The U.S. House on 3 July approved a sweeping tax-and-spending package that would roll back several Affordable Care Act provisions and cut an estimated $1.1 trillion from federal health programmes over the next decade, according to the Congressional Budget Office. President Donald Trump is expected to sign the measure, a central plank of his post-reelection agenda. State officials say the legislation could strip health insurance from up to a quarter of the roughly 400,000 people who buy coverage through the Massachusetts Health Connector, the marketplace that inspired key elements of Obamacare. About 60,000 legally present immigrants would lose access to premium tax credits, while another 40,000 U.S. citizens could be deterred by new income, household-size and immigration documentation requirements. Massachusetts, which has the nation’s lowest uninsured rate at 2 percent, warns the changes would reopen coverage gaps the state closed when it enacted its own individual mandate in 2006. Audrey Morse Gasteier, executive director of the Connector, said the bill would impose “friction, red tape and delays” that risk pushing vulnerable residents—particularly those with chronic illnesses—out of the system and could drive up premiums for those who remain.