House Republicans passed a federal budget bill by a vote of 215 – 214 in the middle of the night Thursday that includes massive cuts for Medicare and Medicaid in order to extend tax breaks to billionaires.

Medicare could face nearly $500 billion in cuts over the next decade under Republicans’ “One Big Beautiful Bill Act,” which also proposes significant reductions to Medicaid and other healthcare programs.

President Donald Trump and his White House have repeatedly vowed to protect Medicare and block any cuts to the vital health care program that serves 67 million Americans—most of them seniors. But according to top Democrats citing a report from the Congressional Budget Office,

Hospitals, physicians, health insurers, long-term care providers and others warn of serious consequences for the healthcare system.

New rules would restrict access to the low-income health insurance program, punish states covering undocumented children, and shift costs to states.