Editor’s note: This article has been updated throughout.

President Donald Trump signed into law a sweeping package of tax cuts Friday that will largely benefit the wealthy. The tax cuts and stepped-up immigration enforcement funding will be financed by what advocates call “historic” cuts to government health insurance and nutrition programs that serve lower-income Americans.

Republicans held marathon sessions to get Trump’s “one, big, beautiful bill” to the president ahead of the July 4 holiday so that its enactment would coincide with the country’s 249th birthday.

The package of tax breaks, immigration enforcement funding and spending cuts is projected to add at least $3.3 trillion to the national deficit over the next decade and lead to at least 12 million Americans losing health care coverage, according to the nonpartisan Congressional Budget Office and other estimates.

The largest spending cuts will come from Medicaid, the popular government health insurance program that covers more than 70 million lower-income Americans.

Medicaid cuts were a major sticking point for a handful of GOP members in competitive districts and several senators in states where people disproportionately rely on the program. Democrats in both chambers were universally opposed.

Republican Sen. Josh Hawley of Missouri wrote an op-ed for the New York Times under the title “Don’t Cut Medicaid.” Sen. Lisa Murkowski said it would devastate rural hospitals in her state of Alaska. Hawley quickly changed his mind after some minor tweaks to the bill, though, and Murkowski did the same after securing some provisions specific to Alaskans. Sen. Thom Tillis of North Carolina held firm in his opposition to the bill over concerns about the Medicaid cuts, choosing to retire after Trump threatened to support a primary opponent in his next election. Republican Sen. Rand Paul of Kentucky also voted against the package due to deficit concerns. Vice President JD Vance cast the tie-breaking vote. 

Though there was Republican opposition from moderates and fiscal hawks when the legislation arrived back in the House, all but two were persuaded, Reps. Brian Fitzpatrick of Pennsylvania and Thomas Massie of Kentucky. House Speaker Mike Johnson of Louisiana said no changes to the bill were made in exchange for votes; instead, the White House promised executive action on priorities for lawmakers who cooperated and threatened primary challenges for those who didn’t, according to multiple news reports.

Democrats were largely on the sidelines as the bill was written and negotiated — because Republicans control the Senate and the House and also because  Senate Republicans used a process called reconciliation, which allows the majority party to bypass the 60-vote filibuster requirement and approve legislation by a simple majority vote. 

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 just renewed. Democrats used it to enact President Joe Biden’s COVID-19 stimulus bill and the Inflation Reduction Act.  

Here are the programs serving women, children and LGBTQ+ Americans that the law changes:

Medicaid

The legislation will cut federal spending on Medicaid and the Children’s Health Insurance Program (CHIP) for low-income infants and children by more than $1 trillion over the next decade — an 18 percent larger cut than in the first version approved by the House, according to Georgetown University’s McCourt School of Public Policy. 

The federal-state Medicaid health insurance program covers more than 40 percent of all births in the country, and about 37 percent of those enrolled are children. Nationally, CHIP covers about 7 million children and several hundred thousand pregnant people.

Trump’s tax bill will cut Medicaid spending in part by imposing a strict 80-hours-a-month work requirement for adults without children or disabilities — this change must be implemented by the end of 2026, after the midterm elections, but states have the option of doing it sooner. Three million Americans enrolled in Medicaid report that they are unable to work due to caregiving responsibilities, according to an AARP analysis. The 19th has reported on how these stepped-up work requirements would disproportionately impact middle-aged and older women. 

The legislation creates new limits on Medicaid coverage for immigrants in the country legally. It will also require states to charge Medicaid recipients above the poverty line for co–payments for some health care. 

A provision that would have prohibited Medicaid from covering gender-affirming care for transgender people — minors and adults — was stripped out by the Senate parliamentarian. But the Senate parliamentarian approved a provision that will prevent Planned Parenthood and other reproductive health care clinics from receiving Medicaid reimbursements for the provision of non-abortion care like pap smears and tests for sexually transmitted diseases. 

Some of the largest savings will come from the stepped-up work requirements and the reduction in the amount that states are able to tax Medicaid providers, impacting Medicaid expansions in as many as 22 states, according to KFF, a nonpartisan health policy organization.
The legislation will likely also trigger the rollback of Medicaid expansions in some states that have passed laws that end the expansion if the federal government changes the federal-state funding formula.

SNAP  

Trump’s tax-and-spending cuts bill will require more SNAP recipients in their 50s and 60s to work and provide fewer exemptions for parents.  

The proposal lowers 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 legislation lowers the age to 14.

Additionally, the legislation will shift some SNAP costs to states — since its inception, SNAP benefits have been fully funded by the federal government.

The federal government will continue to fund SNAP for states that have a payment error rate below 6 percent, but starting in 2028, states with error rates above that but below 13.3 percent will have to contribute 5 to 15 percent of the cost. The upper limit on the error rate was meant as a carveout for Alaska in order to win Murkowski’s vote, but was written in a way that will include other states with the highest error rates, undercutting its intent. 

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

Child tax credit

The legislation permanently increases the child tax credit to $2,200 from $2,000. 

The final version changed a provision that would have required both of a child’s parents to have a Social Security number to access the credit, even if the child also has a Social Security number. Now, only one parent will have to have a Social Security number to claim the credit. 

There is a cap on the refundable portion of the child tax credit, limiting the ability of the country’s lowest-income parents to access it.

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