The One Big Beautiful Bill Act (OBBBA) is the House Republican reconciliation bill that packages President Trump's major legislative priorities into a single measure. Congressional budget reconciliation allows certain budget-related legislation to pass the Senate with a simple 51-vote majority rather than the 60-vote supermajority usually required to overcome a filibuster. The OBBBA includes approximately $1 trillion in Medicaid cuts over 10 years, primarily through: mandatory work requirements for able-bodied adults aged 19-64 (taking effect 2027); limits on state provider taxes that states use to draw down federal matching funds (taking effect 2028); changes to the federal matching rate; and elimination of the ACA Medicaid expansion enhanced matching rate. The Congressional Budget Office projected that the Medicaid cuts would cause between 13 and 17 million Americans to lose coverage over 10 years.