On July 3, after an 8 hour 44 minute floor speech opposing the bill by House Minority Leader Hakim Jeffries (D-NY), the House passed H.R. 1, the One Big Beautiful Bill Act, by a vote of 218 to 214. The bill is expected to result in the loss of health insurance for at least 11.5 million people and reduce federal Medicaid funding by at least $900 million over the next 10 years.

In a statement released upon passage of the bill, Katie Smith Sloan, president and CEO, LeadingAge, said, “This legislation deals a significant blow to a core element of our country’s social safety net: Medicaid. The consequences will not be pretty.”

LeadingAge members actively worked to improve and ultimately oppose the massive package, which extends, makes permanent, and creates various tax cuts, which primarily benefit the wealthiest U.S. households, and provides funding for border control and immigration enforcement. The bill’s cuts to funding and enrollment access to Medicaid, insurance provided by the Affordable Care Act, and the Supplemental Food Assistance Program brought a wide range of individuals and organizations out in droves over the last several months to oppose the bill’s many negative impacts on the federal social safety net.

LeadingAge members reached out to their federal officials more than 8,000 times since December 2024 when it was clear Republican control of the House, Senate and White House would result in the use the budget reconciliation process to enact tax cuts at the expense of peoples’ health and welfare needs. LeadingAge held hundreds of visits with congressional offices and wrote, coordinated, and signed onto dozens of letters to House and Senate offices describing the negative impact of potential policies under discussion for inclusion in the bill, including a final plea on July 2 to House members to oppose the bill. The bill’s threats to Medicaid were also the focus of LeadingAge’s April 2025 Lobby Day, where hundreds of LeadingAge members described the bill’s impacts to elected officials and their staff in person.

With passage of the bill, which does include a moratorium on the Center for Medicare and Medicaid Services (CMS)’s mandatory nursing home staffing requirements for nine years and a permanent 12% increase to state allocations of the 9% low income housing tax credit along with a 25% bond financing threshold, there is much work to be done as federal agencies now begin to implement its components and states wrestle with the complicated and cruel ways the bill requires them to carry out the bill.

LeadingAge will provide summaries of various key pieces of the legislation as well as the overall bill in the coming days.

President Trump says he’ll sign the bill into law on July 4.

Read about the bill in our serial post on budget reconciliation.