President Donald Trump got what he wanted Thursday as the GOP-controlled U.S. Congress gave their final stamp of approval for the sweeping domestic policy package previously dubbed the “One Big Beautiful Bill Act” by a final vote of 218-214. No Democrats voted for the legislation, while just two Republicans were against it.
The behemoth measure has been pared down by more than 100 pages to just under 900 in its final House-approved form. Republican proponents have labeled the package an “all-at-once” fulfillment of Trump’s campaign promises, though it was not without staunch detractors on both sides of the aisle.
Highlights include cementing the 2017 tax cuts, phasing out EV and clean energy incentives, funding for a large increase in detention centers and border walls, and slashing about $1 trillion in Medicaid over the next decade. The legislation is expected to add about $3.3 trillion to the national debt.
How will it affect my healthcare?
The counterweight to a loss in future tax revenue will be a significant decrease in Medicaid funding to the tune of around $1 trillion.
Projections from the nonpartisan Congressional Budget Office estimate that just under 12 million Americans will become uninsured and three million more will no longer qualify for SNAP benefits, previously known as food stamps. While states who recently expanded their Medicaid programs will lose the most funding relative to current levels, non-expansion states like Mississippi will feel significant effects.
About 118,000 Mississippians could lose health coverage altogether, while the state’s hospitals could also get hit with major funding gaps.
For patients, a new 80-hour-a-month work requirement will disqualify many for both Medicaid and SNAP, including Americans up to age 65 and those with children 14 and older. Further restrictions include a new $35 co-payment that can be charged for Medicaid services.
Concerns for Mississippi hospitals include a dramatic drop in the state directed program rate, the mark set at the federal level for what is reimbursed to care providers supplying Medicaid services. The decrease could cost state hospitals hundreds of millions of dollars, according to the Mississippi Hospital Association.
In 2023, rate increases saved more than a few Magnolia State hospitals from shutting their doors in rural areas, while relieving stress from major medical systems as well.
Additionally, a further pullback in supplemental payments made to hospitals serving uninsured patients could significantly impact state healthcare providers. Mississippi has one of the highest rates of uninsured people in the U.S., according to the Center for Mississippi Health Policy, and state medical facilities provide about $600 million in uncompensated care annually.
Leah Smith, vice president of policy and advocacy for Mississippi Hospital Association, says the combination of each factor could be a major financial burden on both individuals and hospitals.
“All of those things collectively are going to be a really big hit over time and that’s the issue,” Smith said “None of us want to go to the doctor and not be able to afford it. There are working people in Mississippi that want to find a way.”
A silver lining for largely rural states like Mississippi is that bill provides for the Rural Hospital Stabilization Fund, a $25 billion sum to be doled out over five years. Half of the fund will be distributed evenly to each state, while the other half will be distributed at the discretion of the Centers for Medicare & Medicaid.
But according to the National Rural Health Association, the fund will only make up about 43% of what rural hospitals will lose under the new policies.
What about my taxes?
Those standing behind the bill are pointing to massive tax relief for Americans, or at least the avoidance a steep increase if the 2017 “Trump Tax Cuts” were allowed to expire.
According to Rep. Michael Guest (R-Miss.), the new bill will help the average Mississippian avoid a 24% tax hike, while providing doubled child tax credits and standard deductions relative to previous policy.
The legislation addressed some key campaign points for Trump in 2024, such as eliminating taxes on tips and a new $6,000 deduction for seniors who earn $75,000 or less, ending taxes on Social Security for 88 percent of Americans aged 65 and up.
In all, the package contains about $4.5 trillion in tax cuts.
The new policy will also boost the child tax credit from $2,000 to $2,200. But an analysis from Columbia University found millions of children in low-income families won’t qualify for the full credit due to income requirements. Around 45% of Mississippi children will be excluded from the full credit.
An analysis from the Congressional Budget Office asserts the greatest tax relief will go to the wealthiest households in the U.S., about $12,000 annually, while middle-income taxpayers will get a tax break of $500 to $1,500.
The shuffled tax code is projected to cost low-income taxpayers around $1,600 every year.
What will the new bill pay for?
The freshly passed legislation will provide around $350 billion to bolster U.S. border and national security, including $46 billion for the Mexico border wall and $45 billion for additional migrant detention facility capacity.
Further funds will go toward hiring 10,000 new Immigration and Customs Enforcement officers, complete with $10,000 signing bonuses to entice new ICE agents and Border Patrol officers to join the effort.
Trump has noted that his administration’s objective is to deport one million people per year.
A $10 billion grant fund to aid states with immigration enforcement and deportation will also be established. Part of the funding will also come from new fees levied on immigrants, such as when they are seeking asylum protection in some cases.
Billions more in funding will be poured into the U.S.’s defense capabilities with the Pentagon receiving cash for ship building, munitions systems, and “quality of life” improvements for military personnel. The proposed “Golden Dome” missile defense system is also getting $25 billion for development.
What else?
Clean energy tax breaks will be stripped in heavy-handed fashion.
The relief for projects driven by renewable sources like wind and solar were a defining piece of the Biden administration’s landmark policy bill in 2022. Other breaks like those for electric vehicle buyers will dissolve on Sept. 30, instead of the previously established end date of 2032.
A provision in the bill will also increase the U.S. debt limit by $5 trillion.
What do Mississippi leaders think?
Republican Gov. Tate Reeves has been a public proponent of stripping economic regulations at the state and federal level. On Wednesday, Reeves pushed those on Capitol Hill to make the bill law via an X post:
“The US Congress should pass the One Big Beautiful NOW and let’s unleash the American economy to grow like Mississippi’s economy next year!!”
Sen. Cindy Hyde-Smith (R-Miss.) praised the bill, emphasizing her support of making the 2017 tax cuts permanent:
“This legislation is not perfect, but it is a bold step toward forcing greater efficiency, savings, and accountability from our federal government. It is certainly better than forcing a more than $4.0 trillion tax hike on everyone.”
Mississippi Democratic Party Chairman Cheikh Taylor specifically blasted Hyde-Smith for her support of the bill in a statement issued by the state party:
“Let’s be absolutely clear. This bill is not beautiful. It is brutal. And Senator Cindy Hyde-Smith’s cheerleading for it is a disgrace to every struggling family in Mississippi.”
Guest called Democratic pushback “fear-mongering,” and said that the bill will help all Americans:
“I think we’re going to see some amazing growth in our economy. As John F. Kennedy said, a rising tide floats all boats, so that’s what I believe this legislation will help accomplish.”
Rep. Bennie Thompson (D-Miss.) spoke on the House floor Wednesday before passage, imploring his lawmaker counterparts to reject the bill, what he called a “political giveaway.”
“House Republicans just passed the most dangerous piece of legislation in modern American history. To appease President Trump, Republicans voted to rip healthcare from 17 million Americans, dole out tax cuts to billionaires, and give billions to Trump and Kristi Noem to fund mass deportations and more masked ICE agents to invade our communities.”
In the end, the GOP majorities in both chambers prevailed, just meeting President Trump’s deadline of July 4 for final passage.
Click here to read the 870-page bill.
