The Republican-controlled U.S. Senate voted on Tuesday to pass a wide-ranging tax-cut and spending bill sought by President Donald Trump, which would cut Medicaid healthcare and food assistance programs for the poor and disabled.

Republicans are attempting to use the budget reconciliation process to boost President Donald Trump’s priorities and reduce health coverage. That process has been used to pass nearly every major piece of health legislation for decades — except usually lawmakers use it to expand health care,

States are spending 15 percent of their home-generated revenue on the program, seeing their largest cost increases in 20 years.