House Passes Massive Tax-and-Spending Bill; Trump to Sign It Into Law on Fourth of July

The House passed a massive tax-and-spend bill today that will cut federal Medicaid spending by nearly $1 trillion over the next10 years and increase the number of people in the U.S. by approximately 11 million.

The bill does include the pharmacy benefit management provisions that groups in favor of industry reform and greater regulation wanted to include. The New York Times reported today that it includes a victory for the pharmaceutical industry with new rules that broaden the exemption to Medicare price negotiation under the Inflation Reduction Act to drugs that are approved to treat more than one rare disease.

The bill also includes phased-in limits on state-imposed provider taxes that are expected to further reduce Medicaid funding.

The bill passed 218-214 this afternoon with two Republicans — Brian Fitzpatrick of Pennsylvania and Thomas Massie of Kentucky — voting with all the Democrats in opposition. In what promises to be a moment of high political theater, President Donald Trump is expected to sign the bill into law tomorrow. Early in his second administration, Trump pushed for an ambitious “one big beautiful bill” instead of a more cautious approach, and his slogan became the bill’s formal name.

Estimates about the bill resulting in millions more people in the U.S. lacking health insurance coverage came from the Congressional Budget Office before the Senate made final tweaks.

Democrats and Medicaid advocates say the new work and eligibility requirements will drastically reduce Medicaid enrollment and harm people who will forgo medical care with no means to pay for it. The White House and Republicans say the requirements strengthen the program for people who most need it.

The effect of the Medicaid cuts on rural hospitals loomed as an obstacle to the bill's passage but the Senate ended up adding a $50 billion fund rural hospitals that diffused that issue.