Republicans in the U.S. House of Representatives approved a sweeping package early Thursday morning that contains what advocates call “historic” cuts to government health insurance and nutrition programs that serve lower-income Americans. 

President Donald Trump wanted “one, big, beautiful bill” and GOP Speaker Mike Johnson pushed to get the package through the House before the Memorial Day recess. The bill now moves to the Senate, where it is expected to undergo significant changes. 

The proposal approved in the House would slash $1.7 trillion in government spending to pay for the renewal of the tax cuts from Trump’s first term, which largely benefited corporations and the wealthy. Some of the largest cuts would come from Medicaid, the popular government health insurance program that covers more than 70 million lower-income Americans. House Republicans also agreed on significant changes in eligibility to the Supplemental Nutrition Assistance Program (SNAP), commonly known as food stamps, which helps more than 40 million Americans buy groceries every month. Both programs are disproportionately used by women and children.

Democrats have been largely on the sidelines because Republicans in the Senate will use a process called reconciliation, which allows the majority party to bypass the 60-vote filibuster requirement and approve legislation by a simple majority vote. There are 53 Republicans in the 100-seat Senate. 

It has become common for both parties to take advantage of reconciliation when they control the White House and both chambers of Congress. Republicans used reconciliation to enact the 2017 Trump tax cuts that they are now attempting to renew. Democrats used it to enact President Joe Biden’s COVID-19 stimulus bill and the Inflation Reduction Act.  

Here are the programs serving women and children that House Republicans’ bill would change:

Medicaid

House Republicans’ proposal aims to slash $625 billion from Medicaid over the next decade, leading to an enrollment drop of more than 10 million people, according to KFF, a nonpartisan health organization. 

The federal-state health insurance program covers more than 40 percent of all births in the country, and about 37 percent of those enrolled are children. Three million Americans enrolled in Medicaid report that they are unable to work due to caregiving responsibilities, according to an AARP analysis. 

The legislation approved by the House would cut Medicaid spending in part by imposing a strict 80-hours-a-month work requirement for adults without children or disabilities. The 19th has reported on how these stepped-up work requirements would disproportionately impact middle-aged and older women. 

The bill also would make it easier for states to cancel Medicaid coverage if recipients do not provide additional paperwork to show they meet eligibility requirements; force states to require co-payments for some types of care for Medicaid enrollees who live above the federal poverty threshold; and reduce the reimbursement rate for states that use their own funds to cover immigrants not lawfully in the country, according to a detailed analysis by KFF.

The version of the bill passed by the House would prohibit Medicaid from covering care for non-abortion services provided by Planned Parenthood clinics, which are already banned from using federal funds to pay for abortions. It also would limit coverage of gender-affirming care as an essential benefit under Affordable Care Act plans and prohibits Medicaid and the Children’s Health Insurance Program (CHIP) from covering the treatment. Earlier drafts limited this prohibition to care for minors; the approved bill extends it to care for all ages. 

SNAP  

The package passed by House Republicans would require more SNAP recipients in their 50s and 60s to work and provide fewer exemptions for parents.  

The proposal would lower the age at which work requirements end by a decade, to 54. Right now, parents with dependent children under 18 are exempt from working; the bill lowers that age to 7. 

Additionally, the Republican-approved legislation would require states to take on more of the costs of administering SNAP and limit the ability of future administrations to raise benefit amounts. 

Changes to SNAP could affect school nutrition programs, as many students qualify for free meals based on whether they and their families are eligible for food stamps. 

The Congressional Budget Office has not yet evaluated the SNAP provisions in the reconciliation bill. Their analysis of past similar legislation adding new work requirements showed that it could result in more than 3 million fewer people participating in the federal nutrition program. 

Child tax credit

The House Republicans’ tax bill would increase the amount of the child tax credit to $2,500 from $2,000 through 2028, the last year of Trump’s term. The tax credit would then drop back down and be indexed to inflation. 

Another provision in the approved House version would require a child’s parents to have a Social Security Number to access the credit, even if the child also has a Social Security Number.

The intent is to block immigrant parents in the country illegally and without work authorization from claiming the benefit; these parents are already typically excluded from accessing the credit. In mixed immigration status households, where one parent has a Social Security Number and the other does not, the child would still be ineligible for the credit. 

The House version of the tax bill also caps the refundable portion of the child tax credit at $1,400 per qualifying child, down from $1,700. This change would limit the ability of the country’s lowest-income parents to access the credit.