Trump's new tax and spending bill ties Medicaid to work rules starting in 2027—some could lose coverage even earlier, depending on their state.

Congress has signed off on a $3.4 trillion legislative package featuring new tax breaks, spending cuts, and more funding for defense and immigration enforcement, delivering President Donald Trump his “big, beautiful bill” despite rumblings from fiscal hawks about the projected $4 trillion it could add to the national debt over the next decade.