CNN —

The House GOP narrowly passed its massive tax and spending cuts package ahead of its Memorial Day deadline, sending President Donald Trump’s “one big, beautiful bill” over to the Senate, where it will likely face many changes.

The package includes several controversial measures that would deeply cut into two of the nation’s key safety net programs – Medicaid and food stamps – while making permanent essentially all of the trillions of dollars of individual income tax breaks contained in the GOP’s 2017 Tax Cuts and Jobs Act. What’s more, it would fulfill Trump’s campaign promises to cut taxes on tips and overtime, albeit temporarily.

The magnitude of the measures is evident in the estimates of the cost they would incur or the savings they would produce.

The tax changes in the package would add $3.8 trillion to the nation’s debt over a decade, according to a Congressional Budget Office analysis released before last-minute changes were made to the bill.

Funding for Medicaid would be slashed by nearly $700 billion, according to CBO, though that figure will likely grow even larger once CBO factors in changes made to the bill. The food stamps program would see a cut of $267 billion in federal support.

House Republicans included other Trump campaign promises, such as significant investments in staffing at the US southern border, new systems to discourage immigration into the US and a gigantic new missile defense shield. Then there are other longtime GOP policy goals, such as an overhaul of the nation’s outdated air traffic system, new fees targeting electric cars and a pivot away from federal student loans.

Overall, the House was looking for at least $1.5 trillion in spending reductions to offset the legislation’s sweeping tax breaks and investments in defense and immigration control. Senate Republicans are likely to make additional changes, which could soften some of the deep cuts in the House bill.

The Senate also has stricter rules for what can be included since congressional Republicans are pushing the legislation through the budget reconciliation process, so they don’t need Democratic support in the Senate.

Here’s what we know about the House GOP package:

Medicaid work requirements

For the first time in Medicaid’s 60-year history, certain recipients ages 19 to 64 would be required to work at least 80 hours a month to retain their benefits. They could also meet the controversial mandate by engaging in community service, attending school or participating in a work program.

The requirement would now take effect by the end of 2026, instead of at the start of 2029. Advancing the date is expected to lead to more people losing their health insurance coverage and to cut more deeply into Medicaid’s federal support.

The mandate would not apply to parents, pregnant women, medically frail individuals and those with substance-abuse disorders, among others.

Republicans have long sought to add work requirements to Medicaid, which provides health insurance to more than 71 million low-income Americans. The first Trump administration granted waivers to several states to implement such a mandate, but the efforts were halted by federal courts.

The new Medicaid work requirements are expected to result in millions of people losing their health care coverage, multiple analyses have shown. While many adults on Medicaid have jobs, they may have trouble meeting the reporting requirements, obtaining exemptions or landing enough hours each month to maintain their eligibility.

The package also mandates states to check Medicaid expansion enrollees’ eligibility every six months, instead of annually, and to require that certain low-income adults covered under Medicaid expansion pay for a portion of their care. Recipients would also have to prove they have US citizenship or legal immigration status.

In addition, the legislation would penalize states that have expanded Medicaid and that provide Medicaid coverage to undocumented immigrants using state funds. These states would see a 10% reduction in their federal matching funds for the expansion population. Several states, including California, New York, Utah and Illinois, cover undocumented children, adults or both in state health plans.

It would also limit states’ ability to levy taxes on health care providers. States use this revenue to boost provider rates and fund health-related initiatives, among other uses. All but one state levy at least one type of provider tax, which some Republicans claim is a scheme by states to get more federal matching funds.

And the legislation includes an incentive for the 10 states that have not expanded Medicaid under a last-minute change. Those states would be permitted to funnel larger supplemental payments to hospitals and other providers, giving the states another reason not to broaden their Medicaid programs to low-income adults. Expansion states would be more limited in the supplemental payments they could send to providers.

The package would postpone implementation of a Biden administration rule aimed at streamlining Medicaid eligibility and enrollment until 2035. Such a delay would make it harder for people to enroll in the program and renew their coverage.

However, the House did not include several other controversial proposals that would have reduced the share of federal funds that states receive.

The bill also calls for codifying a Trump administration proposal that would make changes to the Affordable Care Act enrollment process, including shortening the open enrollment period and eliminating the ability of low-income Americans to sign up year-round.

Plus, in a last-minute change to the bill, GOP lawmakers added a provision to restore funding for federal subsidies that help reduce out-of-pocket costs for lower-income Obamacare enrollees. Trump nixed the funding for the assistance, known as cost-sharing reduction subsidies, in his first term. However, reinstating the cost-sharing subsidies’ funding would likely reduce the generosity of premium subsides for some enrollees, which could prompt them to drop their coverage.

The Medicaid and Affordable Care Act provisions in the package could result in 8.6 million more people being uninsured in 2034, according to an early CBO estimate released by Democratic lawmakers. That number is expected to grow with the latest changes.

Larger child tax credit

The child tax credit would rise to $2,500, up from $2,000, per child from 2025 through 2028. Single parents earning up to $200,000 and married couples earning up to $400,000 qualify. The credit phases out for those with higher incomes.

Also, the legislation would require that parents, in addition to the child, have Social Security numbers. Currently, parents can claim the credit if they have individual taxpayer identification numbers, which some noncitizens who are not eligible for Social Security numbers use to file federal taxes. The change would mean 2 million fewer children would be eligible next year, according to the JCT.

Trump accounts for kids

The package would create a new “money account for growth and advancement,” or MAGA account – which House lawmakers renamed “Trump accounts.” The federal government would provide a one-time $1,000 credit to the accounts of children born from 2025 through 2028 who are US citizens at birth.

The annual contribution limit to the tax-preferred accounts would be $5,000, and money could not be withdrawn before the beneficiary turns 18. After that, the funds could be used for higher education or a first-time home purchase, among other purposes, and taxed at capital gains rates. After a beneficiary turns 31, the account would cease to be a Trump account.

No taxes on tips and overtime

Certain taxpayers would be able to deduct the income they receive from tips on their tax returns, fulfilling a key Trump campaign promise, under the proposal.

But it would only apply to occupations that traditionally receive tips, in an effort to prevent employers and workers from recharacterizing their income as tips to escape taxes. The Treasury secretary would be tasked with publishing a list of such jobs.

Highly compensated individuals, who make more than $160,000 in 2025, would not qualify. The deduction would apply to 4 million tipped workers, according to a fact sheet from Rep. Jason Smith, chair of the House Ways and Means Committee.

Likewise, many hourly employees who receive overtime would not have to pay taxes on that extra compensation. It would apply to 80 million hourly workers, according to Smith. Those who are highly compensated would not qualify.

Both breaks would be available to taxpayers who do not itemize their deductions, who are the majority of Americans. However, the measures would only be in effect from 2025 through 2028.

A boost for senior citizens

Senior citizens would receive a $4,000 increase to their standard deduction from 2025 through 2028, according to the package. But the benefit would start to phase out for individuals with incomes of more than $75,000 and couples with incomes double that amount.

This measure is aimed at fulfilling Trump’s promise to end taxes on Social Security benefits since lawmakers cannot include such a measure under the rules of budget reconciliation, which Republicans are using to advance the package without Democratic support in the Senate.

Car loan interest deduction

The legislation calls for a new temporary deduction for the interest on car loans, in keeping with Trump’s campaign promise.

Eligible taxpayers could deduct up to $10,000 in interest annually from 2025 through 2028. But the tax break would start to phase out for single filers earning more than $100,000 and married couples earning $200,000.

It applies to taxpayers who get car loans starting in 2025 and who buy passenger vehicles that had their final assembly in the US.

More tax breaks

The package would temporarily boost the standard deduction by $1,000 for single filers and $2,000 for married couples.

And it includes some measures that would benefit wealthy Americans. It would make permanent the larger estate tax exemption, which would be set at $15 million per person for 2026 and would be indexed to inflation thereafter.

Plus, it would make permanent a special deduction for the owners of certain pass-through entities who pay their business taxes on their individual tax returns. It would beef up that deduction to 23%, up from 20%. These so-called pass-through businesses include partnerships, such as those formed by lawyers, doctors or investors.

State and local tax deductions

The latest version of the bill would also hike the current limit on state and local tax deductions to $40,000 annually, up from $10,000. But the full amount would be limited to those making $500,000 or less, before it starts to phase back down to $10,000.

For single filers, the cap would be raised to $15,000 for those earning $250,000 or less, before phasing back down to $5,000.

The beefed up cap, which would rise gradually over time, would last until 2034.

Republican lawmakers from high-tax states, including California and New York, had been demanding an increase to the so-called SALT cap for years since it disproportionately hits their constituents. The limit mainly affects higher-income residents in those states.

Republicans introduced the cap as part of their 2017 tax cuts package as a way to help pay for the sweeping legislation. Trump had promised to eliminate the cap on the campaign trail last year, but doing so would be very costly.

Business tax breaks

The package would restore a tax break from the 2017 tax package that allowed businesses to fully write off the cost of equipment in the first year it was purchased. The incentive has been phasing out since 2023.

Also, the legislation would once again allow businesses to write off the cost of research and development in the year it was incurred. The TCJA required that companies deduct those expenses over five years, starting in 2022.

The two provisions would expire after 2029.

The bill would also temporarily allow companies to immediately deduct the cost of constructing or making improvements to certain types of buildings, including manufacturing plants.

However, the package would limit writing off the purchases of professional sports teams.

Defunding Planned Parenthood

The bill would bar Medicaid funding for Planned Parenthood clinics regardless of state laws surrounding abortion. Besides abortion, the clinics also provide STI tests and treatments, cancer screenings and birth control.

Planned Parenthood says that provision could result in 200 facility closures across the country, the vast majority in states where abortion is still legal.

The organization announced that eight facilities in the Midwest would close, including more than half of its Iowa clinics. In a statement, Planned Parenthood cited frozen Title X funding, intensified pressure around abortion laws and the House bill.

Trump has said that abortion laws should be left to states after the US Supreme Court’s 2022 ruling rolling back federal protections.

Higher taxes for universities and foundations

Some universities currently pay a 1.4% tax on the net investment income from their endowments. The bill calls for raising that rate to as high as 21%, depending on the endowment’s size.

Similarly, private foundations would see their tax rate jump to as much as 10%, up from roughly 1.4%.

Raising the debt ceiling

The legislation would also raise the debt ceiling by $4 trillion.

Congress needs to raise the debt limit before its August recess to prevent the nation from defaulting on its obligations, Treasury Secretary Scott Bessent wrote to lawmakers last week.

Under the package, more food stamp recipients would have to work to qualify for benefits.

Currently, adults ages 18 to 54 without dependent children can only receive food stamps for three months over a 36-month period unless they work 20 hours a week or are eligible for an exemption.

The legislation would extend the work requirement to those ages 55 to 64, as well as to parents of children between the ages of 7 and 18. Plus it would curtail states’ ability to receive work requirement waivers in difficult economic times, limiting them only to counties with unemployment rates above 10%.

The bill would also require states to pay for a portion of the benefit costs – at least 5% – for the first time, starting in fiscal year 2028. States with higher payment error rates would have to shoulder more of the burden – as much as 25% of the costs for those with error rates of at least 10%.

Plus, states would have to pick up 75% of the administrative costs, rather than 50%.

Advocates quickly criticized the proposals, saying recipients could lose crucial food assistance and states would be on the hook for millions of dollars, which could lead them to cut benefits and eligibility.

Some 42 million Americans are enrolled in the Supplemental Nutrition Assistance Program, or SNAP, the formal name for food stamps.

Clean energy programs axed

The legislation would effectively deal a blow to the Inflation Reduction Act, former President Joe Biden’s major clean energy law passed in 2022.

In last-minute changes, Republicans sped up the timelines for phasing out key clean energy tax credits to the end of 2028. They also put in a new, narrow set of requirements for energy companies building solar, wind, battery or geothermal to generate electricity, only allowing companies to recoup the credit if they started construction within a 60-day window after the bill was signed into law, and their power was in service by the end of 2028.

Analysts have also said the move will increase Americans’ electricity bills, since it would prevent cheaper wind, solar and batteries from getting on the grid at the same time power-hungry data centers and AI are coming online.

The only carve-out was for nuclear energy, a form of clean energy touted by Trump and Republicans that is much more expensive and time-intensive to build than solar and wind. Nuclear companies could claim a tax break if they started construction by 2028.

The package also claws back unspent IRA funds, targeting a $27 billion grant program at the Environmental Protection Agency and other EPA and Energy Department programs.

Republicans ultimately stripped a provision of the bill that would have sold off 500,000 acres of public land in Utah and Nevada, a measure that was opposed by some Western Republican lawmakers.

Federal student loans

The legislation would dramatically restructure the way students can borrow from the federal government for college, as well as make big changes to the popular Pell grant program.

The package, which CBO projects would save about $350 billion over a decade by limiting the federal role in the student borrowing process, would cap the total amount of federal aid a student can receive annually at the “median cost of college” and end economic hardship and unemployment deferments. Plus, it would bar loan servicers from temporarily suspending student loan payments for more than nine months over a two-year period.

The changes also include terminating the subsidized loan program for undergraduate students and the Graduate PLUS loan program for new borrowers, with a three-year exception for students with such loans. The bill would amend the maximum annual and aggregate loan limits for unsubsidized loans, as well as require undergraduate students to exhaust their unsubsidized loan options before their parents can take out Parent PLUS loans.

In addition, the legislation would terminate all income-contingent repayment plans — including Biden’s SAVE plan, which has been blocked in federal court. Instead, borrowers would have a choice of a standard repayment plan or a repayment assistance plan based on borrowers’ income.

The bill also calls for alterations to the Pell grant program, including requiring students attend school at least half time and increasing the number of credit hours needed for full-time enrollment. But it would expand eligibility for such grants for students enrolled in short-term workforce programs.

And the legislation would create “skin-in-the-game accountability” for colleges participating in the Direct Loan program by requiring them to reimburse the Department of Education for a portion of loans that aren’t fully repaid.

It would also establish a “Promise” program to provide colleges with performance-based grants of up to $5,000 per federal student aid recipient. The colleges must provide students with a guaranteed maximum total price for their program of study based on income and financial needs categories. The formula would reward institutions for strong earnings outcomes, low tuition, and enrollment and graduation of low-income students.

Immigration fees and ICE funds

Immigrants applying for asylum and work authorization, as well as those applying for humanitarian parole and temporary protected status, would have to pay new or higher fees, under the package.

Asylum seekers and parolees would have to pay $1,000 to apply and $550 for an initial work permit, for instance. Plus, sponsors of unaccompanied children would have to pay up to $3,500.

The bill also provides $45 billion to build new immigration detention facilities, including family detention centers, to allow the detention of at least 100,000 people a day, on average. It supports hiring 10,000 more Immigration and Customs Enforcement officers, including money for retention and signing bonuses for the agents, and provides funding for 1 million annual deportations through ground and air transportation.

And it provides $1.3 billion to hire immigration judges and support staff, as well as to expand courtroom capacity.

Border security

The legislation calls for tens of billions of dollars to bolster border security, including $46.5 billion to expand and modernize the border barrier system. Planned investments include the completion of 700 miles of primary wall, the construction of 900 miles of river barriers, and the replacement of 141 miles of vehicle and pedestrian barriers.

The package would also provide $5 billion to acquire, construct or improve Customs and Border Protection facilities. Plus, it would funnel $4.1 billion for the agency to hire and train 3,000 new Border Patrol agents, 5,000 new Office of Field Operations customs officers, 200 new Air and Marine Operations agents, 290 support staff, and eligible retired agents and officers. It would also invest $2 billion in annual retention bonuses and signing incentives.

The bill would provide nearly $1.1 billion to strengthen technology to detect and disrupt the smuggling of illegal drugs and people into the US, and $2.7 billion for border surveillance technology, including tunnel detection capability and unmanned aircraft systems.

And it includes $1 billion for security and planning for the 2028 Olympics in Los Angeles, as well as $625 million for the 2026 FIFA World Cup, which will be hosted by the US, Canada and Mexico. It would also provide $300 million for the Federal Emergency Management Agency for the reimbursement of extra law enforcement costs for protecting presidential residences.

Electric and hybrid vehicle fees

Electric vehicles would have to pay an annual registration fee of $250 and hybrid vehicles would be assessed an annual fee of $100, under the package. The funds would be deposited into the Highway Trust Fund.

But a proposal to levy a $20 annual tax on gas vehicles was dropped, after it faced swift pushback from conservatives.

The legislation would also eliminate seven green programs authorized by the Democrats’ 2022 Inflation Reduction Act, including the Low-Carbon Transportation Materials Grants Program and the Federal Aviation Administration’s Alternative Fuel and Low-Emission Aviation Technology Program.

Federal employee retirement benefits

The package would make a few changes to Federal Employees Retirement System benefits, though the biggest cuts were dropped from the final version of the bill.

For most new, younger retirees, the legislation would eliminate the additional retirement annuity payment they would receive until they are eligible for Social Security benefits. (Other provisions would apply to federal law enforcement personnel and others who have mandatory retirement ages.)

Also, the bill would require new employees to contribute an additional 5% of their pay into the pension system – on top of the standard 4.4% rate – unless they agree to serve “at will,” giving them fewer job protections.

Plus, the legislation would institute a fee for employees’ appeals to the Merit Systems Protection Board, which would be refunded to them if they win their appeal. And it would require a comprehensive audit of workers’ dependents enrolled in the Federal Employees Health Benefits program, including the verification of marriage and birth certificates.

But lawmakers dropped two of the most significant measures. One would have raised the Federal Employees Retirement System contribution rate for many current civilian and postal employees to 4.4% of their salary. Those hired prior to 2014 generally contribute either 0.8% or 3.1%, while more recent hires generally already contribute 4.4%.

The other would have changed the formula for calculating pension benefits, basing it on the average of workers’ highest five years of earnings, instead of highest three years. That would have left many with smaller payments in retirement.

Air traffic control

The bill would appropriate $12.5 billion for the modernization of the nation’s air traffic control system. The funds would begin replacing outdated technology and enhance the hiring of air traffic controllers.

Financial company oversight

The package would limit the embattled Consumer Financial Protection Bureau’s authority to draw funds from the Federal Reserve. Also, it would essentially eliminate the Public Company Accounting Oversight Board, which was established by Congress to oversee the audits of public companies, by shifting its responsibilities to the Securities and Exchange Commission and barring it from collecting fees from companies and brokers and dealers.

Defense

The legislation calls for adding roughly $150 billion to strengthen the nation’s defense programs.

The package includes nearly $25 billion for Trump’s “Golden Dome” missile defense initiative, which calls for developing a space-based system and quickly accelerating defense capabilities against hypersonic threats. It would provide nearly $34 billion for ship building and more than $20 billion for munitions, including ramping up the domestic production of rare earth and critical minerals.

Also, the bill would funnel more than $8.5 billion to improving service members’ quality of life, including renovating military barracks, providing supplemental payments of the Basic Housing Allowance, expanding educational opportunities and child care fee assistance, and broadening professional licensure assistance programs for military spouses.

Judges’ power to hold Trump administration in contempt

The package would defund the enforcement of contempt orders if the judge had previously not ordered the plaintiffs in the case to put up a security bond with a preliminary injunction or temporary restraining order granted in their favor. The goal is to stop frivolous lawsuits, according to a committee spokesperson.

Impact on the deficit

Although the package includes deep reductions in spending, its tax cuts would slash revenue even more, according to several independent analyses. CBO has yet to release an official score of the entire bill.

A preliminary estimate from the Committee for a Responsible Federal Budget said the legislation would add $3.3 trillion to the nation’s debt over the next decade. And annual deficits would jump from $1.8 trillion in 2024 to $2.9 trillion by 2034 as the federal government would continue to spend more than it would raise in revenue, the committee projected.

Similarly, the Penn Wharton Budget Model also found that the package would cost $3.3 trillion over 10 years. It noted that the tax proposals would reduce revenue by $4.6 trillion, while spending on defense, homeland security and immigration enforcement would add more than $300 billion. But the savings in the bill only amount to $1.6 trillion.

These estimates were released before House Republicans updated the bill ahead of a floor vote.

Some House Republicans are downplaying the legislation’s impact on the deficit, arguing that the enhanced economic growth spurred by the package will bring in more revenue. White House press secretary Karoline Leavitt told reporters, “This bill does not add to the deficit.”

This story has been updated with additional developments.

CNN’s Ella Nilsen, Sarah Ferris, Manu Raju, Lauren Fox, Tierney Sneed, Sarah Owermohle and Fredreka Schouten contributed to this report.

‘I cannot guarantee complete confidentiality,’ VA therapists ordered to tell veterans

toggle caption Jeremy Hogan/SOPA Images/LightRocket via Getty Images

Panic, fear, uncertainty, and anger.

Those are the emotions mental health clinicians who work for the US Department of Veterans Affairs describe as they prepare for the VA’s mandatory return-to-office directive. Some are being summoned to offices as soon as Monday, April 14. Representatives from the VA say they are planning to have the back-to-office effort completed by May 5.

For this story, NPR interviewed ten clinicians in VA locations around the country, the majority of whom spoke on condition of anonymity because they were afraid of losing their jobs. Days before the April 14 return-to-office deadline, many were still unclear about the expectations for return dates. Some had received last minute changes or delays for reporting to an office.

In a memo obtained by NPR, regional leadership at one VA facility offered a script for its therapists to read to patients. “Before we begin our session, I want to inform you that I am currently in a shared office space,” reads the script. “While I will do my utmost to maintain your privacy, I cannot guarantee complete confidentiality.”

Sponsor Message

These directives come after the VA indicated it would cut about 80,000 staff in a massive restructuring effort. A widely circulated leaked memo, first obtained by the Associated Press, outlines the effort. In a video addressing the cuts, VA Secretary Doug Collins suggested the agency would eliminate waste and that the “the days of kicking the can down the road are over.” He offered reassurance that VA benefits would not be impacted and that the VA “regrets anyone who loses their job.”

Telehealth hires

Many VA therapists were hired on a telehealth basis and point out that there simply is not space for them to work at VA facilities. They are anticipating confusion and congestion around issues such as parking, bathroom use and adequate kitchen facilities to reheat their lunches.

But the primary concern for therapists is whether they will be able to deliver quality care to their patients in an environment without confidentiality.

In emails and meetings, VA managers described to VA mental health staff “pod” working environments, where clinicians work with headphones in a call-center like configuration to provide telehealth. In one recording obtained by NPR, a manager in a teleconference meeting acknowledged that it was inevitable therapy sessions would be overheard and exhorted people not to share any confidential information.

Sponsor Message

Supervisors working from “a shower”

“We won’t be able to provide private sessions,” says one licensed clinical social worker, who asked to be identified by a middle initial, L., for fear of retaliation. Guaranteed privacy between patient and doctor is a fundamental tenet of quality mental health care, protected by federal law.

A group of 20 House Democrats signed a letter to VA Secretary Doug Collins vocalizing their outrage on this issue. They describe one scenario in which a social worker supervisor has been ordered to return to work “sharing a 100-foot shower with another supervisor,” to provide case management and clinical supervision. “We’re sure you can agree,” they write, “this sort of arrangement is hardly conducive to delivering the quality of care veterans deserve.”

VA response

VA representatives have repeatedly insisted that federal privacy laws will be upheld. In an email response to questions about these issues, VA spokesperson Peter Kasperowicz reiterated an accusation that employees who are sounding alarms are motivated by a desire to “phone it in.”

toggle caption Chip Somodevilla/Getty Images

Kasperowicz wrote that these continuing concerns are “fear mongering from the media,” and wrote that “the small number of employees who are desperate to avoid returning to the office will do more to drive away staff and patients than VA’s commonsense return-to-office policy ever will.”

VA care, he said, would continue uninterrupted and the “VA will ensure that employees have a workspace that is appropriate for the work they do.”

But therapists say they do not see logistically how this is possible.

L. worried the disclaimers therapists are being encouraged to use at the start of sessions would not withstand legal scrutiny, as consent for information sharing needs to be granted in writing.

“Therapists will either cancel the session themselves,” L. says, “and risk being reprimanded, or their patients will cancel.”

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L. forsees longer waiting times for veterans seeking care as a result and points out that veterans are at disproportionate risk for suicide than those who have not served. Wait times are already bad. Often, he says, his clients “have been waiting months and months – many of them with severe mental health issues, including suicidal thoughts.”

Dates changing at the last minute

The VA is one of the biggest providers of mental health care across the US.

In emails shared with NPR, some clinicians were told they would be returning to the office May 5, some were granted exemptions, and some were told to report to work April 14 – though these dates were also subject to change. One document obtained by NPR outlines steps for managers.

“This memo provides a framework to inform a standardized approach to terminating remote and telehealth agreements,” it reads.

Many clinicians expressed bewilderment about why certain workers were on the list of mandatory returns and others are not. Others were evaluating the possibility of working from their cars or finding space in a bathroom stall to conduct therapy sessions.

Some workers were asked to participate in rearranging furniture in order to accommodate group seating arrangements. Tasks like “rolling tables to podded rooms as temporary desks,” or “rolling away excess furniture,” were on a to-do list, obtained by NPR.

“Distress across the board”

The American Psychological Association issued a statement criticizing the policy and raising concerns about compliance with federal privacy laws.

“Providers are facing difficult choices between violating ethical standards regarding patient confidentiality or facing disciplinary action for non-compliance with return-to-office mandates,” reads the statement. It goes on to warn that the policy “could compromise access to care and confidentiality standards that are key to effective mental health treatment.”

Under President Biden, the PACT act allocated nearly $800 billion to expand VA care and benefits for veterans exposed to toxins. The current efforts aim to reduce staffing numbers to the levels VA had before this legislation. It is not clear how VA would reduce staff to 2019 levels and still fulfill its legal requirements under the PACT act.

Many clinicians described their recent experience as a kind of emotional warfare, and noted the irony of compromising their own mental health while trying to provide mental health care for others.

Sponsor Message

” I’m anticipating a good deal of distress across the board,” says L. “And that we will generally fail at our mission of treating veterans.”

If you or a loved one is in crisis, call, text or chat the 988 Suicide and Crisis Lifeline.

Have information you want to share about the ongoing changes across the federal government? Katia Riddle is available through encrypted communications on Signal at Katia.75

Rep. Ryan Mackenzie, R-Pa., said tonight that illegal immigrants are “bringing these diseases into our country” when asked about a measles outbreak in Texas.

“Many of these instances that are coming into our country are from illegal immigrants who have crossed the border with no checks, no actual health records, and they are bringing these diseases into our country,” Mackenzie said during a CNN town hall.

“There is a reason why measles has sparked a threat in our country after decades of being almost eradicated, as I pointed out. And so I think we need recognize that,” he added.

CNN’s Jake Tapper, who co-moderated the event, had asked Mackenzie about the outbreak and whether he has concerns about Health and Human Services Secretary Robert F. Kennedy Jr.

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Trump-backed budget bill approved in US House

House Speaker Mike Johnson (l) speaks to members of the media along with the Republican leader of the Senate, John Thune, after the budget measure passed on Thursday

However the House bill has deeper spending cuts than the one passed by the Senate, and the two versions must be merged into one bill for Trump to sign into law.

After the 216-214 vote on Thursday, Trump posted on social media: “Congratulations to the House on the passage of a Bill that sets the stage for one of the Greatest and Most Important Signings in the History of our Country.”

The spending plan is a key plank in Donald Trump’s legislative agenda and he has called it a “big, beautiful bill”.

The US House of Representatives has passed a budget bill that includes trillions of dollars in cuts to both taxes and government spending, despite opposition from Democrats and Republican hard-liners.

The merger process is called “reconciliation” – and further legislation will be needed to enact the bigger tax cuts that Trump has asked for.

The House plan, currently a broad blueprint with many details still to be worked out, would cut taxes by about $5 trillion (£3.9 trillion).

Over the next decade, it would also add $5.7 trillion to the US government’s debt, according to Reuters. The Treasury reports that US debt currently stands at around $36 trillion.

The possibility of ballooning government debt led a number of Republican hard-liners to initially oppose the bill and demand deeper spending cuts.

Earlier in the week, Speaker of the House Mike Johnson, a Republican, had to push off a vote on the bill for fear that it would not pass in a chamber that is only narrowly controlled by his party.

On Thursday the Republican “no” votes had been whittled down to two: Thomas Massie of Kentucky and Victoria Spartz of Indiana.

The Senate version of the bill was passed on Saturday and calls for a minimum of $4bn (£3.1bn) in spending cuts – a fraction of the $1.5 trillion in cuts that the House has demanded.

Republican leaders in the Senate have described the $4bn figure as a minimum.

“We’ll certainly do everything we can to be as aggressive as possible,” said John Thune, the party’s leader in the chamber.

The scale of the spending cuts laid out in the bill would be many times greater than those already made under Elon Musk’s Department of Government Efficiency – which claims to have saved $150bn so far, although that figure has been disputed.

The budget measure will also slash the money coming into the US federal government. If it eventually passes, the bill will extend tax cuts that were passed during Trump’s first term in 2017.

President Trump has also asked for additional tax cuts on tips – to make good on a campaign promise to end income taxes on tips for service-industry workers – as well as on overtime wages and Social Security retirement benefits.

Those tax cuts, if passed, would further increase US government debt.

The White House has said that money collected through tariffs will help plug the gap, however that plan is far from certain as Trump’s tariff plans continue to evolve with changing rates and dates for taking effect. There is also the possibility that high tariffs may lead to lower imports and, in turn, fewer goods to tax.

In a statement after the House vote, the Treasury Secretary Scott Bessent said: “This vote is more than a budget win; it’s a statement of purpose and strength, which affirms the Trump administration’s commitment to delivering growth and opportunity.”

A rise in federal borrowing requires another vote by Congress to increase the debt ceiling. Although such measures have been contentious, Bessent said during a cabinet meeting on Thursday that he was confident that Congress would raise the ceiling again later this year.

However the leader of the House Democrats, Hakeem Jeffries, called the budget bill a “disgrace” and criticised potential cuts to Medicaid, the US government program that funds health care for low-income Americans.

“House Democrats are going to aggressively push back every day, every week, every month, so we bury this reckless Republican budget resolution in the ground, never to rise again,” he told reporters.

Rep. Suzan DelBene, D-Wash., chair of the Democratic Congressional Campaign Committee, said her party is “on offense” on the “Trump-Musk agenda” in targeting dozens of GOP congressional districts in next year’s mid-term elections.

“And Republicans are running scared— for good reason,” DelBene said this morning on “Way too Early.”

Americans “are seeing prices go up, programs that they depend on being attacked, like Social Security and Medicaid, folks who serve our communities losing their jobs,” DelBene said.

It’s a preview of the message she hopes will be salient in the districts where Democrats plan to mount challenges.

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“It’s kitchen table issues: economy, cost of housing, of food, of child care, of health care,” she said.

DelBene, who also ran the Democratic campaign effort in 2024, said she hopes to take advantage of House GOP incumbents’ running for higher office, such as Andy Barr in Kentucky, who is considering a run for Senate, or John James in Michigan, who is running for governor.

“That’s an opportunity for us,” DelBene said, referring to James. She added, “Open seats can be easier” to flip.

“We also have a lot of seats that were really, really close last time,” she said. “We have seats that have been swinging — they went for Biden in 2020 and Trump in 2024, there are nine of those seats. So those are all opportunities for us,” she said.

“And we saw what happened in Florida too, where Republicans won by huge margins,” she said. “Those were slashed in half in just a few months. It kind of tells you the tenor of where the American people are at and their frustration and anger with Republicans, understandably.”

DelBene noted that the party in the White House tends to fare poorly in midterm election years.

“History is on our side here,” she said. “We only need three seats to take back the majority, and they have a microscopic majority right now.”