How Trump’s big bill could affect women, children and LGBTQ+ Americans

This article was originally published by The 19th.

After more than 24 hours of deliberations, the  U.S. Senate approved a sweeping package of tax cuts Tuesday that largely benefit the wealthy, financed by what advocates call “historic” cuts to government health insurance and nutrition programs that serve lower-income Americans.

President Donald Trump wanted it all in “one, big, beautiful bill,” and Republicans are aiming to get it to the president ahead of the July 4 holiday. The package has now returned to the House, which must approve the same version of the legislation after passing a different version in May.

WATCH: What’s in the version of Trump’s bill passed by the Senate and its chances in the House

The nonpartisan Congressional Budget Office said over the weekend that the Senate package is projected to add $3.3 trillion to the national deficit over the next decade and lead to nearly 12 million Americans losing health care coverage.

The largest spending cuts in the Senate version come from Medicaid, the popular government health insurance program that covers more than 70 million lower-income Americans.

When the bill arrived in the Senate, the Medicaid cuts passed by the House were a major sticking point for a handful of GOP senators, including Sens. Josh Hawley of Missouri, Lisa Murkowski of Alaska and Susan Collins of Maine. Though the Medicaid cuts in the Senate version are even more severe than in the House iteration, Hawley quickly said he would vote for them and Murkowski secured the addition of several provisions specific to Alaskans, though some were stripped out because they did not comply with parliamentary rules.

Over the weekend, Sen. Thom Tillis of North Carolina said he opposed the bill over concerns about how the Medicaid cuts would impact his state; Trump promised to primary him and Tillis said instead he would not seek reelection. Republican Sen. Rand Paul of Kentucky voted against the package due to deficit concerns. Collins remained opposed, forcing Vice President JD Vance to cast the tie-breaking vote.

Democrats were largely on the sidelines because Republicans in the Senate used a process called reconciliation, which allows the majority party to bypass the 60-vote filibuster requirement and approve legislation by a simple majority vote. There are 53 Republicans in the 100-seat Senate.

It has become common for both parties to take advantage of reconciliation when they control the White House and both chambers of Congress. Republicans used reconciliation to enact the 2017 Trump tax cuts that they are now attempting to renew. Democrats used it to enact President Joe Biden’s COVID-19 stimulus bill and the Inflation Reduction Act.

Here are the programs serving women, children and LGBTQ+ Americans that the tax bill would change:

Medicaid

The Senate legislation would cut federal spending on Medicaid and the Children’s Health Insurance Program (CHIP) for low-income infants and children by more than $1 trillion over the next decade — an 18% larger cut than the House-approved version, according to Georgetown University’s McCourt School of Public Policy.

The federal-state Medicaid health insurance program covers more than 40% of all births in the country, and about 37% of those enrolled are children. Nationally, CHIP covers about 7 million children and several hundred thousand pregnant people.

READ MORE: A closer look at who relies on Medicaid

Like the legislation approved by the House, the Senate package would cut Medicaid spending in part by imposing a strict 80-hours-a-month work requirement for adults without children or disabilities — this change must be implemented by the end of 2026, after the midterm elections, but states have the option of doing it sooner. Three million Americans enrolled in Medicaid report that they are unable to work due to caregiving responsibilities, according to an AARP analysis. The 19th has reported on how these stepped-up work requirements would disproportionately impact middle-aged and older women.

The Senate bill would create new limits on Medicaid coverage for immigrants in the country legally. It would also require states to charge Medicaid recipients above the poverty line for co–payments for some health care.

A provision that would have prohibited Medicaid from covering gender-affirming care for transgender people — minors and adults — was stripped out by the Senate parliamentarian. But the Senate parliamentarian approved a provision that would prevent Planned Parenthood and other reproductive health care clinics from receiving Medicaid reimbursements for the provision of non-abortion care.

Some of the largest savings would come from the stepped-up work requirements and the reduction in the amount that states are able to tax Medicaid providers, impacting Medicaid expansions in as many as 22 states, according to KFF, a nonpartisan health policy organization.

The Senate legislation would also trigger the rollback of Medicaid expansions in some states that have passed laws that end the expansion if the federal government changes the federal-state funding formula.

SNAP

Like the package passed by House Republicans, the Senate version would require more SNAP recipients in their 50s and 60s to work and provide fewer exemptions for parents.

The proposal would lower the age at which work requirements end by a decade, to 54. Right now, parents with dependent children under 18 are exempt from working; the House bill lowered that age to 7 but the Senate version would only lower the age to 14.

WATCH: Provision in GOP budget bill puts millions at risk of losing SNAP benefits

Additionally, the Senate legislation would shift some SNAP costs to states — since its inception, SNAP benefits have been fully funded by the federal government.

Under the Senate’s SNAP proposal, the federal government would continue to fund SNAP for states that have a payment error rate below 6%, but starting in 2028, states with error rates above that would have to contribute 5% to 15% of the cost. Alaska and Hawaii would receive a temporary exemption from the cost-sharing requirement.

Changes to SNAP could also affect school nutrition programs, as many students qualify for free meals based on whether they and their families are eligible for food stamps.

Child tax credit

The Senate version would permanently increase the child tax credit to $2,200 from $2,000. The House tax bill approved in May would increase the amount of the child tax credit to $2,500, but only through 2028, the last year of Trump’s term. The tax credit would then drop back down and be indexed to inflation.

The Senate version tweaks a provision in the House-approved version that would require both of a child’s parents to have a Social Security number to access the credit, even if the child also has a Social Security number. The Senate version requires only one parent to have a Social Security number to claim the credit.

Both versions cap the refundable portion of the child tax credit, limiting the ability of the country’s lowest-income parents to access the credit.