The Republican-led House of Representatives has introduced a significant overhaul of the Medicaid program, aiming to reshape healthcare access for millions of Americans.

The Republican speaker of the House insists changes to Medicaid are about cutting “waste and abuse,” as well as improving men’s “dignity.”

House Speaker Mike Johnson (R-La.) arrived for a meeting with House Republicans in Washington on Wednesday morning. House Republicans pushed forward on their sweeping domestic policy bill in marathon sessions that stretched into Wednesday morning, pushing debate over Medicaid and tax cuts. HAITUN JIANG/NYT

The GOP’s budget bill exposes Trump’s ‘working-class party’ rhetoric as phony. It also gives Democrats a massive health care opportunity.

With House passage of the GOP’s tax-and-spending megabill, all eyes turn to the Senate and the crucial decision its Republican leaders must make: either mostly accede to the bill it receives, or rewrite major sections of it.

Sen. Rand Paul, a vocal critic of the Trump-backed budget bill he said has "wimpy" spending cuts, advocated to shift more Medicaid spending to states.

For every bloc with a demand that must be met to earn its support, there is another faction demanding the opposite.

Pa. Democratic U.S. Sen. John Fetterman, left, said he would oppose the "One, Big, Beautiful Bill" passed by the GOP-controlled House while GOP Sen. Dave McCormick seemed poised to support it. (AP Photo/Marc Levy, File) (AP Photos/J. Scott Applewhite (Fetterman) and Marc Levy (McCormick))