The sprawling Republican tax-and-spending package moving through Congress this week promises a windfall for America’s richest families even as it slashes the very programs that millions of low-income people rely on to stay afloat. According to a new examination by the Institute on Taxation and Economic Policy (ITEP), provisions in the bill would hand a combined $1.02 trillion in tax reductions to the nation’s top one percent over the next decade—almost exactly the amount lawmakers intend to cut from Medicaid during the same period.
ITEP’s analysts reached that headline figure by combing through distribution tables from the Joint Committee on Taxation (JCT) and line-by-line revenue estimates for each provision in the nearly 1,000-page measure. The nonpartisan JCT tables show federal taxes paid by the top one percent falling by $132 billion in 2027, $105 billion in 2029, and $93 billion in both 2031 and 2033. Because those tables cover only four of the remaining nine and a quarter years in the standard ten-year budget window, ITEP used additional JCT revenue scores and Congressional Budget Office (CBO) projections of high-income earnings growth to fill the gaps. It also distributed several business-focused giveaways—such as the repeal of a scheduled estate-tax increase and the termination of clean-vehicle credits—that the JCT does not assign to specific income groups.
“A tiny sliver of affluent families—the top 1 percent by income—will receive tax cuts totaling $1.02 trillion over the next decade,” ITEP’s Carl Davis concluded, underscoring that the final sum may in fact prove larger because last-minute Senate changes only expanded the bill’s overall tax relief. Davis added that many of the same households benefited handsomely from the 2017 Tax Cuts and Jobs Act; the new measure would make most of those individual tax cuts permanent while layering on fresh breaks for high-net-worth estates and pass-through business owners.
Numbers for 2026 illustrate the stark tilt of the package. “Sixty-nine percent of the net tax cuts would go to the richest fifth of Americans in 2026, only 11 percent would go to the middle fifth of Americans, and less than 1 percent would go to the poorest fifth,” the study found. That year alone, ITEP projects, “the $107 billion in net tax cuts going to the richest 1% next year would exceed the amount going to the entire bottom 60 percent of taxpayers.”
While the benefits to the wealthiest are clear, so are the costs to public services. Draft spending tables show $930 billion in Medicaid reductions over ten years—achieved through tighter eligibility rules, work requirements, and lower federal matching rates for states that use provider taxes to fund coverage. The CBO estimates that the policy shift would push more than ten million people off the program by 2034, a figure likely to fall heavily on rural residents and people with disabilities who already face access challenges.
The bill’s architects insist that the combination of tax relief and spending restraint will bolster growth. Yet the same CBO analysis projects an increase of roughly $3.3 trillion in federal deficits over the decade, once interest costs are included. Private forecasters at Moody’s have warned that the added red ink could prompt a debt-outlook downgrade, potentially raising borrowing costs for households and state governments.
On Capitol Hill, the legislation has triggered an intense round of procedural brinkmanship. Shortly after the Senate sent its version across the rotunda, House Minority Leader Hakeem Jeffries held the floor for more than eight hours—an all-time record for a member of his party—in an effort to delay passage and spotlight what he called the bill’s “moral inversion of priorities.” Republicans brushed off the protest and rescheduled the vote, confident they have the numbers to put the bill on President Donald Trump’s desk before the Independence Day recess.
Public opinion appears largely aligned with Jeffries’ critique. A Fox News–Kaiser Family Foundation survey conducted last week found that 64 percent of respondents opposed shrinking Medicaid to finance new tax reductions, including 51 percent of self-identified Republicans. The same poll showed fewer than four in ten voters believe the bill will benefit “people like me.”
Progressive health and tax-justice groups say those numbers reflect lived experience. They point to the surge in Medicaid enrollment that followed the pandemic and to the patchwork of state programs that stand to lose billions. In Texas alone, advocacy networks estimate that the work-requirement language could eliminate coverage for nearly a million adults who cycle in and out of seasonal employment.
Senate Republicans have signaled that they may tweak the final text through a fast-track “vote-a-rama,” but few observers expect meaningful changes. Most of the last-minute amendments under discussion would add sweeteners for fossil-fuel producers or extend still more of the expiring Trump-era tax provisions for corporations. That dynamic reinforces ITEP’s central finding: even after accounting for small business credits and child-tax-credit changes, the overwhelming share of benefits flows upward.
With a signing ceremony tentatively slated for July 4, attention is already turning to the states, some of which will have to rewrite their Medicaid budgets within months of enactment. Hospital associations warn that abrupt funding gaps could force closures or service cuts, especially in rural counties that have not recovered from earlier rounds of austerity. Meanwhile, Wall Street analysts expect wealthy investors to accelerate estate-planning and capital-gain strategies in anticipation of the new rules.
For Davis and his colleagues, the bottom-line questions transcend budget mechanics. “Sixty-nine percent of the net tax cuts would go to the richest fifth of Americans in 2026, only 11 percent would go to the middle fifth of Americans, and less than 1 percent would go to the poorest fifth,” their report reiterates. In Davis’s words, “A tiny sliver of affluent families—the top 1 percent by income—will receive tax cuts totaling $1.02 trillion over the next decade.”
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