U.S. House of Representatives Speaker Mike Johnson looks at U.S. President Donald Trump signing the sweeping spending and tax legislation, known as the "One Big Beautiful Bill Act," to mark Independence Day, at the White House in Washington, D.C., U.S., July 4, 2025.

The massive bill is guided by spending requests from the White House. It will extend the 2017 Trump tax cuts, while cutting billions of dollars in social program funding. It’s been described as the largest cuts to social welfare programs since at least the 1990s, and according to some experts the most severe in modern history.

Federal cuts to Medicaid passed under President Donald Trump’s signature legislation — dubbed as the “big, beautiful bill” — are raising concerns among Maryland health advocates and policymakers who warn the changes could affect not only low-income residents but also those with private insurance.