If you or someone you know relies on Medicaid for health insurance, you’ll want to pay close attention. President Donald Trump’s newly passed bill—nicknamed the “Big Beautiful Bill”—is shaking things up in a big way. While the law extends 2017’s tax cuts and eliminates taxes on tips and overtime, it also includes deep cuts to Medicaid, the safety-net health program that currently supports over 78 million Americans.
This bill passed the Senate on July 1 and cleared the House just two days later. And now, millions could lose health coverage over the next decade. According to the Congressional Budget Office (CBO), nearly 11.8 million people could be pushed out of Medicaid or Affordable Care Act (ACA) plans. Add another 5 million if you include those who lose access because the bill doesn’t renew pandemic-era health subsidies.
Why the cuts? And who’s at risk?
Republicans argue that the Medicaid changes will protect taxpayers and encourage able-bodied adults to work in exchange for benefits. Speaker Mike Johnson said the new work requirements will help people “restore dignity and purpose” in their lives.
But critics, like Georgetown University health policy expert Joan Alker, warn that this is a giant step backwards from the progress made under President Obama’s ACA. She says it will shrink coverage and put many low-income families at risk of losing essential care.
Work requirements are coming
If you’re on Medicaid and between jobs, you could soon be asked to work at least 80 hours per month to stay covered—or prove that you qualify for an exemption, like being a student, caregiver, or disabled. These checks would apply to parents with children older than 13, too.
Under the new law, all Medicaid expansion states—which include 40 states plus D.C.—must do eligibility checks twice a year starting by 2027. But if you live in a non-expansion state like Florida or Texas, the impact may be less direct for now—though that could change if your state adopts similar rules.
States could move fast—or slow
There’s some flexibility. States can request waivers to delay implementation, and the Secretary of Health and Human Services (currently Robert F. Kennedy) has the authority to grant extensions. Still, some states may act fast, especially since the bill also reduces how states fund their share of Medicaid starting in 2028.
Medical debt on the rise?
Losing insurance could mean racking up medical bills. And that’s a problem, because medical debt already makes up more than half of the debt sent to collections, according to the Consumer Financial Protection Bureau. The CFPB had planned to wipe medical debt from credit reports altogether—but with its funding cut in this bill, that effort may be over.
Bottom Line
Where you live now plays a major role in whether you keep your Medicaid coverage. And unless you qualify for an exemption, you may soon need to prove you’re working to keep your health benefits. For millions, this could mean making some tough choices—or facing life without insurance.
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