President Donald Trump on 4 July signed an 887-page tax-and-spending package that extends earlier income-tax reductions and channels additional billions to border security. The legislation lifts the child tax credit to $2,200 per child, exempts overtime pay from federal income tax, adds a new deduction for seniors and forgives interest on some student loans. It also establishes so-called “Trump Accounts,” government-funded investment vehicles that will deposit $1,000 for every newborn regardless of household income. To finance these initiatives, the law reduces federal spending on Medicaid and the Supplemental Nutrition Assistance Program by more than $1 trillion. It imposes Medicaid work requirements on childless adults and on parents with children older than 13, while obliging parents of children aged 14 or above to work to keep SNAP benefits. States must now shoulder a larger share of both programs’ costs. Pediatricians and anti-poverty advocates warn the cutbacks could restrict health and nutrition services for infants and toddlers—groups heavily dependent on the safety net; Medicaid currently pays for about 40 % of US births. The measure cleared the Senate on a 50-50 vote, with Vice President JD Vance breaking the tie after an overnight session, and was quickly dubbed a “megabill” by Republican leaders. With the White House indicating deeper reductions in its next budget proposal, health-care providers and social-service groups are bracing for additional pressure even as middle- and higher-income households prepare to take advantage of the expanded tax benefits.