Illustration: Shoshana Gordon/Axios
The House gave a reluctant signoff to the Senate-passed reconciliation bill Thursday, sending it to President Trump's desk on a 218-214 vote after GOP leaders spent another all-nighter pinning down the votes.
The big picture: This is the biggest domestic policy package in years — and legacy-defining legislation for Trump and the GOP majorities in the House and Senate.
- It's going to become law despite all of the doubts voiced by many Republicans and virtually all Democrats.
- It includes the biggest rewrite of Medicaid in decades and a sharp phaseout of IRA energy tax credits along with an extension of Trump's 2017 tax cuts.
- Two House Republicans, Reps. Thomas Massie and Brian Fitzpatrick, voted against the final package.
What's inside: The Medicaid overhaul includes the first nationwide work rules for able-bodied adults, new limits on provider taxes that will reduce federal Medicaid spending and more frequent eligibility determinations.
- There's also a temporary 2.5% Medicare physician fee increase and more exemptions for orphan drugs from Medicare price negotiations. And the bill contains a one-year Medicaid funding ban for Planned Parenthood.
- The way in which the reconciliation bill increases the deficit compared to current law would trigger hundreds of billions in cuts to most Medicare spending unless Congress takes further action. That sequester has never actually been triggered, however.
What we're watching: The legislation would lead to 11.8 million more uninsured people, according to Congressional Budget Office estimates — the biggest potential loss of health insurance for Americans since the Affordable Care Act repeal effort in 2017.
Read more on Axios.com.
