Today Medicaid provides health coverage for 71m Americans, 20m more than 15 years ago. The Affordable Care Act fuelled the growth, allowing states to cover more people. But it has also supercharged the price of the programme: in 2023 it cost $880bn,

The Congressional Budget Office estimates the cuts will lead to 8.6 million people losing coverage over the next decade.

House Republicans are struggling to find room for the president's biggest tax cut promises — including on tips and overtime — into their megabill.