One Big Detriment to Public Health: How Will Trump’s ‘One Big Beautiful Bill’ Impact American Healthcare?
What is Trump’s “One Big Beautiful Bill”?
After 29 hours of debate, the United States House of Representatives narrowly passed the controversial “One Big Beautiful Bill” (OBBB), voting 218 to 214 in favor of the bill on July 3, 2025 (Moore, Grisales, & Walsh, 2025). Raising the debt ceiling by $5 trillion, OBBB permits the federal spending of $46.1 trillion over the next decade (Winters, 2025)(Congressional Budget Office, 2025). Although the bill expands the government’s borrowing power, President Trump is expected to use this flexibility to expand immigration enforcement while scaling back social initiatives, such as Medicaid and SNAP, largely through administrative restrictions rather than explicit benefit cuts (Moore, Grisales, & Walsh, 2025).
To reduce spending, OBBB complicates and delays sign-up processes for the Affordable Care Act (ACA) and Medicaid, adding layers of complex paperwork and verification requirements that function as de facto barriers to care (Moore, Grisales, & Walsh, 2025). The price of healthcare will remain fixed, but accessibility for eligible individuals will decline sharply, disproportionately harming vulnerable communities. Within reproductive and maternal health, these access barriers map directly onto the six domains of obstetric racism—including unaffordable care, constrained options, and violations of the Black Birthing Bill of Rights (BBBR)—as documented by Odems et al. in their study of Black women’s perinatal experiences (Odems et al., 2024).
How Will ‘One Big Beautiful Bill’ Impact Medicaid?
Perhaps the largest barrier for vulnerable communities is the bill’s new work and education requirements to qualify for Medicaid. In Washington, D.C., and the 40 states that expanded Medicaid under the Affordable Care Act, a subset of Medicaid enrollees must now provide paperwork proving they are working, volunteering, or in school for a minimum of 80 hours per month, with a narrow set of exemptions for caregiving and other special circumstances (Galewitz, Appleby, Rayasam, & Wolfson, 2025). Health researchers hypothesize that such requirements will have minimal impact on employment because most working-age Medicaid beneficiaries are already working, seeking work, disabled, attending school, or constrained by caregiving responsibilities (Galewitz & Armour, 2025).
The primary effect will instead be bureaucratic: increased churn, dropped coverage, and confusion, especially among people with unstable work hours, language barriers, or limited internet access (Galewitz, Appleby, Rayasam, & Wolfson, 2025). Georgia’s earlier experiment, which cost over $90 million while directing only $26 million toward actual care, previews this imbalance between administrative cost and health benefit. These dynamics are particularly dangerous for Black women, who are more likely to rely on Medicaid during pregnancy and more likely to experience adverse outcomes when they lose coverage during the perinatal period (Dihwa et al., 2022). Obstetric racism, as a form of anti-Black structural and clinical harm, is intensified when coverage lapses restrict access to prenatal visits, labor support, and postpartum follow-up, reinforcing patterns of neglect and coercion documented by Odems et al. and Davis in their analyses of Black women’s birthing experiences (Odems et al., 2024).
Some argue that cuts to Medicaid will only impact a small sliver of Americans because roughly 92% of the population has some form of health insurance (Dihwa et al., 2022). Yet about 90 million people are enrolled in Medicaid or the Children’s Health Insurance Program (CHIP), not including territories like Puerto Rico (Dihwa et al., 2022). For Black and Latino communities, Medicaid expansion has played a central role in advancing health equity, including improved prenatal care, reduced infant mortality, and better management of chronic conditions that complicate pregnancy (Dihwa et al., 2022). OBBB’s bureaucratic restrictions reverse these gains, creating conditions where pregnant Black women face both reduced coverage and intensified racialized surveillance—core features of obstetric racism (Odems et al., 2024).
Why is Medicaid Important for Obstetric Racism?
Medicaid is cost-effective; it pays providers less and spends less per person than private insurance or Medicare, while reaching those with the greatest medical and social needs (Brownstein, 2025). Losing Medicaid forces people to make trade-offs between healthcare and essentials like housing, food, and childcare, decisions that disproportionately fall on Black women as caregivers in households already contending with racialized economic inequality (Brownstein, 2025). In maternal health, this translates into delayed prenatal care, skipped appointments, and reduced access to birthing options such as midwifery or community birth centers that have shown promise in counteracting obstetric racism (Oparah et al., 2021)
Even Americans not directly enrolled in Medicaid rely on its stabilizing effect. In 2022, 96% of U.S. hospitals reported that at least half of their inpatient days were paid by Medicare or Medicaid (American Hospital Association, 2024). Without these revenue streams, hundreds of hospitals—especially in rural and low-income urban communities—face risk of closure (Brownstein, 2025). When a hospital closes, communities lose both critical obstetric services and employment opportunities, producing “maternity care deserts” where Black pregnant people must travel farther for care, often encountering overcrowded and under-resourced facilities. This spatial and institutional abandonment mirrors what Odems et al. describe as violations of Black women’s birthing rights, from disrupted bonding time to unaffordable care and racially discordant provider relationships (Odems et al., 2024).
Birth Justice, Black Birthworkers, and Resistance to Policy Harm
The effects of OBBB do not unfold in a vacuum; they intersect with ongoing struggles against obstetric racism and for birth justice. In “Creativity, Resilience and Resistance: Black Birthworkers’ Responses to the COVID-19 Pandemic,” Julia Chinyere Oparah, Jennifer E. James, Destany Barnett, and colleagues document how Black doulas, midwives, and other birthworkers responded to COVID-era restrictions that excluded support people, disrupted care continuity, and exposed Black birthing people to heightened risk
(Oparah et al., 2021). Black birthworkers described inadequate or inconsistent care, forced separations from newborns, and barriers to accompaniment—conditions that resonate with the structural and interpersonal features of obstetric racism identified by Odems et al. and Davis (Odems et al., 2024).
The Black Women Birthing Justice (BWBJ) collective, which led the Battling Over Birth and Still Battling Over Birth research projects, frames these harms within a Research Justice and Birth Justice lens. BWBJ’s work shows how Black mothers and birthworkers experience coercion, fear-based counseling, and threats involving police or child protective services, all of which are intensified when access to care is precarious and dependent on punitive bureaucratic systems (Oparah et al., 2021). Cuts and barriers to Medicaid under OBBB exacerbate these dynamics by:
Increasing the likelihood that Black pregnant people will enter pregnancy uninsured or lose coverage mid-pregnancy.
Reducing reimbursement pathways for Black doulas and midwives, undermining the very workforce shown to buffer obstetric racism’s harms (Guerra-Reyes & Hamilton, 2017; Davis, 2019, as cited in Oparah et al., 2021)
Weakening community-based organizations that rely on Medicaid-related funding streams to provide culturally rooted, Black-led perinatal services.
These trends run directly counter to federal efforts like the Black Maternal Health Momnibus Act, championed by the Black Maternal Health Caucus, which aims to expand and diversify the perinatal workforce, invest in community-based organizations, and address social determinants of maternal health (Black Maternal Health Caucus, 2020; Underwood et al., 2021). Where Momnibus moves toward structural remedies for obstetric racism, OBBB pulls in the opposite direction by constricting coverage and undermining community capacity.
What Can We Do?
The projected deaths and layoffs associated with Medicaid cuts can feel inevitable, but numerous strategies exist to oppose and mitigate the harms of OBBB. Families USA, a nonprofit organization committed to health equity, provides step-by-step guidance on how to meet with members of Congress to advocate for Medicaid and ACA protections (Families USA, 2025)(Families USA, 2017). Larger coalitions such as the Modern Medicaid Alliance bring together over 100 regional and national organizations—including professional associations—to offer state-by-state data on Medicaid enrollment and outcomes, equipping citizens with accurate statistics to use in policy discussions (Modern Medicaid Alliance, 2023).
From a birth justice perspective, supporting Black-led organizations like Black Women Birthing Justice, Black Mamas Matter Alliance, and networks of Black doulas and midwives is essential. Their work aligns with the community-driven research and advocacy strategies outlined in Oparah et al. and Odems et al., centering Black women’s narratives as evidence and demanding structural shifts in how care is funded, delivered, and evaluated (Oparah et al., 2021) (Odems et al., 2024). Informing oneself about Medicaid’s enrollment barriers, assisting others with navigation, and amplifying Black birthworkers’ testimonies are all direct ways to resist how OBBB deepens obstetric racism and to move toward a maternal health system grounded in equity and reproductive justice.
Works Cited
American Hospital Association. “Fact Sheet: Majority of Hospital Payments Dependent on Medicare or Medicaid | AHA.” American Hospital Association, 6 May 2024, www.aha.org/fact-sheets/2022-05-25-fact-sheet-majority-hospital-payments-dependent-medicare-or-medicaid. Accessed 10 July 2025.
Black Maternal Health Caucus. “Underwood, Adams, Booker Unveil the Black Maternal Health Momnibus Act to Address America’s Maternal Health Crisis.” Black Maternal Health Caucus, 7 Feb. 2021, underwood.house.gov/media/press-releases/underwood-adams-booker-unveil-black-maternal-health-momnibus-act-address. Accessed 10 July 2025.
Brownstein, Maya. “Medicaid Cuts: What’s at Stake | Harvard T.H. Chan School of Public Health.” Harvard T.H. Chan School of Public Health, 5 June 2025, hsph.harvard.edu/news/medicaid-cuts-whats-at-stake/. Accessed 10 July 2025.
Davis, Dána-Ain. “Obstetric Racism: The Racial Politics of Pregnancy, Labor, and Birthing.” Medical Anthropology, vol. 38, no. 7, 2019, pp. 560–573.
Dihwa, Vimbainashe, et al. “Medicaid Can and Should Play an Active Role in Advancing Health Equity.” Health Services Research, vol. 57, no. 2, 20 Sept. 2022, pp. 1–9, pmc.ncbi.nlm.nih.gov/articles/PMC9660413/, https://doi.org/10.1111/1475-6773.14069. Accessed 10 July 2025.
“Federal Debt and the Statutory Limit, March 2025.” Congressional Budget Office, 26 Mar. 2025, www.cbo.gov/publication/61265. Accessed 9 July 2025.
Families USA. “Defending Health Care - Families USA.” Families USA, 28 Mar. 2025, www.familiesusa.org/our-work/defending-health-care/. Accessed 10 July 2025.
“How to Set Up a Meeting with Your Member of Congress - Families USA.” Families USA, 30 May 2017, familiesusa.org/resources/how-to-set-up-a-meeting-with-your-member-of-congress/. Accessed 10 July 2025.
Galewitz, Phil, et al. “5 Ways Trump’s Megabill Will Limit Health Care Access.” National Public Radio, 2 July 2025, www.npr.org/sections/shots-health-news/2025/07/02/nx-s1-5453870/senate-republicans-tax-bill-medicaid-health-care. Accessed 9 July 2025.
Galewitz, Phil, and Stephanie Armour. “Medicaid Work Requirements Could Leave Disabled People Without Insurance.” KFF Health News, 2025, kffhealthnews.org/news/article/medicaid-work-requirements-disabled-insurance-big-beautiful-bill-gop/. Accessed 10 July 2025.
Modern Medicaid Alliance. “Tips for Leveraging the Medicaid Dashboard - Modern Medicaid Alliance.” Modern Medicaid Alliance, 7 Mar. 2023, modernmedicaid.org/pollingresearch/tips-for-leveraging-the-medicaid-dashboard-2/. Accessed 10 July 2025.
Moore, Elena, Claudia Grisales, and Deirdre Walsh. “Trump on Fourth of July Signs ‘One Big Beautiful Bill’ to Implement His Agenda.” National Public Radio, 3 July 2025, www.npr.org/2025/07/03/nx-s1-5454841/house-republicans-trump-tax-bill-medicaid. Accessed 9 July 2025.
Odems, Dorian S., et al. “‘It Seemed Like She Just Wanted Me to Suffer’: Acts of Obstetric Racism and Birthing Rights Violations Against Black Women.” SSM – Qualitative Research in Health, vol. 6, Dec. 2024, article 100479, https://doi.org/10.1016/j.ssmqr.2024.100479. Accessed 10 Jan. 2026.
Oparah, Julia Chinyere, Jennifer E. James, Destany Barnett, Linda Marie Jones, Daphina Melbourne, Sayida Peprah, and Jessica A. Walker. “Creativity, Resilience and Resistance: Black Birthworkers’ Responses to the COVID-19 Pandemic.” Frontiers in Sociology, vol. 6, 24 Mar. 2021, article 636029, pmc.ncbi.nlm.nih.gov/articles/PMC8022614/, https://doi.org/10.3389/fsoc.2021.636029. Accessed 10 Jan. 2026.
Roberts, Eric T., and José Figueroa. “Experts: Medicaid Cuts Could Prove Fatal for Thousands.” Penn LDI, July 2025, ldi.upenn.edu/our-work/research-updates/experts-medicaid-cuts-could-prove-fatal-for-thousands. Accessed 10 July 2025.
Winters, Mike. “Senate Version of Trump’s Budget Bill Would Raise the Debt Ceiling by $5 Trillion—What It Could Mean for Your Wallet.” CNBC, 24 June 2025, www.cnbc.com/2025/06/24/how-the-largest-debt-ceiling-increase-in-us-history-could-affect-you.html. Accessed 9 July 2025.
