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The massive spending bill the House Republicans passed in the middle of the night on Thursday will have devastating consequences for people with kids — and the people who want to have them.
The One Big Beautiful Bill Act, the Trump-coined name given to the GOP’s budget, is a proposal that decimates what’s left of the safety net in order to give even more money to the richest people in America. The massive budget proposes $880 billion of cuts from federal spending in order to cover a whopping $4.5 trillion in tax cuts. Much of the money cut will come out of Medicaid, the government-funded health care program that covers low-income people, babies and the elderly. The bill still faces significant hurdles in the Senate, where Republicans seem skeptical of it.
But Republicans were celebratory after the House vote, praising the cuts as a way to eliminate waste, fraud and abuse from Medicaid and touting the bill as a historic maneuver. “This is arguably the most significant piece of Legislation that will ever be signed in the History of our Country!” Trump posted on Truth Social after the vote.
“The House has passed generational, truly nation-shaping legislation,” Speaker Mike Johnson (R-La.) told reporters on Thursday.
But once again, those hardest hit will be the most vulnerable, including a group the GOP claims to love: families.
“It’s the largest proposed cut to Medicaid in its 60-year history,” said Sarah Coombs, the director for health system transformation at the National Partnership for Women and Families, a nonprofit dedicated to promoting reproductive health and rights. “If this bill passes, the effects are so pervasive I think it will be significantly hard to come back from it.”
The Trump administration has spent a lot of time positioning itself as a government that promotes and supports babies and families. Back in February, President Donald Trump, who has used the cringe-inducing term “fertilization president” to describe his support for fertility treatments, issued an executive order to expand access to IVF. “My Administration recognizes the importance of family formation, and as a Nation, our public policy must make it easier for loving and longing mothers and fathers to have children,” the order stated.
And in his first public speech as vice president, JD Vance proclaimed that he wanted more people to have children. “I want more babies in the United States of America,” he said at the March for Life, an anti-abortion rally held each year in Washington, D.C.
Trump advisor Elon Musk, who infamously has at least 14 children by multiple women, has claimed that the declining birth rate is “the biggest danger civilization faces by far.”
But while the GOP won’t stop whining about the declining birth rate and how much they love babies, they sure are working hard to make it more difficult for people to start families.
Medicaid provides health insurance for 71 million low-income people across the country, in rural areas and cities alike. It covers 40% of all births, and more than half of births in rural areas. But the GOP’s proposal would effectively put its help out of reach for many Americans: The new bill slashes Medicaid by about $700 billion, and includes new, far stricter, work requirements that will kick millions of people off the program.
“A lot of the administration’s messaging around promoting childbearing is completely contradictory to what these Medicaid cuts are going to do,” said Amani Echols, the senior manager of maternal and infant health at the National Partnership for Women and Families.
It is true the fertility rate in the U.S. has been declining for decades. In 1970, the general fertility rate was 87.9 births per 1,000 females, compared to 54.6 per 1,000 females in 2024. According to the Centers for Disease Control, there were 3.6 million babies born in the U.S. last year. It’s a slight increase from 2023, but overall it’s a continuation of the trend of dropping fertility rates.
Wealthier nations, including the U.S., have generally been able to offset low fertility rates with an increase in immigration. According to a 2024 University of Pennsylvania study, America won’t face a drastic decline in population because of net positive immigration — another area where the Trump administration’s policies will do untold harm.
There are a lot of likely factors behind the drop in birth rates, from people waiting to have children at later ages (including a decrease in teen pregnancy), to better access to contraception, to changes in social norms and family structures. But one of the big ones is the sheer cost, both in money and the logistical difficulty of childrearing in a nation that has few policies to help parents with the financial or structural task of taking care of children. A 2024 NerdWallet survey found that 38% of people between the ages of 27 and 42 said they didn’t have kids or plan to have them because it’s too expensive.
According to the Congressional Budget Office’s analysis on May 11, if this budget passes the Senate and is signed into law, more than 13 million people will lose their health care over the next decade. That means increased health care costs for uninsured people and a heightened risk of incurring medical debt.
“The cost itself will deter people from even having children,” Echols said. “Out-of-pocket costs for pregnancy costs, on average, $18,000. That’s not a cost that families who just lost their [Medicaid] eligibility can afford.”
Then there is the medical side. For people who are already pregnant, the risk of pregnancy or birth complications goes up when you don’t have health insurance. If you’re not regularly seeing a care provider it can be harder to manage chronic illnesses that increase the likelihood of pregnancy complications, like high blood pressure or diabetes.
The ripple effects of the cuts could also impact people with private insurance. Medicaid covered 19% of all hospital spending in 2023, but some of the provisions in the bill change the way hospitals are reimbursed, and opens the door for hospitals and providers to be paid less money for the same care. The problem is likely to be worse for many rural hospitals that are operating on negative margins.
“Increased costs for hospitals could lead to hospitals closing their doors and that affects everyone in the community,” Akeiisa Coleman, a program officer at the Commonwealth Fund, a private foundation that promotes quality health care, told HuffPost.
“We’ve already seen a trend of hospitals closing their Labor and Delivery units first. That’s usually the first warning sign that the hospital is about to close,” she continued. In rural areas, it’s hard to justify the cost of operating maternal units when there are fewer people actually using them. For pregnant people in areas with no obstetric providers, that often means traveling farther for prenatal care and to give birth, risking delayed care in the case of an emergency.
“These Medicaid cuts are disproportionately harmful to people having children in rural areas,” which often lean in support of Trump, Coombs said. “The Trump administration is not prioritizing his own constituents.”
But while they’re slashing the actual programs that can help children and families, the Trump administration has floated some nonsensical proposals to help boost the fertility rate.
Shortly after getting confirmed, Transportation Secretary Sean Duffy circulated a memo around the Department of Transportation telling staffers that when they’re dealing with programs and grants they should “give preference to communities with marriage and birth rates higher than the national average.”
The Trump administration has reportedly been mulling some ideas to help promote having children. The White House has suggested providing $5,000 to women who give birth, which should cover something like two to three months of childcare, depending on where you live. But if that wasn’t enough, the Trump administration is also considering bestowing a National Medal of Honor on women who have six or more children — an idea borrowed from Nazi Germany.
You might need postpartum care and health insurance for your infant, but the Trump administration seems to think $23 a month over the course of 18 years and a medal will suffice.
Of course, there are also significant hints that the cuts are not quite as counterintuitive as they would appear. The administration has made no secret that they believe some babies are more valued than others. Trump himself has derided the children of immigrants as “anchor babies” and suggested that they are a drain on government benefits.
In fact, as Republicans debated the Medicaid cuts, one of the central themes that emerged were public reminders that cuts to public services would hit not only marginalized groups, but would impact Trump supporters as well.
“Medicaid, you’ve got to be careful with because a lot of MAGA is on Medicaid,” Steve Bannon, an adviser to Trump during his first term, said in February.
Others, anonymously, put it more bluntly. “Medicaid is not just for Black people in the ghetto, these are our voters,” an anonymous Republican operative reportedly said to investigative journalist Tara Palmeri in March.
The disconnect between cutting programs that help families and then promoting having a gaggle of kids is because their concern over fertility isn’t just about economic decline, but rather who they want to have children.
“Cutting Medicaid is a direct reflection of who they want to prioritize and who they want having babies,” Echols said. “They’re making it super clear what families they value in this country.”
