Senate Republicans are defending their changes to federal Medicaid spending in their final push to pass President Donald Trump’s budget reconciliation bill before Independence Day, arguing that the bill does not technically cut the health insurance program for disabled and low-income people.

Republican leadership has insisted for weeks that the One Big Beautiful Bill Act is not primarily a healthcare reform package, but reductions in Medicaid spending have been a crucial piece to recoup some of the costs from the sweeping tax cuts that take center stage in the legislation.

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As of March, nearly 71.3 million adults were enrolled in the federal-state joint program of Medicaid, and more than 7 million children were enrolled in the Children’s Health Insurance Program. For fiscal 2023, the Medicaid program cost around $890 billion, with federal dollars covering 69% of the bill.

Democrats have waged a multimonth campaign against what Senate Minority Leader Chuck Schumer (D-NY) has called the “big ugly betrayal” by saying that the bill will decimate coverage for low-income people.

In defense of the bill’s Medicaid changes during an amendment voting session on Monday, Sen. Roger Marshall (R-KS) argued on the Senate floor that the GOP Medicaid reforms are designed with the intention of “preserving” and “strengthening” program integrity for pregnant women, children, and disabled people.

“We are fiscally making Medicaid more sound,” Marshall said. “It’s only in Washington, D.C., that you increase spending at a rate faster than inflation and you call it a cut.”

Sen. Ted Budd (R-NC) posted on X on Sunday evening that Medicaid spending has increased by more than 200% since 2008 and by roughly 51% since 2019, largely due to increases in enrollment from the Medicaid expansion population of able-bodied adults without dependents.

The Congressional Budget Office’s projected federal spending on Medicaid and Obamacare increased by $1.9 trillion, increasing 25% from 2021 to 2025, according to conservative think tank the Paragon Health Institute.

Robing Rudowitz, vice president at the healthcare think tank KFF and Medicaid policy specialist, told the Washington Examiner that the CBO’s analysis of the most up-to-date version of the bill “will reduce federal Medicaid spending over the next ten years by about $1 trillion relative to expected federal spending without the legislation.”

Much of the spending cuts come from imposing work requirements on able-bodied adults without dependents and changing federal reimbursement rates for the Medicaid expansion population.

Medicaid eligibility was extended to able-bodied adults without dependents under the Patient Protection and Affordable Care Act of 2010, better known as Obamacare.

Federal reimbursement for able-bodied adults is also higher than for traditional Medicaid enrollees. Brian Blase, head of the Paragon Health Institute, testified before Congress last week that states receive $9 of federal reimbursement for Medicaid expansion enrollees compared to $1.33 in reimbursement for traditional enrollees.

“Nobody is voting to take away Medicaid benefits from patients for whom Medicaid was designed to serve,” Budd said Sunday. “Senate Republicans are trying to slow the rate of exponential cost increases for a program we all agree must survive for future generations.”

But Democrats on Monday continued to focus their attempts to block the bill using the Medicaid provisions of the text.

“It’s caviar over kids, hedge funds over healthcare, Mar-a-Lago over the middle class,” said Sen. Ron Wyden (D-OR), the ranking member on the Senate Finance Committee, which oversees the Medicaid program.

“These Medicaid cuts are going to reach down to every corner of America’s healthcare system,” Wyden said.

Democrats also highlighted that the bill would particularly affect seniors who are enrolled in both Medicare and Medicaid, particularly those in nursing homes.

“The bill we are voting on today takes away key revenue for states and nursing homes,” Sen. Jack Reed (D-RI) highlighted during voting.

Reed cited a study from Brown University School of Public Health that found roughly 500 nursing homes across the country would be at risk of closure with reductions in federal Medicaid reimbursement.

About two of every three seniors use Medicaid benefits to pay for their nursing home care.

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Protesters were photographed by the Associated Press on Capitol Hill on Monday carrying cardboard coffins in protest of the reductions in Medicaid funding.

At least 33 people were arrested in the Russell Senate Office Building by Capitol Police last week, protesting the Medicaid and food stamp cuts in the bill. Protesters at last week’s event held signs saying “Kill the Bill before it Kills Us.”