health care economics

WASHINGTON (Reuters) – President Donald Trump‘s tax-cut legislation cleared its final hurdle in the US Congress on Thursday, as the Republican-controlled House of Representatives narrowly approved a massive package that would fund his domestic agenda and push millions of Americans off health insurance.

The 218-214 vote amounts to a significant victory for the Republican president that will fund his immigration crackdownmake his 2017 tax cuts permanent and deliver new tax breaks that he promised during his 2024 campaign.

It also cuts health and food safety net programs and zeroes out dozens of green energy incentives. It would add $3.4 trillion to the nation’s $36.2 trillion debt, according to the nonpartisan Congressional Budget Office.

Despite concerns within Trump’s party over the 869-page bill’s price tag and its hit to healthcare programs, in the end just two of the House’s 220 Republicans voting against it, following an overnight standoff. The bill has already cleared the Republican-controlled Senate by the narrowest possible margin.

The White House said Trump will sign it into law at 5 PM ET (2100 GMT) on Friday, the July 4 Independence Day holiday.

Republicans said the legislation will lower taxes for Americans across the income spectrum and spur economic growth.

“This is jet fuel for the economy, and all boats are going to rise,” House Speaker Mike Johnson said.

Every Democrat in Congress voted against it, blasting the bill as a giveaway to the wealthy that would leave millions uninsured.

“The focus of this bill, the justification for all of the cuts that will hurt everyday Americans, is to provide massive tax breaks for billionaires,” House Democratic Leader Hakeem Jeffries said in an 8-hour, 46-minute speech that was the longest in the chamber’s history.

Trump kept up the pressure throughout, cajoling and threatening lawmakers as he pressed them to finish the job.

“FOR REPUBLICANS, THIS SHOULD BE AN EASY YES VOTE. RIDICULOUS!!!” he wrote on social media.

Though roughly a dozen House Republicans threatened to vote against the bill, only two ended up doing so: Brian Fitzpatrick of Pennsylvania, a centrist, and Thomas Massie of Kentucky, a conservative who said it did not cut spending enough.

Marathon Weekend

Republicans raced to meet Trump’s July 4 deadline, working through last weekend and holding all-night debates in the House and the Senate. The bill passed the Senate on Tuesday in a 51-50 vote in that saw Vice President JD Vance cast the tiebreaking vote.

According to the CBO, the bill would lower tax revenues by $4.5 trillion over 10 years and cut spending by $1.1 trillion.

Those spending cuts largely come from Medicaid, the health program that covers 71 million low-income Americans. The bill would tighten enrollment standards, institute a work requirement and clamp down on a funding mechanism used by states to boost federal payments — changes that would leave nearly 12 million people uninsured, according to the CBO.

Republicans added $50 billion for rural health providers to address concerns that those cutbacks would force them out of business.

Nonpartisan analysts have found that the wealthiest Americans would see the biggest benefits from the bill, while lower-income people would effectively see their incomes drop as the safety-net cuts would outweigh their tax cuts.

The increased debt load created by the bill would also effectively transfer money from younger to older generationsanalysts say. Ratings firm Moody’s downgraded US debt in May, citing the mounting debt, and some foreign investors say the bill is making US Treasury bonds less attractive.

The bill raises the US debt ceiling by $5 trillion, averting the prospect of a default in the short term. But some investors worry the debt overhang could curtail the economic stimulus in the bill and create a long-term risk of higher borrowing costs.

On the other side of the ledger, the bill staves off tax increases that were due to hit most Americans at the end of this year, when Trump’s 2017 individual and business tax cuts were due to expire. Those cuts are now made permanent, while tax breaks for parents and businesses are expanded.

The bill also sets up new tax breaks for tipped income, overtime pay, seniors and auto loans, fulfilling Trump campaign promises.

The final version of the bill includes more substantial tax cuts and more aggressive healthcare cuts than an initial version that passed the House in May.

During deliberations in the Senate, Republicans also dropped a provision that would have banned state-level regulations on artificial intelligenceand a “retaliatory tax” on foreign investment that had spurred alarm on Wall Street.

The bill is likely to feature prominently in the 2026 midterm elections, when Democrats hope to recapture at least one chamber of Congress. Republican leaders contend the bill’s tax breaks will goose the economy before then, and many of its benefit cuts are not scheduled to kick in until after that election. Opinion polls show many Americans are concerned about the bill’s cost and its effect on lower income people.

(Reporting by Bo Erickson, Richard Cowan and David Morgan Additional reporting by Andrea Shalal and Jasper Ward Writing by Andy Sullivan Editing by Scott Malone, and Alistair Bell)