The Senate on Tuesday approved the latest version of President Donald Trump’s sweeping tax and immigration spending package, with Vice President JD Vance casting the decisive tie-breaking vote following an all-night session. As the legislation now moves to the House, it faces mounting scrutiny over provisions that propose the most significant rollback of Medicaid in the program’s 58-year history.The reconciliation bill includes more than $1 trillion in Medicaid cuts over the next decade, a move that has drawn rare public criticism from within the Republican Party. Speaking in the Senate over the weekend, Senator Thom Tillis of North Carolina questioned the impact on his constituents. “What do I tell 663,000 people in two years, three years,” he asked, “when President Trump breaks his promise by pushing them off of Medicaid because the funding’s not there anymore?”According to projections by researchers from the University of Pennsylvania, Harvard, and Yale, the toll could be far worse than just the loss of health insurance. Their analysis estimates that the proposed Medicaid reductions could result in over 51,000 additional deaths each year, particularly affecting those who are elderly, poor, or chronically ill.Currently, Medicaid provides coverage to approximately 1 in 5 Americans, including low-income families, people with disabilities, and elderly residents in long-term care. Among the most vulnerable are the 13 million dual-eligible individuals who receive both Medicare and Medicaid benefits. These individuals depend on Medicaid subsidies to afford life-saving medications. Researchers estimate that 18,200 dual-eligible individuals could die annually if those subsidies are withdrawn.The bill also introduces work requirements for most nonelderly adult Medicaid recipients and ends enhanced premium tax credits under the Affordable Care Act (ACA) marketplaces. A separate study by Yale researchers projects that these changes could result in more than 20,000 additional deaths each year due to loss of insurance coverage.Another provision of the bill delays implementation of new nursing home staffing standards by a decade. Based on studies linking nurse staffing to resident mortality, researchers at the University of Pennsylvania estimate that the delay could lead to an additional 13,000 deaths annually among nursing home residents.Experts warn that the real-world impact of these cuts will extend far beyond coverage statistics. States, unlike the federal government, must operate with balanced budgets, and the deep reduction in federal Medicaid funding will likely compel governors and legislatures to scale back benefits, reduce eligibility, or impose time limits on coverage. Rural and urban healthcare providers—including hospitals and clinics—are also expected to bear the brunt, with many potentially forced to cut services or shut down.Also read | Why Trump’s ‘Big Beautiful Bill’ matters: What’s inside, what it means, and why the fight was so fierce
