Billions in Medicaid cuts passed by Republicans as part of President Trump’s “One Big Beautiful Bill” will have widespread negative implications on people across the United States, multiple experts told Newsweek.
Why It Matters
Trump’s touted tax overhaul and spending cuts package, which passed Thursday on a 218-214 vote in the House after months of haggling in both chambers of Congress, has provoked broader concerns about health care access and funding—notably to vulnerable populations who rely on Medicaid and the social safety net.
The CBO estimates the roughly $1 trillion in Medicaid cuts over the next decade will result in 12 million people losing coverage by 2034. Trump had repeatedly promised not to cut Medicaid benefits, including by the White House’s own admission as recently as March. The cuts are deeply unpopular, according to polls, and present a political challenge for Republicans ahead of next year’s midterm elections.
What Is the Big, Beautiful Bill?
The One Big Beautiful Bill Act is a sweeping reconciliation package that advances Trump’s domestic policy agenda. It includes major tax reforms, spending cuts, and regulatory changes across multiple sectors. The bill passed the House and Senate along party lines and is positioned as a cornerstone of Trump’s second-term legislative goals.
The 1,200‑page package will:
- Permanently extend the 2017 Trump tax cuts, while exempting overtime pay, tips and some Social Security income from taxation.
- Impose 80‑hour‑per‑month work requirements on many adults receiving Medicaid and apply existing SNAP work rules to additional beneficiaries.
- Repeal most clean‑energy tax credits created under President Biden.
- Authorize a $40 billion border security surge and fund a nationwide deportation initiative.
- Raise the federal debt ceiling by $5 trillion, with the Congressional Budget Office estimating that it could add $3.4 trillion to the deficit over the next 10 years.
When Did the Big, Beautiful Bill Pass the Senate?
The bill narrowly passed the Senate on Tuesday after an overnight session.
The 50-50 vote generally along partisan lines was tipped in Republicans’ favor by Vice President JD Vance, who cast the decisive tiebreaker vote.
Has the Big, Beautiful Bill Been Signed?
President Trump signed his package of tax breaks and spending cuts into law Friday during a White House ceremony.
How the Big, Beautiful Bill Will Impact Medicaid Beneficiaries
The bill includes changes to eligibility for Medicaid, including mandating that Medicaid recipients must carry out some kind of work for at least 80 hours a month, which has prompted many health care experts and lawmakers to warn that it will only push millions off the program.
Other concerns include diminished care in rural communities and increased out-of-pocket costs for doctors’ visits.
To accommodate the bill’s signature tax cuts, which mostly benefit the wealthy, the cuts have to come from somewhere, according to Miranda Yaver, assistant professor of health policy and management at the University of Pittsburgh.
Consistent with prior Republican approaches, the cuts are coming from America’s safety net programs, she said.
“One in five Americans relies on Medicaid for their health coverage, and one in seven Americans relies on SNAP for their food security, so cutting these critical programs will be devastating,” Yaver said.
Roughly 92 percent of Medicaid beneficiaries are already working or would be exempt, according to KFF.
But what threatens their coverage is not noncompliance with work hours; rather, the administrative burdens of documenting their work or exemption, according to Yaver.
“For that reason, the requirement can be better characterized not as a work requirement, but rather as a paperwork requirement. … Some have characterized Medicaid paperwork requirements as a solution in search of a problem, because contrary to some characterizations of people playing video games in basements, most people on Medicaid are working or would be exempt,” she said.
“I don’t think it’s a solution in search of a problem so much as it is a solution to a different problem: low-income Americans being provided health insurance.”
Jake Haselswerdt, associate professor at the Truman School of Government & Public Affairs at the University of Missouri, agreed that the paperwork aspect is likely going to be an issue.
“We’re going to have to see, what are the regulations look like? How do states implement this?” Haselswerdt told Newsweek. “But I’m not optimistic, especially coming from a Missouri standpoint.
“We have maybe the worst Medicaid agency in the country. The call center wait times at times have been the worst in the country.”
Chris Howard, professor of government and public policy at William & Mary, told Newsweek that cuts to Medicaid and to the Affordable Care Act [ACA] will have “profound effects” at the state level.
Millions of people across the country will lose health insurance, he said, including an estimated 300,000 in his state of Virginia.
“Basically, Republicans are trying to undermine big parts of the [Affordable Care Act, or Obamacare] without having to replace them,” Howard said. “They learned that ‘repeal and replace’ did not work in Trump’s first term, so now they just want to repeal.”
Large rural populations in some of the hardest hit states, like Virginia and Kentucky which have expanded Medicaid under the ACA, will receive reduced federal funding for individuals who rely on Medicaid.
“States can’t run budget deficits, and they are highly unlikely to replace all the lost funds,” Howard said. “More people will lose coverage. In the health care system, every dollar of benefit to someone is also a dollar of income to someone else.
“Hospitals and nursing homes, especially in rural areas, depend heavily on Medicaid dollars. Many of them will have to lay off workers or close down. If hospitals have to provide more uncompensated care to the uninsured, there will be pressure on private insurance to raise rates.”
Rural hospital closures not only increase driving distances for medical care, Yaver said, but they can also deter businesses from operating in communities with economic downturn.
She called the rural hospital fund in the bill “a drop in the bucket relative to the devastation headed their way.”
Haselswerdt said the ramifications on Americans’ health and well-being will also take a hit. The rural hospital fund, around $25 billion, won’t be enough across all 50 states, he said.
“Nothing’s permanent because policy can change, but we think of them as permanent cuts—this kind of short-term, financial Band-Aid,” Haselswerdt said. “I don’t really think makes that much of a difference. [When] people lose coverage that means these hospitals are delivering more freer charity care that never gets paid for.
“That was something that was demonstrated with the ACA. When coverage expanded under the ACA, it helped hospitals; they had less uncompensated care to deal with. So, if you change policy in such a way that more people are showing up at hospitals without health coverage, it’s not going to be good for those hospitals.”
What the White House Has Said About Impact on Medicaid
A “Myth vs. Fact” sheet released by the White House on June 29 responds to numerous critiques of the One Big Beautiful Bill, including on Medicaid.
The White House called it a “myth” that the legislation “kicks American families off Medicaid.”
“As the President has said numerous times, there will be no cuts to Medicaid,” the statement reads. “The One Big Beautiful Bill protects and strengthens Medicaid for those who rely on it—pregnant women, children, seniors, people with disabilities, and low-income families—while eliminating waste, fraud, and abuse.
“The One Big Beautiful Bill removes illegal aliens, enforces work requirements, and protects Medicaid for the truly vulnerable.”
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