Republicans on the House Energy and Commerce Committee advanced legislation Wednesday afternoon containing cuts to Medicaid and health care provisions some of the most controversial and contentious provisions that will be included in the “big, beautiful bill” of President Trump’s ambitious legislative agenda.

The panel voted along party lines 30-24 after a marathon meeting that lasted more than 26 hours with just two breaks for House votes. The bill now heads to the House Budget Committee, which will meet Friday morning to combine it with legislation from other committees advancing Trump’s priorities namely the extension of tax cuts and new tax breaks for tips and overtime pay

The Energy and Commerce Committee was tasked with finding $880 billion in savings over a decade, and much of that came from cuts to Medicaid spending.

The GOP plan calls for states to impose work requirements on childless adults ages 19 to 64, with certain exemptions. It puts a stop to a longstanding practice of states levying taxes on health providers to pay for their Medicaid programs and to boost their federal match. It would penalize states that pay for Medicaid for those who entered the country without authorization. It also codifies changes proposed by the Trump administration to shorten the Affordable Care Act’s open enrollment period, among many other provisions.

The provisions would result in 10.3 million people losing Medicaid coverage by 2034 and 7.6 million people going uninsured, according to a partial analysis by the Congressional Budget Office (CBO).

Democrats repeatedly cited some other CBO estimates that projected millions more losing health coverage, which Republicans said was misleading.

“It’s clear that all this bill does is take away health care for millions of Americans in order to pay for giant tax breaks for billionaires and big corporations. And that’s not what the American people want,” ranking member Frank Pallone Jr. (D-N.J.) said.

Republicans argued the decline in insurance would be mostly among those who entered the U.S. without permission and “able-bodied” adults who should be working. They accused Democrats of misrepresenting the impact to score political points.

“Our priority remains the same: strengthen and sustain Medicaid for those whom the program was intended to serve: expectant mothers, children, people with disabilities, and the elderly,” Chair Brett Guthrie (R-Ky.) said in his opening statement, adding that the reforms will “return taxpayer dollars to middle-class families.”

The hearing became contentious at times. Members occasionally sniped at each other.

“If I could roll two eyes, I would,” Rep. Dan Crenshaw (R-Texas), a veteran who wears an eyepatch, said in the markup of Democrats’ arguments. 

Crenshaw accused Democrats of spreading lies, leading to a back-and-forth about whether that was permissible of him to say. “My message to all of you who were tricked into being here, guess what, your Medicaid benefits aren’t at risk under this bill, full stop. They’re using you, and they’re lying to you,” Crenshaw said. 

During the first hour alone, Republicans’ opening statements were interrupted by protesters angry about the plan to cut Medicaid. U.S. Capitol Police arrested 26 demonstrators, many in wheelchairs, who held up the proceeding shortly after it began. The group Popular Democracy in Action took credit for that protest.

The length of the markup was in itself a protest from the committee’s Democrats, who forced Republicans into many votes on ill-fated amendments. House Minority Leader Hakeem Jeffries (D-N.Y.) made a late night appearance at the hearing at one point to also show opposition to Medicaid cuts. 

That all-night, marathon markup was a physical feat for some members. Rep. Debbie Dingell (D-Mich.) appeared to doze off during the hearing. 

Rep. Richard Hudson (R-N.C.) said he was surviving on energy drinks, fruit and nicotine pouches.

“I’ve had four Celsius,” Hudson said. “I’m on my third can of Zyn.”

The health care portion was the final section of the Energy and Commerce bill that lawmakers debated during the marathon session, which began mid-afternoon Tuesday and also covered energy, environment and communications.

It also repeals numerous programs passed by the Democrats in their 2022 bill that sought to combat climate change and pollution. This includes a $20 billion “green bank” program that provides financing institutions with money to fund climate-friendly projects and a $3 billion block grant program that seeks to reduce pollution in disadvantaged communities.

But it is Medicaid that has been the biggest flashpoint throughout the GOP debate over how to enact Trump’s agenda, with moderates and members in vulnerable seats wary of the political consequences of supporting significant cuts to the popular program.

Those more moderate and vulnerable lawmakers saw some wins with the bill’s drafters opting to not lower the federal matching rate for Medicaid, known as the federal medical assistance percentage (FMAP). They also omitted a per-capita cap on Medicaid spending.

Fiscal hawks, meanwhile, have been agitating for those steep cuts. Some, including Freedom Caucus Chair Andy Harris (R-Md.) and Rep. Chip Roy (R-Texas) said the plan does not do nearly enough to bring down Medicaid spending.

“The proposal to stop waste, fraud, and abuse in Medicaid will do little to achieve that,” Harris wrote Tuesday evening in a post on social platform X. 

Some of those members said Wednesday they are looking for changes to the Medicaid provisions before supporting it ahead of a projected floor vote next week. One of their main complaints was that the new work requirements would not take effect until 2029 with members saying they could not expect that to actually happen if the start date is so far in the future.

“In my opinion they don’t go far enough,” said Rep. Eric Burlison (R-Mo.), a member of the House Freedom Caucus who does not support the package.

Rep. Ralph Norman (R-S.C.), another deficit hawk in the Freedom Caucus, said he wants “substantial” changes.

“I’m not flexing this as a, because I’m trying to get something for South Carolina,” he told reporters after the meeting. “I’m trying to get the math in order to get this country back on track financially, and it just hasn’t happened.”

On the other end of the spectrum and Capitol some more populist-minded Republicans are warning against substantial Medicaid reforms. Writing Monday in The New York Times, Sen. Josh Hawley (R-Mo.) said steep cuts are “both morally wrong and politically suicidal.”

Those calls for more adjustments and tweaks to the legislation before a vote on the House floor will create a challenge for Speaker Mike Johnson (R-La.) who will have to bridge the gap with a slim majority in order to pass the bill by his own Memorial Day deadline and send it to the Senate.

Rachel Frazin contributed.