House Passes Reconciliation Bill; Legislation Advances to Senate for Consideration

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On Thursday, May 22, House Republicans passed , the “One Big Beautiful Bill Act.” After weeks of intraparty negotiations and last-minute concessions in a manager’s amendment released less than 12 hours before the final vote, House Speaker Mike Johnson (R-LA) was able to advance the legislation in a final vote of 215–214.

Overall, the House-passed bill maintains the policy themes of the legislation that advanced from the House Energy and Commerce (E&C) and Ways and Means (W&M) Committees on May 14. These include:

• Targeting cuts at the Medicaid expansion group created by the Affordable Care Act (ACA)
• Limiting the tools available to states to finance their share of the Medicaid program
• Broadening prohibitions on providers of reproductive health services or abortions and for transgender individuals and noncitizens;
• Imposing significant administrative requirements for states and people seeking health coverage through the Marketplace and Medicaid;
• Funding cost-sharing reductions and ending silver-loading;
• Ending passive reenrollment for Marketplace enrollees;
• Discontinuing individuals’ ability to receive an advance premium tax credit while their application is pending; and
• Limiting overall opportunities to enter the Marketplaces.

An initial analysis from the Congressional Budget Office (CBO) that at least 8.6 million individuals would be without health coverage by 2034 based only on the original E&C provisions. CBO also projected that Marketplace enrollees could lose coverage under the W&M provisions. (CBO is still measuring the interactions between the two.)

Now, all eyes turn to the Senate’s consideration of the bill. In the Senate, a budget reconciliation bill is not subject to the filibuster and, as such, can be passed by a simple majority vote (51 votes) rather than the typical 60-vote threshold required to end a filibuster. The Senate is widely expected to revise the legislation in order to reflect its own spending and saving priorities.

Senate Majority Leader John Thune (R-SD) set a July 4 deadline for his chamber’s vote on the legislation, but the Senate Republicans’ ability to meet this self-imposed cutoff date—particularly given likely modifications to the legislation—remains to be seen.

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