AMY GOODMAN: This is Democracy Now!, democracynow.org, The War and Peace Report. I’m Amy Goodman.

President Donald Trump signed his sweeping tax and spend bill into law on July 4th, after a monthslong push that saw just three Republicans in the Senate and two in the House break away to oppose how it slashes the social safety net while extending tax cuts to the rich and ballooning the deficit. That left room for the measure to pass with the final vote mostly along party lines.

SPEAKER MIKE JOHNSON: On this vote, the yeas are 218, the nays are 214. The motion is adopted.

AMY GOODMAN: As House Speaker Mike Johnson announced that the measure had passed, he was surrounded by Republican lawmakers who mimicked Trump’s thumbs-up pose and danced to his unofficial anthem, ”YMCA,” that played in the chamber.

What critics are calling Trump’s “big, ugly bill” includes some $1 trillion in federal cuts to Medicaid and could kick 17 million people off healthcare. It makes the largest-ever cuts to food assistance benefits, could cause the closure of nursing homes and rural hospitals across the country, raises housing and energy costs and supercharges Trump’s crackdown on immigrants, all while extending Trump’s tax cuts for the rich and delivering massive new tax benefits for the wealthiest Americans.

New York Congressmember Alexandria Ocasio-Cortez said Democrats will campaign against Republicans who voted for the bill.

REP. ALEXANDRIA OCASIO-CORTEZ: There have to be consequences to these votes, and we have to decide if this is just a joke or just for TV, or if this is our real lives. And I hope people vote like it’s our real life.

AMY GOODMAN: Since Thursday’s vote, TV ads are already already running in swing districts currently represented by Republican supporters of the budget package, like Congressmember David Valadao in California’s 22nd Congressional District, where more than 60% of its constituents reportedly rely on Medicaid.

SAVE MY CARE AD: Republicans in Congress promised not to cut Medicaid. But then?

SPEAKER MIKE JOHNSON: The bill is passed.

SAVE MY CARE AD: It’s the biggest cut to Medicaid in history. And Congressman David Valadao just voted for it. More than 13 million Americans could lose healthcare — seniors, veterans and children with disabilities. Why did he do it? To give another huge tax break to billionaires and big corporations. Tell Congressman Valadeo we can’t afford to have our healthcare taken away, not now, not ever.

AMY GOODMAN: For more, we’re joined by John Nichols, national affairs correspondent for The Nation. His new piece is headlined “Republicans Just Voted to Do Immoral and Irreparable Harm to the United States: The GOP chose to betray both morality and economic common sense by approving Trump’s one big, ugly bill.”

John, welcome back to Democracy Now! Can you talk about the significance of what took place? I mean, interestingly, while the tax cuts go into effect immediately — is this correct? — the Medicaid cuts will happen after the midterms.

JOHN NICHOLS: That’s exactly right. This bill was drawn as a political document. There’s no question of what Donald Trump and the Republicans in congressional leadership wanted to do. They wanted to do what Republicans have done in every circumstance where they’ve gotten the White House in recent decades. And that is a massive tax cut for the wealthy, in this case, roughly three-point — I hope I’ve got the number right. It keeps kind of moving up and down, but, you know, it’s in the multiple trillions of dollars over the period of what we’re talking about here. But they also had to figure out some ways to, quote-unquote, “pay for this.” And as you suggest, they put the tax cut for the wealthy up front. I mean, that’s going to come across the board. And then they put a lot of damaging, you know, almost poison pills into the document as regards all of these safety net programs. And so, a lot of the cuts will come over time. People won’t feel them immediately.

And yet, this is the bottom line: In states across the country, not according to liberal Democrats, not according to progressive think tanks, but according to Republicans who are on the ground in these states, and one Republican in the U.S. Senate, Thom Tillis, this is going to have a devastating impact on Medicaid, on access to healthcare, so that we will get to a point where roughly 5% of Americans are at threat of losing their healthcare. That’s a massive, massive shift. In addition, you’ve got roughly 11.8, 12 million people at risk of losing SNAP anti-hunger benefits. And when we look at all the numbers here, because of the way the tax cuts are massively weighted toward the wealthy, you have members of Congress, who are pretty serious analysts of all this, telling us that roughly 40% — going to underline that, 40% — of Americans will end up worse off under this. They won’t get a significant tax cut. They will lose health benefits. They will lose anti-hunger benefits and a lot of other benefits, as well. This is the most massive transfer of wealth upward in American history, and yet it’s designed to create a circumstance where Republicans can run in 2026 and claim that they didn’t do the damage.

I’ll give you one more set of facts that are just useful. This comes from Governor Andy Beshear in Kentucky. Kentucky is a state that votes quite Republican in federal elections. Beshear is a Democrat, but he’s had to work with a Republican Legislature. He’s a very kind of facts and numbers guy. He says this is the worst piece of federal legislation in his lifetime. He says that 200,000 Kentuckians — this is just one state — 200,000 Kentuckians will lose healthcare, 20,000 healthcare workers will lose their jobs, and as many as 35 rural hospitals are now in danger of closing in that one state. And that doesn’t even take in the devastating impact to nursing homes, especially in small towns.

AMY GOODMAN: I want to ask you about the Republican Congressmember Derrick Van Orden of Wisconsin, who voted for Trump’s budget bill even as he called on your governor, Wisconsin Governor Tony Evers, to sign the state budget before Trump signed the federal budget bill into law on July 4th. He wrote in a letter, quote, “Delaying the state budget enactment beyond July 3rd risks losing vital opportunities for the state’s healthcare system and the Wisconsinites who rely on it. Healthcare and rural healthcare, in particular, is vital to us in Wisconsin. We cannot leave anything on the table.” Explain what’s going on here.

JOHN NICHOLS: Sure. This new law has all sorts of draconian components to it that are incredibly damaging to the way in which states have set up their healthcare systems. Remember, states across the country get federal funding, and then they establish a state-based healthcare system for working people who can’t afford the high cost of healthcare. And those systems often have an intermingling of federal and state money. The way that what — what this bill does, it created a circumstance where states that didn’t have a budget locked in with a program for spending that state and federal money by July 1st ran the risk of — or by, you know, the — before the bill was passed, I should say, before the federal bill was passed, ran the risk of losing substantial amounts of money.

So, to give you an example, in Wisconsin, Governor Tony Evers, knowing that this was indeed a real risk, signed the bill after 1 a.m. the other day. You know, literally, it was up into the middle of the night. So, as soon as it got through the Legislature, they signed the new Wisconsin budget. And that is because this federal bill, as it implements, is going to make it dramatically harder for the states to establish and maintain healthcare programs for working people who can’t afford. And if I can just give you one more factoid on that, if we can use that word, Thom Tillis, the senator from North Carolina, Republican senator from North Carolina, a former Republican legislative leader, said what this bill does is sort of, kind of blow apart the systems that states have set up to establish their healthcare programs.

AMY GOODMAN: And, John, just very finally, you had Lisa Murkowski saying what’s good for Alaska is not necessarily good for the country; this bill is not good for many Americans in the country. They got carve-outs — right? — to get them to say — that was Murkowski. Thune himself, the Senate majority leader in South Dakota — they got carve-outs to protect their, for example, rural hospitals.

JOHN NICHOLS: They did in some cases. But I will emphasize to you that while there were some techniques, some tricks kind of put in here to help rural hospitals, they will not be sufficient. And more damaging here, not discussed at nearly the level it should have been, is rural nursing homes. And the way that this bill is written, it poses a dramatic threat to nursing homes across the country. There is a real possibility that millions of families that go through that devastating challenge of trying to figure out how to care for an elder or a person with disabilities are going to be put into one of the most devastating circumstances that the government has ever imposed on folks as regards healthcare.

AMY GOODMAN: John Nichols, I want to thank you for being with us, national affairs correspondent for The Nation. His new piece, we’ll link to at democracynow.org, “Republicans Just Voted to Do Immoral and Irreparable Harm to the United States,” speaking to us from Madison, Wisconsin.