The bill, ushered through Congress by Republican leadership and signed by Trump Friday, includes $4.5 trillion in tax cuts, slashes spending on Medicaid, and creates temporary tax deductions for overtime and tipped income. It includes $170 billion for immigrant detention and for new personnel for Immigration and Customs Enforcement.

President Trump's tax and spending bill sets in motion nearly $1 trillion in cuts to Medicaid and other health policy changes that could loom over the midterm elections. But the real effects likely won't be felt until well after the ballots are cast.

State officials estimate 310,000 Pennsylvanians will lose Medicaid coverage and anticipate strain at health facilities caused by federal budget cuts.