work requirements.

Older Americans up to age 64, rather than 54, who are able-bodied and without dependents would need to work or engage in the community programs for 80 hours a month. Additionally, some parents of children older than 7 years old would need to fulfill the work requirements; under current law, the requirement comes after children are 18.

Republicans said they want to root out waste, fraud and abuse in the federal programs.

The Congressional Budget Office has estimated 8.6 million fewer people would have health insurance with the various changes to Medicaid and the Affordable Care Act. It also said 3 million fewer people each month would have SNAP benefits.

Republicans have been racing to finish up the package by Memorial Day, a deadline imposed by Johnson as he tries to overcome objections within his own ranks.

Conservatives are insisting on quicker, steeper cuts to federal programs to offset the costs of the trillions of dollars in lost tax revenue. GOP leaders have sped up the start date of the Medicaid work requirements from 2029 to 2027.

At the same time, more moderate and centrist lawmakers are wary of the changes to Medicaid that could result in lost health care for their constituents. Others are worried the phaseout of the renewable energy tax breaks will impede businesses using them to invest in green energy projects in many states.

Plus, a core group of lawmakers from New York, California and other high-tax states want a bigger state and local tax deduction, called SALT, for their voters back home.

As it stands, the bill would triple what’s currently a $10,000 cap on the state and local tax deduction, increasing it to $30,000 for joint filers with incomes up to $400,000 a year. They have proposed a deduction of $62,000 for single filers and $124,000 for joint filers.

Trump has been pushing hard for Republicans to unite behind the bill, which has been uniquely shaped in his image, and he said after meeting with House lawmakers privately Tuesday at the Capitol that anyone who doesn’t support the bill would be a “fool.”

But it’s not at all clear that Trump, who was brought in to seal the deal, changed minds.

One of the conservative Republicans, Rep. Thomas Massie of Kentucky, said afterward he’s still a no vote.

“We’re still a long ways away,” said Rep. Andy Harris (R-Md.), chair of the House Freedom Caucus.

The Committee for a Responsible Federal Budget, a nonpartisan fiscal watchdog group, estimates that the House bill is shaping up to add roughly $3.3 trillion to the debt over the next decade.

Mascaro, Freking, Askarinam and Cappelletti write for the Associated Press.

WASHINGTON — President Trump implored House Republicans at the Capitol to drop their fights over his big tax-cut bill and get it done, using encouraging words but also the hardened language of politics over the multitrillion-dollar package that is at risk of collapsing before planned votes this week.

During the more than hourlong session Tuesday, Trump warned Republicans to not touch Medicaid with cuts, and he told New York lawmakers to end their fight for a bigger local tax deduction, reversing his own campaign promise. The president, heading into the meeting, called himself a “cheerleader” for the Republican Party and praised Speaker Mike Johnson (R-La.). But he also criticized at least one of the GOP holdouts as a “grandstander” and warned that anyone who doesn’t support the bill would be a “fool.”

“We have unbelievable unity,” Trump said as he exited. “I think we’re going to get everything we want.”

The president arrived at a pivotal moment. Negotiations are slogging along and it’s not at all clear the package, with its sweeping tax breaks and cuts to Medicaid, food stamps and green energy programs, has the support needed from the House’s slim Republican majority. Lawmakers are also being asked to add some $350 billion to Trump’s border security, deportation and defense agenda.

Inside, he spoke privately in what one lawmaker called the president’s “weaving” style, and took questions.

The president also made it clear he’s losing patience with the various holdout factions of the House Republicans, according to a senior White House official who spoke on condition of anonymity to discuss the private meeting.

But Trump disputed that notion as well as reports that he used an expletive in warning against cutting Medicaid. Instead, he said afterward, “That was a meeting of love.” He received several standing ovations, Republicans said.

Yet it was not at all clear that Trump, who was brought in to seal the deal, changed minds.

“We’re still a long ways away,” said Rep. Andy Harris (R-Md.), the chair of the House Freedom Caucus.

Conservatives are insisting on quicker, steeper cuts to federal programs to offset the costs of the trillions of dollars in lost tax revenue. At the same time, a core group of lawmakers from New York and other high-tax states wants bigger tax breaks for their voters back home. Worries about piling onto the nation’s $36-trillion debt are stark.

With House Democrats lined up against the package, calling it a giveaway to the wealthy at the expense of safety net programs, GOP leaders have almost no votes to spare. A key committee hearing is set for the middle of the night Tuesday in hopes of a House floor vote by Wednesday afternoon.

“They literally are trying to take healthcare away from millions of Americans at this very moment in the dead of night,” said House Democratic leader Hakeem Jeffries of New York.

Trump has been pushing hard for Republicans to unite behind the bill, the president’s signature domestic policy initiative in Congress.

Asked about one of the conservative Republicans, Rep. Thomas Massie of Kentucky, Trump lashed out.

“I think he is a grandstander, frankly,” the president continued. “I think he should be voted out of office.”

But Massie, a renegade who wears a clock lapel pin that tallies the nation’s debt load, said afterward he’s still a no vote.

Also unmoved was Rep. Mike Lawler, one of the New York Republicans leading the fight for a bigger state and local tax deduction, known as SALT: “As it stands right now, I do not support the bill. Period.”

The sprawling 1,116-page package carries Trump’s title, the “One Big Beautiful Bill Act,” as well as his campaign promises to extend the tax breaks approved during his first term while adding new ones, including no taxes on tips, automobile loan interest and Social Security.

Yet, the price tag is rising and lawmakers are wary of the votes ahead, particularly as the economy teeters with uncertainty.

The Committee for a Responsible Federal Budget, a nonpartisan fiscal watchdog group, estimates that the House bill is shaping up to add roughly $3.3 trillion to the debt over the next decade.

Republicans criticizing the measure argued that the bill’s new spending and tax cuts are front-loaded, while the measures to offset the cost are back-loaded.

In particular, the conservative Republicans are looking to speed up the new work requirements that Republicans want to enact for able-bodied participants in Medicaid. They had been proposed to start Jan. 1, 2029, but Majority Leader Steve Scalise (R-La.) said on CNBC that work requirements for some Medicaid beneficiaries would begin in early 2027.

At least 7.6 million fewer people are expected to have health insurance under the initial Medicaid changes, the nonpartisan Congressional Budget Office said last week.

Republican holdouts are also looking to more quickly halt green energy tax breaks, which had been approved as part of the Biden-era Inflation Reduction Act, and are now being used for renewable energy projects across the nation.

But for every change Johnson considers to appease the hard-right conservatives, he risks losing support from more traditional and centrist Republicans. Many have signed letters protesting deep cuts to Medicaid and food assistance programs and the rolling back of clean energy tax credits.

At its core, the sprawling legislative package permanently extends the existing income tax cuts and bolsters the standard deduction, increasing it to $32,000 for joint filers, and the child tax credit to $2,500.

The New Yorkers are fighting for a larger state and local tax deduction beyond the bill’s proposal. As it stands, the bill would triple what’s currently a $10,000 cap on the state and local tax deduction, increasing it to $30,000 for joint filers with incomes up to $400,000 a year. They have proposed a deduction of $62,000 for single filers and $124,000 for joint filers.

Trump, who had campaigned on fully reinstating the unlimited SALT deduction, now appears to be satisfied with the proposed compromise, arguing it only benefits “all the Democratic” states.

If the bill passes the House this week, it would move to the Senate, where Republicans are also eyeing changes.

Mascaro, Freking, Askarinam and Cappelletti write for the Associated Press. AP writers Darlene Superville and Seung Min Kim contributed to this report.

WASHINGTON — House Republicans proposed sweeping tax breaks Monday in President Trump’s big priority bill, tallying at least $4.9 trillion in costs so far, partly paid for with cuts to Medicaid, food stamps and green energy programs used by millions of Americans.

The House Ways and Means Committee named its package “THE ONE, BIG, BEAUTIFUL BILL” in all capital letters, a nod to Trump himself. It seeks to extend the tax breaks approved during Trump’s first term — and boost the standard deduction, child tax credit and estate tax exemption — while adding new tax breaks on tipped wages, overtime pay, Social Security benefits and auto loans that Trump promised during his campaign for the White House.

There’s also a tripling of the state and local tax deduction, called SALT, from $10,000 up to $30,000 for couples, which certain high-tax state GOP lawmakers from New York and California already rejected as too meager. Private universities would be hit with a hefty new tax on their endowments, as much as 21%, as the Trump administration goes after the Ivy League and other campuses. And one unusual provision would terminate the tax-exempt status of groups the State Department says support “terrorists,” which civil society advocates warn is a way to potentially punish those at odds with the Trump administration.

Overall, the package is touching off the biggest political debate over taxes, spending and the nation’s priorities in nearly a decade. Not since 2017 has Congress wrestled with legislation as this, when Republicans approved the Trump tax cuts but also failed to repeal and replace the Affordable Care Act, or Obamacare. The cost assessments are only preliminary, and expected to soar.

“Republicans need to UNIFY,” Trump posted on social media before departing for a trip to the Middle East.

Trump said when he returns to Washington, “we will work together on any and all outstanding issues, but there shouldn’t be many — The Bill is GREAT. We have no alternative, WE MUST WIN!”

But one key Republican, Sen. Josh Hawley of Missouri, implored his party not to impair Medicaid, arguing that cutting healthcare to pay for tax breaks is both “morally wrong and politically suicidal.”

“If Republicans want to be a working-class party — if we want to be a majority party — we must ignore calls to cut Medicaid and start delivering on America’s promise for America’s working people,” Hawley wrote in the New York Times.

Late Monday, the House Agriculture Committee released its proposals — cutting $290 billion from federal nutrition programs, in part by shifting costs to the states and requiring able-bodied adults without dependents to fulfill work requirements until they are 64 years old, rather than 54, to qualify for food aid.

Round-the-clock work ahead

As Republicans race toward House Speaker Mike Johnson’s Memorial Day deadline to pass Trump’s big bill, they are preparing to flood the zone with round-the-clock public hearings starting Tuesday and stitch the various sections together in what will become a massive package.

The politics ahead are uncertain. The bipartisan Joint Committee on Taxation said Monday that tax breaks would reduce revenue by $4.9 trillion over the decade — and that was before Trump’s new tax breaks were included.

Texas Rep. Chip Roy, a member of the conservative House Freedom Caucus, warned the price tag could climb to $20 trillion, piling onto the deficits and debt.

“I sure hope House & Senate leadership are coming up with a backup plan,” Roy posted on social media, “…. because I’m not here to rack up an additional $20 trillion in debt over 10 years.”

House Republicans have been huddling behind closed doors, working out final provisions in the 389-page tax portion of the package.

The legislation proposes to boost the standard deduction many Americans use by $2,000, to $32,000 per household, and increase the child tax credit from $2,000 to $2,500 for four years. It adds a new requirement focused on preventing undocumented immigrants from benefiting from the credit even if the children are U.S. citizens, which the Center on Budget and Policy Priorities, a liberal think tank, estimates would affect 4.5 million children who are U.S. citizens or lawful residents.

It would also increase the estate tax exemption, which is now $14 million, to $15 million and index future increases to inflation.

As for the president’s promises, the legislation includes Trump’s “no taxes on tips” pledge, providing a deduction for those workers in service industry and other jobs that have traditionally relied on tips. It directs the Treasury secretary to issue guidance to avoid businesses gaming the system.

The package also provides tax relief for automobile shoppers with a temporary deduction of up to $10,000 on car loan interest, applying the benefit only for those vehicles where the final assembly occurred in the United States. The tax break would expire at the end of Trump’s term.

For seniors, there would be a bolstered $4,000 deduction on Social Security wages for those with adjusted incomes no higher than $75,000 for individuals and $150,000 for couples.

But one hard-fought provision, the deduction for state and local taxes known as SALT, appears to be a work in progress. The legislation proposes lifting the cap to $15,000 for single filers and $30,000 for couples, but with a reduction at higher incomes — about $200,000 for singles and $400,000 for couples.

“Still a hell no,” wrote Rep. Nick LaLota (R-N.Y.) on social media.

Battle over Medicaid, food aid

Meanwhile, dozens of House Republicans have told Johnson and GOP leaders they will not support cuts to Medicaid, which provides some 70 million Americans with healthcare, nor to green energy tax breaks that businesses back home have been relying on to invest in new wind, solar and renewable projects.

All told, 11 committees in the House have been compiling their sections of the package as Republicans seek at least $1.5 trillion in savings to help cover the cost of preserving the 2017 tax breaks, which are expiring at the end of the year.

The final section from the Agriculture Committee proposed cutting the Supplemental Nutrition and Assistance Program, known as SNAP, by expanding work requirements, limiting future expansions of the program and forcing states to shoulder more of the cost.

Along with new work requirements for older Americans, it would also require some parents of children older than 7 to work to qualify, down from 18 years old. Only areas with unemployment rates over 10% would be eligible for waivers.

Some Republicans have already balked at the increased costs to the states, which would be required to contribute at least 5% of the cost of SNAP allotments beginning in 2028.

At the same time, the legislation would invest $60 billion in new money for agriculture programs, sending aid to farmers.

On Sunday, House Republicans on the Energy and Commerce Committee unveiled the cost-saving centerpiece of the package, with at least $880 billion in cuts largely to Medicaid to help cover the cost of the tax breaks.

While Republicans insist they are simply rooting out “waste, fraud and abuse” to generate savings with new work and eligibility requirements, Democrats warn that millions of Americans will lose coverage. In the 15 years since Obamacare became law, Medicaid has only expanded as most states have tapped into federal funds.

A preliminary estimate from the nonpartisan Congressional Budget Office said the proposals would reduce the number of people with healthcare by 8.6 million.

To be eligible for Medicaid, there would be new “community engagement requirements” of at least 80 hours per month of work, education or service for able-bodied adults without dependents. People would also have to verify their eligibility to be in the program twice a year, rather than just once.

There are substantial cuts proposed for green energy programs and tax breaks, rolling back climate-change strategies from the Biden-era Inflation Reduction Act.

Mascaro and Freking write for the Associated Press. AP writers Amanda Seitz, Leah Askarinam and Mary Clare Jalonick contributed to this report.