Sufficient number having risen, the yeas and nays are ordered. Members will record their votes by electronic device. This is a five minute vote.

A president can issue as many executive orders as they want, but if they want their agenda to really have teeth, to have real lasting impact, they need to pass legislation.

On this vote, the yeas are 215, the nays are 214, with one answering present. The bill is passed.

Well, early Thursday morning, President Donald Trump's massive tax and spending cuts package, which is literally called the One Big Beautiful Bill Act, passed through the House and moved one step closer to becoming law.

One reason this vote is such a win is because it comes after days and honestly weeks of internal Republican fighting over how much to cut, how much protect, and how much allow it all to add to the deficit.

'Now, there are some big caveats here. One, it still has to pass the Senate, so there'll be changes. And two, the bond markets are freaking out about just how much the bill will add to the deficit, which is a really wonky way of saying, investors think America is a risky investment right now, especially in light of Trump's tariff-happy trade war. But still, this bill is full of consequential stuff that could impact millions of Americans for years to come, so what's in it? Today, CNN senior writer Tami Luhby runs down some of the bill's biggest cuts, and one Medicaid recipient tells us why she's terrified of what they could mean for her and her family. From CNN, this is One Thing, I'm David Rind.

'Okay, Tammy, so President Trump's so-called big, beautiful bill just passed through the I'll leave it to others to say whether it is truly beautiful, but it is without a doubt big. So can you unpack what exactly is in it?

This bill is remarkably sweeping. It was well over 1,000 pages, and that wasn't even the final version yet. But it has many, many provisions. And the magnitude of the provisions can be seen in just how much some of them would cost and how much savings some of then would produce. These are early estimates because the bill was changed just before it was passed. But the tax provisions... Could carry a price tag of more than $3.8 trillion over 10 years. And the cuts to Medicaid could cost nearly $700 billion, although that's expected to go up. And cuts to food stamps also in several hundred billion. So these are very big changes that the House is proposing.

To put it simply, this bill gets Americans back to winning again, and it's been a long time coming.

'One of the top priorities of President Trump and congressional Republicans this year is to extend the 2017 Tax Cuts and Jobs Act because the individual income tax provisions, which are trillions of dollars worth of tax cuts, are set to expire after the end of this year. So in this bill that the House passed, they essentially extend all of those individual income-tax cuts.

It revives our economy. It will deliver historic tax relief. It will make the largest investment in our border security in a generation.

It also includes a lot of priorities that President Trump and House Republicans have, including more money for border security, immigration crackdowns, defense. It would look to overhaul the air traffic control system. One other notable feature in the package is that it would actually increase the child tax credit temporarily as well. The original 2017 Tax Cuts and Jobs Act increased the child's tax credit from $1,000 to $2,000. But that would expire after the end of this year. So the new bill would actually increase the child tax credit to $2,500 from 2025 through 2028.

No tax on tips. No tax on tips.

There are also several priorities from President Trump's campaign last year that are included in the bill. Notably, no taxes on tips.

Waitresses, and caddies, and drivers, and everybody. It's a large, large group of people that are being really hurt badly. They make money. Let them keep their money.

No taxes on overtime, an auto loan interest deduction, and they couldn't quite put in no taxes on social security benefits. So what they did was increase the standard deduction for senior citizens. With those tax breaks for tips, overtime, auto loan, interest deduction and the higher standard deduction, for seniors, those are all temporary and they'll phase out after 2028.

Wow. I mean, that's a lot of stuff. I want to zero in on these cuts to Medicaid and food stamps, because that's going to affect a lot of people, right?

'Yes, there will be millions and millions of people who are affected by this, or at least at risk of having their food assistance or their health coverage taken away from them. And by the way, Medicaid has more than 71 million people enrolled, and that's about one in five people in the U.S. So one of the main Medicaid provisions in this bill is that it would impose work requirements on people who are in Medicaid expansion. Those are generally low-income adults. Medicaid expansion was a provision of the Affordable Care Act, and 40 states plus Washington, DC have expanded their Medicaid programs to cover these low- income adults.

And that's just what it sounds like, where you have to work a certain amount of hours to get the coverage.

So you would have to work. There are also provisions you could volunteer, you could be in school, you could in a work training program, but the requirement is 80 hours a month. And the issue that many experts say is that many people on Medicaid are already working, but the problem is, is that the reporting of these hours, be it work or school or volunteering, it's the reporting that experts are worried will trip a lot of people up. And actually cause them to lose coverage. We saw in Arkansas in 2018, which implemented work requirements under the first Trump administration, that around 18,000 people lost their coverage, many of them because they couldn't get through the red tape, not because they weren't working. And various studies have shown that work requirements do not actually increase employment.

And the rationale from Republicans to institute these requirements, right, is just that this will help cut down on what they say is waste, fraud, and abuse within Medicaid by making sure that people are actually...

'The Republicans have said that they want to protect Medicaid for whom they consider the most vulnerable, the people with disabilities, senior citizens, children. And they have never liked, obviously, the expansion to low-income adults. So this is how they feel that low- income adults who can work should work. And therefore, this is a way to make them work. The Trump administration tried to do this in his first term. By granting waivers to multiple states, but they were knocked down by the courts. There are other provisions that would affect Medicaid enrollees. Those in the expansion program would have to have their eligibility checked every six months, and they would have pay a certain amount of the cost of their care. Also, the legislation would penalize states that have expanded Medicaid and that provide Medicaid-type coverage to undocumented immigrants using state funds.

Incredible for Medicaid, for Medicare. The only thing, we're going to leave it exactly as it was, other than for, obviously, waste, fraud, and abuse. We're strengthening it. We're going make these things even stronger. The Democrats are going to make it even stronger,

President Trump comes out and say we're not gonna kick anybody off Medicaid. No one's going to lose their coverage

The experts say that's not technically true. People will lose coverage. Some of the early estimates of the bill say maybe around 8.6 million people would lose coverage from the Medicaid and Affordable Care Act provisions in the bill, but that number is expected to go up now because originally the work requirements were supposed to kick in by 2029, but now they may kick in as early as the end of 2026.

What about cuts to food stamps though? Cause this is again, something vulnerable. Americans have been kind of worried about being on the chopping block here.

'Yes, there are two or three main measures that the bill contains concerning food stamps. Now, food stamps already has what's kind of considered a work requirement for certain adults. The bill would actually expand the number of adults who would face this work requirement, and it would also curtail states' abilities to ask for and receive waivers in difficult economic times. So yes, in that way, similar to Medicaid, there would be more people losing their coverage because they'd be stuck in red tape. But another issue that is concerning a lot of experts is that now for the first time, states would be required to pay for part of the food stamp benefit. Now in Medicaid, Medicaid is a shared cost between states and the federal government. The federal government picks up most of the costs, but states do have to kick in. Food stamps, however, has always been. 100% financed by the federal government. So now states will be on the hook for providing some of the funding. And a lot of states don't have a lot of money, so experts are worried that they may try to curtail the food stamp program in some way, make it harder to enroll in order to be able to save money because they can't necessarily afford it. So while House Republicans and President Trump say they want to protect the vulnerable, particularly in Medicaid, the bill that they have passed could actually hurt a lot of these vulnerable people, including kids, senior citizens, people with disabilities. For instance, states may find that they have to eliminate some optional programs that they provide in Medicaid. And one of these is home and community-based services, which helps keep a lot of people with disabilities and senior citizens in their homes instead of going to nursing homes. And that's one reason why you see advocates for these groups, you know, slamming this bill, because they say that this could end up hurting in that way seniors, it could end forcing seniors and people with disability into nursing homes and robbing them of their independence. So, and those are some of the ways that it can actually hurt people outside of the low-income adults that the Trump administration and congressional Republicans are mainly targeting.

When we come back, I'm going to talk to one of those vulnerable people.

Oh, I'm going to give my dog a bone. It'll keep him quiet. I just remembered it's very important. Okay, sorry about that.

What kind of dog?

Oh, he's a bit of a mutt and, you know, if he sees other dogs going by the window, he will bark, so.

It's a good hack.

'This is Rachel Scher. She lives in Beacon, New York, about two hours north of New York City with her husband and 17-year-old daughter, Melby. She's held a lot of jobs in the creative field, art curator, conference designer, writer, just to name a few, but she's been on Medicaid since it expanded in New York back in 2014.

You know, partly because of the birth of our daughter, I couldn't afford, we couldn't affordable childcare we were living in New York City at the time. So our income went way down and under the expansion, we were able to qualify for Medicaid.

'In addition to the childcare issues, Rachel has been dealing with a series of medical issues for years, including really bad tremors. But then, right after the election last year, Rachel got some life-changing news. She was diagnosed with Parkinson's disease.

'Truthfully, there was a sense of relief because there were just so many different things going on with me and I had actually been tested for Parkinson's like a year before this diagnosis and I tested negative, so we still weren't clear what was going on, but I had a really significant worsening of symptoms and so they tested me again with very expensive tests, it's nuclear medicine. And this time it came back with a positive result. So they put me on a medication that was sort of short-term that I'm sure was incredibly expensive. You know, it's covered by Medicaid and a lot of my symptoms resolved. So I have been doing better, but Parkinson's is famous for, you know, the efficacy of medication will expire. So sort of the scariest thing is this is irreversible. You know, it's like. Most people end up needing significant, like around the clock, care. So my mind went to how much this would cost and since going on Medicaid with the Medicaid expansion in 2014, one of the great things, not only that our healthcare was covered, was just the sense of no surprises coming in the mail, you know, suddenly getting the. News that, oh, no, this isn't covered, this thing isn't covered, or you have a deductible or a copay, because I have

You had a solid foundation under you.

And that really helps with the stress, which is a major factor.

Well, so I assume you've been following this, this bill that's been making its way through Congress. It just passed the House. As you best understand it, how would it impact you and your situation?

'So, you know, just total disaster. We're terrified because, I mean, what we're looking at with the expenses related to my Parkinson's diagnosis, not to mention my daughter's significant medical issues, which include, you now, she's part of the mental health epidemic of the pandemic. So my husband, thank God, is in good health, but he's 73 years old. So, you know, we're not even one of those families who are waiting for, you now, a shoe to drop, like in the form of a diagnosis, we were there. And our fear, and it seems extremely well-founded at this point. I mean, it really seems like this is gonna happen, that we could be cut from the rolls of Medicaid. And at that point. Again, given the expenses of our medical issues, I think we would be bankrupt very quickly. We are renters. We would be facing that choice that, you know, so many uninsured people currently face where they have to choose between paying for their bills and their rent and, you know, or going into terrible debt with medical care.

There are some exemptions, as I understand it, to the work requirements, you know, parents, pregnant women, medically frail individuals, those with substance abuse disorders. Do you think you're gonna fall into one of those categories?

I mean, the medical frailty, I know, you know, I was thinking a lot of I've been thinking a lot about disability, but at this point, I don't qualify. I understand that can take years. Yeah. You know, right now, thanks to the medication, I am able to work, I've changed careers sort of in hopes of finding something more stable than what I've been doing. So I worked with seniors as an activities assistant. I often feel like I'm... Sort of touching on my curatorial background, you know, coming up with activities. I do talks, but also games. I've worked in memory care. I mean, I absolutely love this work and I was working at an assisted living facility for about a year when the management changed and all of a and artwork load doubled and I physically couldn't keep up. So. I left that job and now I've just gotten, I mean, that was like two years ago. I've been looking for work all this time, you know, for a 56 year old woman. Pickings are very, very slim. And, um, but I've, just gotten a job working at a senior, a municipal senior center for six hours a week.

Six. And they've been talking about numbers much higher than that for the requirement. So you want to work. You can work.

I very much want to work, yeah.

Up to a limit.

Yes, like I couldn't do 20 hours a week. I think I could for now, but I think this is something that's really being ignored is where are those jobs for a lot of people? You know, I can't go to work at Target. I wouldn't mind, like, I'm not picky, but I physically cannot.

I mean, I think Republicans, their argument is they want to root out what they say is waste, fraud, and abuse in the program. They want to make sure that the money's being responsibly spent. And that's why they need these work requirements and kind of this red tape that they want to put in place. What would you say to that?

I don't know where to start. I feel very emotional about that because I think. They're coming up with systems designed to fail. And I just see that in everything they're doing, you know, the cutting the federal government to the skeleton. Yeah, I honestly don't know what to say about waste, fraud, and abuse, because it's just meaningless to me.

Recently, Rachel and her daughter, who has also been dealing with some neurological issues, have been pouring themselves into activism. They even traveled with a local group to Washington D.C. Earlier this week in an effort to put pressure on lawmakers.

And that gives me hope, actually, as long as I'm working with these folks. I am able to not ask these questions too much that sort of drain away the energy because it seems like there's nothing to do, at least. We are making changes on the local level and I'm learning so much and that's just good for my brain and it's great for my daughter.

Well, Rachel, wishing you nothing but the best, and thanks so much for taking the time to talk to me. I really appreciate it.

Thank you so much, I'm thrilled to be able to talk about these things in depth.

One Thing is a production of CNN Audio. This episode was produced by me, David Rind. Our senior producers are Matt Martinez, Felicia Patinkin, and Faiz Jamil. Matt Dempsey is our production manager. Dan Dzula is our technical director, and Steve Lickteig is the executive producer of CNN Audio. We get support from Haley Thomas, Alex Manasseri, Mark Duffy, Robert Mathers, John Dianora, Leni Steinhart, Jamus Andrest, Nicole Pesaru, and Lisa Namerow. Special thanks to Wendy Brundidge. We'll be back on Wednesday. I'll talk to you then.