House passes healthcare cuts in "One Big Beautiful Bill" by single vote

The One Big Beautiful Bill Act (H.R. 1) is over 1,000 pages long and was bundled under budget reconciliation to avoid a 60-vote filibuster.

The House passed the legislation on Jun. 25, 2025 by a 215–214 vote with one Republican voting “present.”

It cuts $880 billion from Medicaid over 10 years while extending $3.8 trillion in tax cuts, according to the Congressional Budget Office’s 10-year score.

CBO estimates the bill adds $2.4 trillion to primary deficits and, including interest costs of $0.6 trillion, $3.0 trillion to the national debt over 10 years.

If temporary tax and spending provisions were made permanent, independent analysts project the total cost would rise to $5.0 trillion.

By 2034, CBO projects 10.3 million people would lose Medicaid coverage due to work requirements and enrollment restrictions.

The bill imposes an 80-hour per month work, volunteer or training requirement on non-disabled, childless adults to maintain Medicaid eligibility—despite 74% of them already working.

Families can contribute up to $5,000 per year to so-called “Trump accounts,” with a $1,000 federal match for children born 2024–2028.

It temporarily raises the child tax credit by $500 (from $2,000 to $2,500) and increases the standard deduction by $1,000 for individuals and $2,000 for joint filers through 2028.

The bill raises the federal debt ceiling by $4 trillion and must be passed by Jul. 4, 2025 to avoid expiration of 2017 Tax Cuts and Jobs Act provisions.

Two House Republicans—Warren Davidson (OH) and Thomas Massie (KY)—voted against the bill; Andy Harris (MD) voted present.

Majority Leader John Thune and Minority Leader CSChuck Schumer will manage Senate floor strategy, with only three Republican defections allowable in a 53–47 GOP majority.

The nonpartisan Senate parliamentarian enforces reconciliation rules and has flagged several provisions as potentially out of scope.