The House of Representatives passed the President Donald Trump-backed “One Big Beautiful Bill” in a 215-214 vote May 22 after debating for hours overnight on the controversial legislation that includes significant cuts to Medicaid.
The move comes after the GOP-led House Rules Committee released revisions to the bill and voted 8-4 to advance it after debating from 1 a.m. EDT May 21 to around 10:40 p.m. EDT.
Here are six things to know:
1. Healthcare revisions to the multitrillion-dollar legislation include a two-year acceleration of Medicaid work requirements for able-bodied people ages 18-64 no later than Dec. 31, 2026. The work requirements were originally set for 2029, but have been accelerated to generate faster savings. States also have the opportunity to move up the date if they would like.
2. States that have not expanded Medicaid under the ACA will also receive higher payments under the revised bill, an incentive for them to maintain their stance. Along with cuts to Medicaid, the bill could slash nearly $500 billion in Medicare funding over the next decade, according to a May 20 report from the nonpartisan Congressional Budget Office.
3. Gender transition procedures will no longer be covered by ACA plans beginning Jan. 1, 2027.
4. The bill rebrands individual coverage health reimbursement arrangements (ICHRA) to Custom Health Option and Individual Care Expense (CHOICE) arrangements. This provision solidifies the 2019 regulations that now allow employers to use ICHRAs to help employees purchase individual coverage, as well as cover certain medical expenses, without violating group plan rules. It also includes significant reforms to health reimbursement arrangements and high deductible health plans.
5. The bill, which President Trump and GOP leaders argue is aimed at tackling “waste, fraud and abuse,” now heads to the Senate, where Republicans hold a 53-47 majority. However, it is not clear when the vote will be held, NBC News reported May 22.
6. The bill’s revisions have also resulted in backlash from several healthcare advocacy groups. In statements issued May 21 and May 22 , Rick Pollack, president and CEO of the American Hospital Association, urged the House to reject the legislation and said that the bill’s Medicaid legislative proposals “severely restrict the use of legitimate state funding resources and supplemental payment programs, including provider taxes and direct payments, under the guise of eliminating waste, fraud and abuse.”
America’s Essential Hospitals President and CEO Bruce Siegel, MD, MPH, said that their organization “strongly opposed” the “deep Medicaid cuts” in the bill, highlighting that the cuts would “threaten the health and well-being of millions of Americans.”
The Federation of American Hospital’s president and CEO Chip Kahn on May 22 called the bill a “death knell to critical hospital services” and stressed that the organization was ready to work with lawmakers to secure policies that protect healthcare and local hospitals. “There is still time to “take heed and turn this ship,” he said.
The Association of American Medical Colleges also criticized the bill’s proposal to eliminate Grad PLUS loans for new borrowers, effective July 1, 2026. It would also cap graduate and professional student loans at $150,000, which is below average medical school debt, and would block residency loan payments from counting toward Public Service Loan Forgiveness.
“[The] elimination of the Grad PLUS loan program and increased restrictions on medical residents’ eligibility for Public Service Loan Forgiveness will make it harder for patients to get the care they need by undermining the ability of future physicians to attend medical school,” AAMC president and CEO David Skorton, MD, and Chief Public Policy Officer Danielle Turnipseed, said in a statement.
