President Donald Trump has signed the Republican-backed One Big, Beautiful Bill Act—dubbed the Big Ugly Law by opponents—ending months of partisan wrangling over the future of federal health spending. The measure seeks nearly $1 trillion in budget savings by tightening eligibility and adding work requirements across Medicaid, the Affordable Care Act marketplaces and the Children’s Health Insurance Program. Policy analysts estimate about 11.8 million adults and children could lose health coverage over the coming decade. Beginning next year, states must verify Medicaid recipients’ income every six months and require able-bodied adults aged 19–64 to work, study or volunteer at least 80 hours a month. The law also lets states impose waiting periods and premium lockouts in CHIP and narrows subsidy access for some immigrants. Democratic lawmakers condemned the legislation, warning of higher emergency-room costs and citing projections of 51,000 additional preventable deaths annually. Supporters say the overhaul will curb spending growth and encourage workforce participation, but health-care groups caution that administrative hurdles could sweep eligible people off the rolls.