Republicans in the US Congress approved President Trump's tax reform by a narrow 218 to 214 vote in the House of Representatives after passing the Senate.[1] The reform includes cuts to the Medicaid health insurance and food assistance programs, while clients will have to prove eligibility for benefits more often.[1] The Independent Congressional Budget Office estimates that the bill will increase the national debt by $3.4 trillion from the current $36.2 trillion over ten years.[1] More money will be allocated to border protection, combating illegal migration and defense.[1] The reform could result in the loss of health insurance for about 14 million Americans within a year if it were to repeal parts of the Obamacare Affordable Care Act.[2] U.S. health care costs account for about 20 percent of GDP and are the highest in the world, fueling the reform debate.[6] Republicans showed unity despite concerns about the impact on debt and health care.[1]