This week at Unbreaking, July 3
Last week, we shared that many of the cruelest provisions in the Trump administration’s budget megabill were ruled out by the Senate parliamentarian. This week, the bill passed the Senate and went back to the House, with House Republicans still working to pass the bill by Trump’s imposed July 4th deadline. It’s very likely that some version of this bill will pass soon and that millions of people will lose healthcare as a result. We have the details below, and more in our explainers.
Medicaid
The GOP budget bill passed by the Senate includes more than a trillion dollars in cuts to Medicaid. With other provisions in the bill and related actions from the administration, it’s expected to push 17 million people out of health coverage.
Senate Democrats were able to get several especially cruel provisions ruled out of the bill, including those targeting refugees, asylum seekers, and other immigrants and an attempt to defund gender-affirming care for Medicaid users. What remains is, frankly, also very cruel, just more broadly targeted.
The New York Times has a helpful breakdown of when the various parts of the bill will go into effect. Medicaid work requirements will mostly begin at the end of 2026—after the midterm elections.
KFF has had impeccable analysis of the healthcare cuts and their harms, detailed breakdowns of the bills’ versions, and strong polling. Their analysis makes the damage this bill will do very clear.
At some point, a version of this bill is going to become law. When it does, Unbreaking will cover—and keep covering—whatever resilience work and community support programs we can find. Nothing can take the place of better governance, but when that fails, we help each other however we can.
Transgender Healthcare
As mentioned above, the GOP attempted to block coverage of gender-affirming care for transgender people who are enrolled in Medicaid and to make it harder for people to buy Affordable Care Act (ACA, also known as Obamacare) marketplace healthcare plans that cover gender-affirming care. Fortunately, the Senate parliamentarian ruled out both provisions and Senate Republicans pulled them from the final text of the bill.
Separately, in March, the Centers for Medicare and Medicaid Services (CMS) proposed a change to ACA marketplace plans that would prohibit states from mandating that gender-affirming care be considered an “essential benefit”—meaning that those plans would no longer be legally required to cover it. The proposed changes were finalized on June 20th and will go into effect in 2026. Once in effect, these new rules will make it harder and more expensive to access gender-affirming care.
In other news, the US Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA) announced in June that it would end funding for LGBTQ+ specialized services at the national suicide prevention hotline. The hotline has been used over 16 million times, and SAMHSA estimates that 1.4 million of those connections were routed through the LGBTQ+ service. (The suicide hotline still exists; the cut only targets its LGBTQ+ focused service.)
We’ll be following updates as they come and will share here and on Bluesky as we can.
Up next
We’ll be looking at the final bill closely to understand what made it through and what to expect in the days ahead. In the meantime, we’re working hard on pages related to the US immigration system, due process, and targeted repression, as well as researching issues around data safety and security, with dozens of other pages in the hopper. We could use more researchers, writers, and editors helping us make sense of what’s happening—please join us.
As always, we invite you to use and adapt our content for sharing with your readers and communities: everything on our site is available under a CC BY 4.0 license. We welcome translations, adaptations to other formats, and especially encourage organizers and journalists to make use of what we’ve developed. And if you make something with our content, please let us know—we’d love to hear from you.