Seventy-one million people are now in jeopardy of losing vital services—including a disproportionate number of African Americans — after the House Republican majority passed a sweeping bill that cuts trillions from the nation’s social safety net while still raising the national debt by $4 trillion.
The legislation, backed by President Donald Trump and driven through by the MAGA-controlled House, passed by a razor-thin 215-214 vote early Thursday morning. Two Republicans, Reps. Thomas Massie of Kentucky and Warren Davidson of Ohio, joined all Democrats in voting no. Far-right Rep. Andy Harris of Maryland voted present.
At the bill’s core are $736 billion in cuts to Medicaid — the largest in U.S. history — and severe reductions to the Supplemental Nutrition Assistance Program (SNAP), commonly known as food stamps. Medicaid covers more than 71 million Americans, including a third of all Black individuals in the country, and SNAP supports roughly 42 million people. Critics say the cuts will devastate families, overwhelm states, shutter hospitals, and deepen racial and economic inequality.
Congresswoman Summer Lee of Pennsylvania voted against the measure and called it “cruel, calculated, and undemocratic.”
“This bill rips health care away from seniors, children, and people with disabilities,” said Lee. “It throws millions off SNAP, undercuts school meals, and still hands out massive tax breaks to the rich and powerful. MAGA Republicans have made it clear who they serve — and it’s not the American people.”
The legislation also extends Trump’s expiring 2017 tax cuts, eliminates federal taxes on tips and overtime pay, and funnels billions into military expansion and mass deportation efforts — key pillars of Trump’s 2024 campaign platform.
Despite touting it as a plan to reduce government spending, the bill adds $4 trillion to the debt — while forcing states to absorb the cost of reduced federal support. Experts say many states will be left with painful choices: slash benefits, reduce Medicaid rolls, hike taxes, or cut essential services like education and transportation.
“These aren’t just numbers. These are lives,” said Alice Burns, associate director of the Program on Medicaid and the Uninsured at KFF. “This scale of rollback is unprecedented, and we don’t fully know how catastrophic the fallout will be.”
Research shows the impact could be deadly.
A National Bureau of Economic Research study found that Medicaid expansion under the Affordable Care Act saved at least 27,400 lives between 2010 and 2022. States that refused expansion missed the opportunity to save an additional 12,800 lives.
Another study published this month in the New England Journal of Medicine found that low-income seniors and disabled individuals who lost access to Medicaid drug subsidies were far more likely to die — especially those with chronic conditions.
The racial impact is clear. Nearly one in three Black Americans relies on Medicaid.
In states that didn’t expand Medicaid, Black residents are overrepresented in the coverage gap, earning too much to qualify for traditional Medicaid but too little to afford marketplace insurance.
“This isn’t just bad policy — it’s a moral failure,” said Lee. “There’s nothing beautiful about choosing billionaires over babies, or corporations over communities. This bill is as cruel as the vision behind it.”