House Republicans are pushing to slash at least $1 trillion from two of the nation’s bedrock safety net programs, Medicaid and food stamps, as part of their sweeping package aimed at enacting President Donald Trump’s agenda.

Speaker Mike Johnson negotiated a number of last-minute changes to the megabill to ensure passage, including moving up the start date for Medicaid work requirements. The House passed the bill 215-214 on Thursday morning.

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