The debate over how many people would lose health insurance under the Republican health care overhaul and its impact on the budget deficit obscures one of the major and most far-reaching effects of the proposal: sweeping changes to Medicaid. As a candidate, President Trump had promised "no cuts" to Medicaid. The Republicans' American Health Care Act, which Trump supports, would end an expansion of the coverage and restructure funding for it. The bill is the first part of a plan to repeal and replace the Affordable Care Act enacted under President Obama. Medicaid provides assistance to some 74 million low-income Americans, through a combination of federal and state funds. Everything from maternity coverage to pediatric care to care for people with disabilities and senior nursing home care is covered. According to the Kaiser Family Foundation , nearly half of all births are paid for through the program, and the vast majority of nursing home stays. Almost two-thirds of all spending is for