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The Big Beautiful Betrayal
By now you have likely heard that President Trump’s “One Bill Beautiful Bill” narrowly passed both the House and Senate and was signed by the President on his orchestrated July 4th deadline. Advocates pushed back hard against this bill, calling it the “Big Beautiful Betrayal” because of its steep cuts to healthcare and food assistance programs.
The bill includes a work requirement (at least 80 hours a month) for most individuals aged 19-64 enrolled in Medicaid. While there are exceptions for guardians of children under 13, guardians of children with disabilities, and people with disabilities, there is no recognition of other types of family caregivers who are not currently working because they are providing care. Work requirements go into effect January 1, 2027, so it isn’t immediate. States will need to put in place infrastructure and determine what this reporting will look like. Additionally, starting December 31, 2026, states must redetermine Medicaid eligibility more frequently – every 6 months, rather than once a year – for individuals enrolled in Medicaid Expansion (with an exemption for people who receive SSI benefits).
The bill also marks the expiration at the end of the 2025 calendar year of the enhanced ACA (Affordable Care Act) Tax Credits, which will lead to increases in monthly premiums for individuals and families on ACA health plans. It includes changes and restrictions on who is eligible for ACA plans and how they may enroll. Between the changes to Medicaid, and to the ACA , the Congressional Budget Office estimates 16 million people will lose their health insurance by 2034.
Notably, the bill reduces the amount of federal funding given to states for Medicaid. This budget loss is a huge blow to state Medicaid budgets, with an expected reduction in services. Home and Community Based Services are considered “optional” under Medicaid, which may mean that states choose, or are forced to choose, cuts to these services first, ironically pushing more individuals into costly institutional care settings. The other major concern, sounded by the American Hospital Association and other healthcare groups, is that that hospitals and clinics will be impacted financially, and may be forced to close, especially in rural communities. This second point garnered concern with some Republican representatives from rural areas, but not enough to change their vote, especially after they were appeased with a limited $50 billion rural health fund promised to offset this.
We will continue to share news about this bill’s impact as more unfolds.
Families USA Summary of Provisions Related to Medicare, Medicaid & Affordable Care Act
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