Early Thursday morning, by a vote of 215-214-1 (1 member voting present and 2 members not voting), the House passed the “One Big Beautiful Bill Act,” the reconciliation bill. The passage is a major victory for the President and Speaker Johnson. Passage of the bill followed days of round-the-clock negotiations within the GOP and a marathon session in the House Rules Committee.

The text and summary of the One Big Beautiful Bill Act can be found here.

The proposed changes to Medicaid included in the One Big Beautiful Bill Act include: instituting work reporting requirements, new cost-sharing requirements for patients who are covered under Medicaid expansion, requiring more frequent eligibility checks by states, removing Planned Parenthood and other abortion providers from Medicaid, constraining state match funding, restricting coverage for gender affirming health care, and barring states from using their own funds to provide Medicaid to those without documented immigration status.

NCSD is concerned about the impact of these proposed cuts to Medicaid and the ACA contained in the One Big Beautiful Bill Act. Medicaid is the single largest source of insurance coverage for people living with HIV and it also provides vital access to care for tens of millions of Americans living with and at risk for HIV, STIs, and viral hepatitis. Any cuts to the program will result in lost coverage, increased gaps in health care, and weakened health care infrastructure. We also know that many of the Medicaid changes proposed in this bill will shift burden and administrative costs to states and state health departments.

The One Big Beautiful Bill Act now moves to the Senate, where it does face an uphill battle for passage as written. This bill—as a reconciliation bill—can pass the Senate with 51 votes, and with the Senate’s current party divisions, only 3 Senators can vote “no” and still have the bill pass. Senators Hawley (R-MO), Johnson (R-WI), Paul (R-KY), Tillis (R-NC), Murkowski (R-AK), and Collins (R-ME) have all expressed concerns about the House-passed One Big Beautiful Bill Act, for a variety of reasons.

For context, if the Senate makes any changes to this bill, it will need to go back to the House to pass the Senate-passed version before it goes to the President for signature. So, there is a lot of legislative process ahead of this bill and these proposals before it is a done deal.

And if you want to be kept up to date on the ins and outs of this process and other federal policy changes, please join PriorityONE!