President Donald Trump’s “One Big Beautiful Bill” (OBBBA), just signed by the Senate, has caused broad alarm at its deep impacts on the US healthcare system. The bill, which proposes cutting federal expenditure by more than $1.1 trillion in healthcare over a ten-year period, promises to take away health coverage for millions of Americans, especially the most vulnerable, and pose a risk to the existence of rural hospitals and critical health services.
Gigantic cuts to Medicaid and loss of coverage
The single largest portion of spending cuts in the bill are from Medicaid, the federal-state program covering low-income individuals, children, the disabled, and the elderly. According to the Congressional Budget Office (CBO) analysis, the bill would cut Medicaid spending by close to $800 billion over 10 years and result in a projected 11.8 million individuals losing their health coverage by 2034.
Along with other provisions affecting the Affordable Care Act (ACA) marketplaces and Medicare, the amount of Americans lacking health insurance may grow to 17 million. The bill introduces stricter eligibility standards, including new work requirements for healthy, working-age adults aged 19 through 64 who are enrolled in Medicaid expansion programs and need to work at least 80 hours a month at their job, as a volunteer, in school, or in job training.
These reductions will disproportionately harm low-income earners, seniors, and people with disabilities who depend on Medicaid to secure life-sustaining healthcare services. With almost 70 million Americans covered under Medicare and more than 7 million senior and 10 million disabled American citizens covered under Medicaid, the cuts in the bill promise to unravel five decades of progress toward making healthcare more accessible.
Rural hospitals and healthcare infrastructure at risk
The Medicaid reductions in the bill go beyond coverage of the individual to threaten the bottom line of rural health centers and hospitals. Much of rural hospital operations rely on Medicaid reimbursements to remain operational. The slowdown in federal spending can close down such hospitals or cut back services, further restricting access to care in already disadvantaged populations.
This possible deterioration of rural health infrastructure provokes concern regarding further health inequities and decreasing performance for rural populations, who tend to struggle with access to timely and quality medical care.
Human cost: Lives at stake
Other than insurance coverage, the University of Pennsylvania, Harvard, and Yale researchers warn that the bill’s cut in Medicaid could lead to over 51,000 more deaths each year. The most affected would be the worst off—poor, elderly, and sickly people.
North Carolina Senator Thom Tillis was also pained, wondering how he was going to justify half a million of his own constituents losing their Medicaid benefits because Obamacare is funded. This heartless human cost transcends the party divisions the bill has made.
Impact on the Affordable Care Act and Medicare
The bill also addresses the Affordable Care Act by repealing premium tax credits and restricting enrollment policies. Around 3.1 million individuals will lose health insurance coverage as a result of ACA marketplace changes, and another 4.2 million will lose coverage with the expiring of premium tax credits.
Medicare that insures close to 70 million Americans also precariously dangles on long-term changes that can impact benefits as well as eligibility though details are less clear. The net effect of Medicaid, ACA, and Medicare can have the power to destabilize the safety net for millions of Americans who rely on these programs.
Economic and political context
The bill, which was approved by one vote in the Senate when Vice President JD Vance made a tie-breaking vote, is part of a series of Republican bills that aims to increase tax cuts, fund border security, and cut federal spending. The healthcare reductions in the bill will further fuel inequality and add more individuals who do not have health insurance when access to medical treatment is a dire concern, critics assert.
The Kaiser Family Foundation (KFF) estimated that the bill would leave millions of people uninsured and burden the healthcare system, particularly in those states that had expanded Medicaid under the ACA. The bill has not yet passed the House, where some Republicans have complained about the contents of the bill.
