The budget reconciliation bill that passed the US House of Representatives on Thursday and was promptly to be signed into law by Donald Trump represents the particular perversity of national politics in America: seemingly no one wants it, everyone hates it, and it is widely agreed to be devastating for staggering numbers of Americans. And yet, the bill felt inevitable: it was a foregone conclusion that this massive, malignant measure was something that everyone dreaded and no one had the capacity to stop.
They didn’t really even try. In the Senate, a few conservative Republicans made noise about the bill’s dramatic costs: the congressional budget office estimates that the bill will add $3.3 tn to the deficit over the coming decade, and the senator Rand Paul, a budget hawk from Kentucky, declined to vote for it for this reason. But other Republicans, who used to style themselves as fiscally responsible guardians against excessive government spending, engaged in a bit of freelance creative accounting in order to produce an estimate that falsely claimed the cost of the bill would be lower. Most of them quickly found themselves on board.
Moderate Republicans, or what remain of them, also quickly quit the field. Thom Tillis, a Republican from North Carolina facing down an uncertain re-election bid, expressed concerns about the bill’s massive cuts to Medicaid, the federal low-income healthcare program on which many Americans – and many of his constituents – rely. When Donald Trump threatened to secure a primary challenge to Tillis in retaliation, the senator announced that he would not seek re-election after all; he voted against the bill, but also ended his political career. Susan Collins, of Maine – she of the perennial “concern” about the sadistic Republican agendas that she continues to support – made a rare departure from her usual formula and voted against the bill, a move that came close on the heels of polling showing her dismal approval rating among her constituents. That left just Lisa Murkowski, of Alaska, who agreed to play ball: she would vote for the bill, which she had publicly disparaged, in exchange for some money for her state. The result was that Alaska will be exempted, at least temporarily, from new rules associated with the Supplemental Nutrition Assistance Program, or Snap, which helps low-income Americans buy enough food to keep themselves alive. Republicans threw in a tax deduction for Alaskan whaling captains – of all things – and with that, her vote was secured.
When the bill was sent to the House, a handful of Republicans threatened to withhold their votes over budget and Medicaid concerns. But no one believed them. They were always going to cave, abandon their stated principles and follow Trump’s orders, and they did. Trump, after all, had said that he wanted the bill passed in time for the Fourth of July; it passed on the third. He says jump, and the Congress asks: How high?
They do so even when the demands that Trump makes are morally grotesque. The bill will devastate Americans. Its massive cuts to Medicaid, combined with expiring Obamacare subsidies, will result in an estimated 17 million Americans losing health coverage over the next 10 years, effectively undoing the expansion of healthcare coverage that was achieved with Barack Obama’s health law. Cuts to Snap are so profound that they cannot be made up with additional state spending; some people who are eating today because they have food assistance will go hungry in the future. There are deep cuts to federal loans and grants for college students, and a near-reversal of the Biden-era Inflation Reduction Act’s investments in green energy, with tax breaks now going to climate-damaging sectors like coal and oil instead. Because the bill creates a dramatic budget deficit, law requires that Medicare, the healthcare program for seniors, will face cuts, too.
All of this is to say nothing of the downstream effects of the legislation. The steep cuts to Medicaid, in particular, will devastate America’s already fragile and partial healthcare system. Planned Parenthood is now excluded from federal Medicaid dollars, meaning that about 200 of its roughly 600 clinics will probably have to close, making abortion less accessible even in states where it is legal, and putting contraception and STD and cancer screenings out of reach for untold numbers of American women. Many rural hospitals will likely have to close, too, along with nursing homes. Those healthcare clinics that remain will have longer wait times and more crowding, and offer more expensive care. Ultimately, fewer people will be going to the doctor, and more of them will suffer and die needlessly of treatable and preventable conditions.
But the bill does have winners. It has been called, among other things, the largest tax cut in the nation’s history, although the benefit is disproportionately to billionaires. The budget of Ice, Trump’s anti-immigrant secret police force, is also expanded exponentially: from $3.5bn to $48.5bn, making it the nation’s largest law enforcement agency, though still no more accountable.
The bill, in other words, steals from the sick, the elderly, the hungry and the curious, and gives that plundered loot to billionaires and jackboots. It will warp American life – already sickly and impoverished by the standards of our peer nations – in cruel and enfeebling ways. It will make us sicker, poorer, more fearful, more ignorant and more endangered. It will make the rich, meanwhile, even richer.
Why are Republicans voting for a bill that will hurt their own constituents? A bill that undermines their stated values and threatens their careers and will immiserate people they care about – if only themselves?
One of the more confounding aspects of the Trump era is his ability to vacate what the constitution’s authors – and indeed most reasonable adults – would have assumed would be a defining feature of the contest among the branches: self-interest. Republicans will follow him anywhere, even to unpopular votes, even to self-sabotage, and frequently to the diminishment of their own branch’s relevance. Some say that now, he is leading them to a midterm defeat. Democrats made a show of their opposition to the bill – in the minority, shows are about all they can accomplish – with the minority leader Hakeem Jeffries delivering an eight-and-a-half-hour, filibuster-style speech on the floor telling the stories of Americans who will be hurt by the legislation, laying out the bill’s cruelty and recklessness. But you could also detect a hint of pleasure in his voice as he read out the testimonies of Americans who live in what the Democrats see as particularly vulnerable districts for Republicans in 2026.
The bill is unpopular now, and it is likely to become much more so as the full breadth of its cuts to social services, and its impacts on Americans seeking to get healthcare, buy food, secure an environmentally livable future or go to school, become clear. Many of the politicians who ultimately voted for it criticized it sharply just days or hours before. They will be attacked about this in the midterms: the suffering that the bill will cause will be cut into television and social media ads and played incessantly on networks in what the Democrats believe are winnable districts. But it is unclear, in the end, if hurting Americans, including their own voters, really will come back to bite the Republican party. It hasn’t for a long time.
Moira Donegan is a Guardian US columnist
