In a dramatic 51-50 vote marked by partisan division and procedural brinkmanship, the US Senate passed President Trump’s sweeping domestic policy bill, featuring over $1 trillion in Medicaid cuts, surpassing even the $800 billion reduction approved by the House.

Vice President JD Vance broke the tie after three Republicans defected, citing concerns over the impact on rural hospitals and vulnerable populations. The legislation imposes new work and reporting requirements for Medicaid recipients, restricts states’ use of provider taxes to draw federal funding, and extends coverage limits to childless adults and parents of older children.

The Congressional Budget Office estimates nearly 12 million people could lose coverage under the bill’s provisions.

Marketed by supporters as a crackdown on fraud and “free-riding,” the measure reflects a long-standing Republican aim to trim entitlement spending while financing tax extensions and border enforcement.

Working Americans

Critics argue it undermines a safety-net program that already supports working Americans, nearly two-thirds of adult Medicaid enrollees are employed. The bill’s trajectory now returns to the House, where further resistance is expected. Still, the Senate’s passage represents a major ideological victory for Trump and signals a broader realignment of federal health priorities, with profound consequences for access, equity, and fiscal federalism.

The multibillion-dollar Medicaid cuts approved in Trump’s latest domestic spending bill are inseparable from the administration’s aggressive posture on healthcare fraud enforcement, underscored by the DOJ’s record-breaking Takedown operation.

As the federal government seeks to shrink Medicaid’s footprint, it simultaneously points to widespread abuse of the program – often involving false billing, identity theft, and foreign criminal networks – as justification for tightening eligibility and imposing stricter oversight.

By aligning spending policy with a high-profile crackdown involving more than $14.6 billion in alleged fraud, the administration frames Medicaid not just as a fiscal burden, but as a system in urgent need of discipline, despite mounting evidence that most enrollees are law-abiding workers and patients.

The convergence of cost-cutting and criminal prosecution reveals a broader political strategy: weaponizing enforcement data to justify structural rollbacks in healthcare access.