May 22, 2025

A few moments ago the House of Representatives voted on and passed the ‘big beautiful bill’ it has been wrangling over for weeks.  After 19 hours of debate and reports of lawmakers falling asleep at their desks, tweaks to the bill were made, preparing it for a final vote.  The bill passed by one vote, delivering a major victory for House Leader Mike Johnson.  

Bear in mind:  The bill still has a very long way to go before it arrives on President Trump’s desk.  The bill now heads to the Senate, where Republicans are expected to tear up many of the policy provisions sought by House GOP hardliners.

We will have further information throughout the day.

House bill provisions include:

MEDICAID — Work requirements would kick in at the end of 2026, rather than the start of 2029 as initially proposed. There would be financial incentives for states not to expand coverage to people who are still near the poverty line but have higher incomes than traditional enrollees. And the bill would bar coverage for gender-affirming care for adults under the program, not just minors as initially proposed.

More about the changes made before the final vote a few moments ago:

House Republicans made a few surprise revisions to the Medicaid portion of that bill, including one that would reward states for not expanding Medicaid. That measure would let non expansion states pay doctors and hospitals more than expansion states would be allowed to pay providers.

Another change calls for funding federal subsidies for health insurers that help pay out-of-pocket costs for low-income people who get coverage through the Affordable Care Act’s marketplaces. That’s a reversal of a policy that President Trump instituted during his first term. Trump scrapped the cost sharing reduction payments in 2017, but at the time the Congressional Budget Office estimated that terminating the subsidies actually increases government spending, and it failed to undermine the ACA marketplaces. 

Insurers that cover abortions would not receive the cost sharing reduction payments under the updated bill.

The biggest change calls for starting Medicaid work requirements at the end of next year, up from the beginning of 2029. That change will likely significantly increase the projected savings from work requirements, which were already estimated at $280 billion over a decade. 

Previously, the bill would’ve banned Medicaid coverage of gender-affirming care for minors. The updated bill expands that ban to adults.

Republicans also broadened a measure aimed at denying insurance to immigrants. The previous version called for penalizing states that provide coverage to undocumented immigrants with state funds. Now it would also penalize states that use a federal option available in Medicaid and the Children’s Health Insurance Program to expand coverage for lawfully residing children and pregnant people.

More to follow.  Stand by.