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.

The final version of President Donald Trump’s tax bill will likely come with significant changes to Medicaid, sparking concerns among the millions of Americans who rely on the government program. Trump and the White House insist the changes aren’t about cutting Medicaid,