As negotiations over the massive spending cuts in President Donald Trump’s “Big, Beautiful Bill” continue, congressional Republicans are divided over whether to save federal funding for the President’s Emergency Plan for AIDS Relief (PEPFAR).

Senate leaders on Wednesday passed an amendment to protect the landmark global health initiative, which is credited with saving tens of millions of lives over more than two decades, but other critical HIV programs would be axed under the Senate and House versions of the bill.

Speaking with reporters at the White House Thursday, Office of Management and Budget Director Russell Vought signaled Trump’s support for the amendment and the administration’s confidence that his signature legislative package will cross the finish line.

Republican majorities in both chambers of Congress narrowly passed their respective bills, and GOP leaders are now working in close coordination with the president to reconcile them and finalize additional changes through amendments to underlying rescissions packages.

PEPFAR may be a major stumbling block, however. Conservatives in the Senate tend to support international aid generally and global HIV initiatives specifically, while the House GOP caucus includes a group of hardline budget hawks who pushed hard for more cuts to offset the cost of the bill, which is nevertheless projected to add more than $3 trillion to the deficit.

The so-called “Big Beautiful Bill” extends and builds upon tax cuts passed in 2017 that disproportionately benefit the wealthy, beefing up budgets for immigration enforcement and defense while cutting federal spending nearly everywhere else, especially on Medicaid.

As many as 10 million people are expected to lose their health care coverage, a disproportionate number of them LGBTQ.

Notwithstanding his position on the Senate Republicans’ amendment to save PEPFAR, Trump at the start of his second term froze funding for nearly all foreign aid programs, including HIV prevention and treatment initiatives overseas, leading to shortages of medicine and care.

The “Big, Beautiful Bill” heads to President Donald Trump’s desk following the vote by the Republican majority in the U.S. House of Representatives Thursday, which saw two nays from GOP members and unified opposition from the entire Democratic caucus.

To partially offset the cost of tax breaks that disproportionately favor the wealthy, the bill contains massive cuts to Medicaid and social safety net programs like food assistance for the poor while adding a projected $3.3 billion to the deficit.

Policy wise, the signature legislation of Trump’s second term rolls back clean energy tax credits passed under the Biden-Harris administration while beefing up funding for defense and border security.

Roughly 13 percent of LGBTQ adults in the U.S., about 1.8 million people, rely on Medicaid as their primary health insurer, compared to seven percent of non-LGBTQ adults, according to the UCLA School of Law’s Williams Institute think tank on sexual orientation and gender identities.

In total, the Congressional Budget Office estimates the cuts will cause more than 10 million Americans to lose their coverage under Medicaid and anywhere from three to five million to lose their care under Affordable Care Act marketplace plans.

A number of Republicans in the House and Senate opposed the bill reasoning that they might face political consequences for taking away access to healthcare for, particularly, low-income Americans who rely on Medicaid. Poorer voters flocked to Trump in last year’s presidential election, exit polls show.

A provision that would have blocked the use of federal funds to reimburse medical care for transgender youth was blocked by the Senate Parliamentarian and ultimately struck from the legislation — reportedly after the first trans member of Congress, U.S. Rep. Sarah McBride (D-Del.) and the first lesbian U.S. senator, Tammy Baldwin (D-Wis.), shored up unified opposition to the proposal among Congressional Democrats.

Gay Democratic Congressman Ritchie Torres of New York is unlikely to challenge New York Gov. Kathy Hochul (D) in the state’s next gubernatorial race, he said during an appearance Wednesday on MSNBC’s “Morning Joe.”

“I’m unlikely to run for governor,” he said. ““I feel like the assault that we’ve seen on the social safety net in the Bronx is so unprecedented. It’s so overwhelming that I’m going to keep my focus on Washington, D.C.”

Torres and Hochul were nearly tied in a poll this spring of likely Democratic voters in New York City, fueling speculation that the congressman might run. A Siena College poll, however, found Hochul leading with a wider margin.

Back in D.C., the congressman and his colleagues are unified in their opposition to President Donald Trump’s signature legislation, the “Big Beautiful Bill,” which heads back to the House after passing the Senate by one vote this week.

To pay for tax cuts that disproportionately advantage the ultra-wealthy and large corporations, the president and Congressional Republicans have proposed massive cuts to Medicaid and other social programs.

A provision in the Senate version of the bill that would have blocked the use of federal funds to reimburse medical care for transgender youth was blocked by the Senate Parliamentarian and ultimately struck from the legislation, reportedly after pressure from transgender U.S. Rep. Sarah McBride (D-Del.) and lesbian U.S. Sen. Tammy Baldwin (D-Wis.).

Torres on “Morning Joe” said, “The so-called Big Beautiful Bill represents a betrayal of the working people of America and nowhere more so than in the Bronx,” adding, “It’s going to destabilize every health care provider, every hospital.”