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U.S. House Republicans on Thursday passed a sweeping legislative package containing President Donald Trump’s domestic policy agenda, touching on everything from tax cuts to increased spending on immigration enforcement and defense. 

Dubbed the “One Big, Beautiful Bill,” the measure, which Trump is expected to sign as soon as Friday, passed nearly along party lines in a 218-214 vote. The House, which approved its version of the bill in May, took up the package again after changes were made in the Senate, where it passed on Tuesday in a vote of 51-50. 

Among the bill’s most contested provisions are reduced spending on social programs to help offset an extension and expansion of tax breaks, . It also adds more than $3.3 trillion to the national deficit over the next decade, according to the . 

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Amid unified Democratic opposition, all four Colorado House Republicans — including Rep. Jeff Hurd, a freshman Congressman who represents Colorado’s 3rd Congressional District — voted in favor of the revised bill on Thursday. 

Hurd’s decision to back the bill came despite raising concerns over the breadth of cuts to health care spending that were included in the Senate version. His district stretches across most of western and southern Colorado and includes rural resort areas like Aspen and Glenwood Springs. It also has the highest rate of Medicaid recipients in the state. 

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Nick Bayer, a spokesperson for Hurd’s office, said in a statement on Thursday that the policy bill delivers tax relief while funding the military and securing the border.

Responding to a question about how the bill’s Medicaid cuts will impact Hurd’s district, Bayer said, “There are a number of individuals on Medicaid who are using the program incorrectly or who were not part of the original vulnerable populations the program was created for.” 

Health care advocates, however, have warned that the administrative burdens and increased paperwork the bill poses will inevitably lead to eligible Coloradans losing their Medicaid coverage. They liken it to the impacts of the “Medicaid Unwind” period in 2023, when roughly 575,000 Coloradans were kicked off the program. 

Colorado Democrats, who rallied against the bill since its inception earlier this year, again blasted Republicans for championing the policy. 

Rep. Joe Neguse, whose 2nd Congressional District borders Hurd’s and includes mountain communities like Vail, Steamboat Springs, Summit and Grand counties, ridiculed the bill in a statement on Thursday. 

“The policies embedded in the reckless budget bill will harm many families across the Western Slope and Northern Colorado, whom will feel the strain of this bill, all while billionaires and big corporations enjoy hefty tax cuts made possible by Congressional Republicans,” Neguse said. 

He added that “because of these cuts, many Coloradans will be left without critical support programs, including food assistance and healthcare access, while rural hospitals across our state face the prospects of potential closure.” 

Cuts to health care now top $1 trillion

The bill’s deepest cuts are around health care spending. 

A House-passed version of the bill in May was projected to cut Medicaid by nearly $800 billion, according to an analysis by the nonpartisan budget office. 

Those cuts were achieved through new work requirements for adult Medicaid recipients, an increase in the frequency at which Medicaid eligibility was reevaluated, and restrictions on coverage for abortions, gender-affirming care, and undocumented immigrants. 

Also included in the bill are through the Affordable Care Act marketplace. The legislation shortens enrollment periods, requires more paperwork, and allows for the expiration of heightened benefits passed under former President Joe Biden. 

The Senate version saw further changes. 

The chamber’s parliamentarian blocked the provisions restricting coverage for undocumented immigrants and gender-affirming care from being included in the bill. But Senate Republicans were ultimately able to muster through even deeper Medicaid cuts by passing a cap on provider taxes, or fees. 

Most states, including Colorado, levy these fees on hospitals to generate more money that can be used to pull down greater Medicaid matching funds from the federal government. The fees ultimately drive more funding to hospitals, and health care providers in Colorado warned that reducing the fees . 

Senators did include in the bill a $50 billion fund spread over five years to help rural hospitals, though Democrats said the money was far from enough to offset the loss in funding as a result of the Medicaid cuts. 

Taken together, the changes to Medicaid and the Affordable Care Act amount to a $1.1 trillion cut in federal health care spending that could leave as many as 17 million people uninsured over the next decade, according to the budget office. 

That projection also includes health care coverage losses as a result of the expiration of enhanced tax subsidies for Affordable Care Act marketplace insurance, which Republicans declined to extend in their tax bill. 

Hurd defends Medicaid decision 

As the “big, beautiful bill” wound its way through the legislative process, Hurd repeatedly signaled he opposed cuts to Medicaid that would threaten services or access to care, even as he voted to advance the bill every step of the way. 

He signed on to a letter to House leadership in April by finding cost savings and cutting administrative red tape. He voted the next month bill that contained nearly $800 billion in Medicaid cuts.

Once the bill moved to the Senate, Hurd and 15 other House Republicans urging them to back away from some of the additional cuts to health care spending being proposed. That included the cap on provider fees. 

In their letter to GOP Senate leadership, Hurd and other House Republicans said they “cannot support a final bill that threatens access to coverage or jeopardizes the stability of our hospitals and providers.” 

The Senate ultimately included the cap on provider fees, in addition to stricter work requirements and other provisions, in the policy bill.  

After the Senate passed the bill on Tuesday, Hurd said in a message shared through his spokesperson that the legislation would require “significant changes in order to pass.” 

But as House Speaker Mike Johnson hunted for votes late Wednesday night and into the early hours of Thursday, Hurd backed both a procedural vote to start debate on the legislation and the final package itself. 

Asked what changed, Hurd’s spokesperson, Bayer, said that “after carefully reviewing the final Senate changes, Rep. Hurd believes they accomplish the mission of protecting Medicaid for the vulnerable populations it was originally created for.”

Health care leaders had pressured Hurd and other Colorado House Republicans to reject the policy, arguing it would kick patients off Medicaid and threaten health care funding. At least one community health center, Mountain Family, which operates clinics across Hurd’s district, and other lawmakers to oppose the bill. 

“The communities we serve have higher rates of uninsured than most communities in Colorado,” Mountain Family CEO Dustin Moyer said in a June 10 letter to Hurd, adding that the legislation “will only put health care coverage further out of reach for communities who have limited coverage options.”

Bayer on Tuesday said Hurd “has spoken to district hospitals and health care providers and remains committed to assisting them in delivering care needed in the district.” 

Colorado Dems blast GOP 

Neguse called the bill’s cuts to health care “indefensible,” while Sen. John Hickenlooper said in a statement that “House Republicans – including our colleagues from Colorado – didn’t need to do this.”

Hickenlooper, who joined Colorado’s other senator, Michael Bennet, in opposing the legislation, said, “The choice should have been clear.”

Colorado House Speaker Julie McCluskie, a Democrat representing Western Slope communities in the state Legislature, said the bill’s Medicaid cuts alone will have a $1 billion impact on the state’s budget. 

As Colorado contends with an ongoing budget deficit, McCluskie said further cuts “will force the legislature to consider pausing the important progress we’ve made on priorities like education funding, tax credits for working families and efforts to reduce health care premiums.”

McCluskie said businesses, rural hospitals, STEM research, food pantries and other organizations “will lose the support that they rely on to serve our communities. This is a disastrous outcome for our state, and it will impact people in every corner of Colorado.”

Colorado Gov. Jared Polis said in a statement that it is “deeply disappointing that all the Republican members of our delegation voted for this bill, despite being warned repeatedly of the damage it will cause for their constituents and our state.”

He added, “Colorado Republicans and Trump now own the devastating impacts, cost increases, and chaos this bill will impose on hardworking Coloradans and Americans.”