This week, the House’s reconciliation package, formally called the One Big Beautiful Bill Act, was marked up (aka acted on) in a number of committees. Today, the House Budget Committee met to discuss the One Big Beautiful Bill Act, a procedural step before the bill can advance to the full House of Representatives for a vote. The vote in the Budget Committee failed, 16-21, with five GOP committee members voting against the One Big Beautiful Bill Act. It is believed that the House Budget Committee will reconvene on Sunday night to vote again.

The five GOP members who voted against the One Big Beautiful Bill Act (the House reconciliation bill) over concerns that the bill would add an estimated $2.5 trillion to the national debt. This bill is a large package of bills on many different topics: hence, One Big Beautiful Bill Act. Among other things, this reconciliation bill would: extend the 2017 Trump Tax Cuts (costing $2.2 trillion), increase the standard tax deduction (costing $1.3 trillion), increase the child tax credit (costing $797.3 billion), and increase defense spending and make border wall and immigration restrictions (costing $148.5 billion and $147.3 billion, respectively).

This bill also proposes many dramatic cuts to Medicaid and ACA benefits and reduces SNAP (food stamp) benefits. The cuts to Medicaid and the ACA are estimated to reduce spending by $800 billion and cuts to SNAP by $300 billion. 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.

There are concerns that steeper cuts to safety-net programs could be added to the One Big Beautiful Bill Act to ensure passage of this bill in the House Budget committee—though how those cuts will be received by the full House is unclear. Garnering enough votes among the full GOP caucus—fiscal hawks, members of the conservative Freedom caucus, and moderate GOP members from “blue” states, for example—for the One Big Beautiful Bill Act is proving challenging, as evidenced by the Budget Committee vote today.

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.

This is just step three of a long process for this Reconciliation bill. In addition to passage through the House Budget Committee, the House Rules Committee will rule (ha) on the One Big Beautiful Bill Act before it goes to the full House of Representatives. And then there is a full additional chamber of the Senate with a committee and full Senate floor step. Whew. So, buckle up—it’s going to be a long few weeks.

If you are concerned about these changes to Medicaid and the ACA, here is an action alert that you—as a private individual on your own time—can fill out: ACTION ALERT: Take Action to Protect Medicaid – AIDS United.

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!