U.S. House of Representatives Speaker Mike Johnson looks at U.S. President Donald Trump signing the sweeping spending and tax legislation, known as the "One Big Beautiful Bill Act," to mark Independence Day, at the White House in Washington, D.C., U.S., July 4, 2025.

The reduction in patients who qualify for Medicaid will mean free clinics must fundraise or find other funds to cover costs for care. In addition, some people would lose ACA coverage, causing more people to seek care at free clinics that are already stretched thin.

The massive bill is guided by spending requests from the White House. It will extend the 2017 Trump tax cuts, while cutting billions of dollars in social program funding. It’s been described as the largest cuts to social welfare programs since at least the 1990s, and according to some experts the most severe in modern history.