As those opposing President Donald Trump's sweeping tax reform legislation fight its passage, Republicans in the state Wednesday defended the president's policy bill and said they're prepared to ensure it gets to his desk before Friday's deadline.

A procedural House vote continued Wednesday night to pass Trump's tax and spending cuts package that avoids a 22% tax increase by making key provisions of Trump's 2017 Tax Cuts and Jobs Act permanent, eliminates taxes on tips and overtime pay and expands the State And Local Tax, or SALT, deduction cap to $40,000.

It also expands the child tax credit to $2,200 per child – policies Republicans say will benefit Americans.

"It is the largest tax cut for middle and working class Americans in history, with no tax on tips, overtime, senior’s social security and other measures which together means a 15% average tax cut for Americans earning $15,000 - $80,000 and boosting take home pay for hard working families by over $10,000 a year on average," N.Y. GOP spokesman Jason Weingartner said. 

Republican leaders said just under two-thirds of Americans would see a tax increase if pieces of Trump's 2017 tax law expired.

"If we didn't pass this, Americans would be facing a 22% tax increase, and at this time, I just think that would not be affordable for anybody — rich or poor," said state Assembly Minority Leader Will Barclay, R-Pulaski. "I think that's a very positive thing."

The bill also provides about $350 billion for defense and Trump's immigration crackdown, including more resources to detain immigrants — partially paid for through less spending on Medicaid and food assistance like the Supplemental Nutrition Assistance Program, or SNAP.

“It’s really a betrayal of people of this country,” U.S. Rep. John Mannion, D-22, told reporters Wednesday. 

Democrats like Mannion made a last-ditch effort this week to prevent House leaders from having the votes to pass the bill. The party has fought the legislation, which includes new 80-hour-per-month work requirements for many adults getting Medicaid or food stamps and forces states to pick up more of the cost.

"The legislation is geared toward encouraging states to correct bureaucratic inefficiencies," said Ciro Riccardi, a spokesman for Long Island Congressman Mike Lawler, who is considering a run for governor. "The Senate's bill extended the deadline for states to get their error rates under 6% and avoid incurring a percentage of the cost share. New York has one of the highest error rates in the country while overpayments nationwide are wasting $10 billion a year."

Mannion on Wednesday railed against the legislation's proposed cuts to Medicaid and funding for rural hospitals.

"We want to make sure that more people have access to health care, not fewer, and the costs are lower," he said. "This bill does the exact opposite." 

N.Y. GOP leaders maintain the legislation strengthens Medicaid by reducing waste and fraud and that the money goes to people who need it. 

"It ensures the integrity of the program for the long haul by stopping new money laundering gimmicks like provider taxes and State Directed Payments," Weingartner said.

Health officials argue the proposed changes to Medicaid, which restrict taxes on health providers, could also impact facilities like nursing homes that largely rely on those reimbursements.

The state currently underfunds the care of nursing home residents by $56 per patient per day, New York Health Facilities Association President & CEO Stephen Hanse said. 

Hanse is one of many providers who have met with House Republicans over the last several months about the impacts of Medicaid cuts and enough time to implement the changes.

"Give us this transition period that will give the Legislature and the government providers and everyone working together to find a new methodology to fund Medicaid for nursing homes, which already is desperately underfunded," Hanse told Spectrum News 1.

But providers are set to get what they want. The Senate bill would gradually lower the maximum allowable provider tax rate in states that expanded Medicaid like New York, but would be phased in in 2031. 

House Republican Leadership Chair Elise Stefanik, who represents the state's 21st Congressional District and is considering a run for governor next year, said an estimated $20 billion is spent on fraudulent Medicaid claims annually in the state alone, and taxpayers are shouldering the costs of emergency Medicaid for immigrants without legal status. The cost of emergency Medicaid in the state has ballooned to over 1,200% since 2014, she said.  

“Republicans want to strengthen and secure Medicaid for eligible citizens as it is an indispensable lifeline for our nation’s most vulnerable," Stefanik said in a statement. "However, far-left Democrats continue to fearmonger because they know that President Trump is delivering results for the American people. He ran on the promise that he would root out the wasteful and fraudulent government spending...This spending is unsustainable and in order to continue protecting and preserving benefits for America’s most vulnerable, waste, fraud and abuse must be rooted out.”

Assembly Leader Barclay said he's concerned about proposed cuts to funding for rural hospitals that heavily rely on people who receive Medicaid, which he argues isn't a lucrative model. The U.S. Senate version of the bill, which passed Tuesday, included a rural health relief fund to give Centers for Medicare & Medicaid Services $10 billion over five years to support rural health care providers.

"So even there's some recognition that even these common-sense cuts may have some consequences on institutions...just because they rely on Medicaid funding," Barclay said.

Lawler also backs the Medicaid reforms, which he agrees will slow the growth of state Medicaid programs that have grown fiscally unsustainable. 

"...Democrats' irresponsible policies have turned [Medicaid] into a de facto Medicare for All with inflated payment rates," Riccardi said. "These reforms, many of which phase in over the next few years, are aimed at slowing the growth of state Medicaid programs while ensuring it remains fiscally solvent for eligible recipients — especially the I/DD community, single mothers and the elderly."

The Congressional Budget Office projects the bill will add about $3.3 trillion to the federal debt over the coming decade.