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 successfully passed the controversial “One Big Beautiful Bill” (OBBB). The margin of victory was narrow, with the House of Representatives voting 214 to 218 in favor of the bill on July 3, 2025 (Moore, Grisales, & Walsh, 2025). The entirety of the Republican Party supported the bill, excluding Representatives Thomas Massie of Kentucky and Brian Fitzpatrick of Pennsylvania, both of whom joined the 212 democratic representatives in opposition to the bill. On July 4th, 2025, President Donald Trump signed the bill into law.
Raising the debt ceiling by $5 trillion (Winters 2025), OBBB permits the federal spending of $46.1 trillion (Congressional Budget Office, 2025). President Trump is expected to expand immigration enforcement while scaling back social initiatives, such as Medicaid (government health insurance for low-income households) and SNAP (Supplemental Nutrition Assistance Program). To cut funding, the act will complicate and delay sign-up processes for the Affordable Care Act (ACA) and Medicaid while adding additional complex paperwork (Moore, Grisales, & Walsh, 2025. The price of healthcare will remain fixed, while accessibility for individuals who qualify dramatically declines due to the added barriers, thus disproportionately harming vulnerable populations while failing to achieve meaningful healthcare reform
How Will ‘One Big Beautiful Bill’ Impact Medicaid?
Perhaps the largest barrier for vulnerable communities is the proposed 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 those enrolled in Medicaid will be forced to provide paperwork proving they are working, volunteering, or in school for a minimum of 80 hours a month (Galewitz, Appleby, Rayasam, & Wolfson, 2025). One can also file for an exception in unique cases, like raising a young child or caring for an elderly family member. Health researchers hypothesize the added requirement will have a minimal impact on employment, given that working-age Medicaid enrollees are seeking work, disabled, attending school, or have a unique circumstance preventing them from meeting the 80-hour monthly requirement (Galewitz & Armour, 2025).
Professional concerns lie with potential administrative issues. Numerous states, including Georgia, have experimented with Medicaid requirements in the past. Officialized in June 2023, Georgia’s work requirements cost over $90 million, with a mere $26 million of that total spent on health benefits.
Some argue the financial reductions to Medicaid will only impact a sliver of the American population, given roughly 92% of Americans have health insurance (Dihwa et al., 2022). 90 million Americans, however, are enrolled in Medicaid or the Children's Health Insurance Program. This total does not account for Medicaid enrollees in territories like Puerto Rico (Dihwa et al., 2022). If cut, Medicaid can no longer improve health and social need outcomes as it has done throughout recent years. This is especially true for racial minorities, specifically Latinos and Black Americans.
Why is Medicaid Important?
Medicaid is cost-effective in nature, as it pays providers less and spends less per person when compared to private insurance or Medicare (Brownstein, 2025). With reduced coverage, millions of Americans will be forced to make trade-offs, potentially sacrificing their health for shelter or other necessities. Eric Roberts, an associate professor of general internal medicine at Perelman School of Medicine, argues that over 51,000 people will die daily from entirely preventable causes if the OBBB cuts Medicaid as drastically as planned (Roberts & Figueroa, 2025).
Even Americans who do not rely on Medicaid or government assistance will be impacted by cuts to Medicaid. In 2022, 96% of U.S. hospitals had 50% or more of their inpatient days, or the total number of days patients spend admitted in a hospital, paid by Medicare or Medicaid (American Hospital Association, 2024). Without Medicaid contributing to their revenue, hundreds of hospitals are at risk of closure (Brownstein, 2025). Rural communities often have a primary medical center they rely on. If the facility is closed due to a decline in revenue, community members lose their source of income, while the entire community loses its primary source of healthcare. Resultantly, they are vulnerable, too.
What Can We Do?
The deaths and layoffs that will accompany cuts to Medicaid seem unavoidable. While there will be severe economic and health-related consequences, there are numerous ways to advocate for support funding for Medicaid. Families USA, a non-profit organization advocating for health equity, encourages face-to-face meetings with representatives or senators to show public support for Medicaid and the ACA (Families USA, 2025). They provide a thorough guide, walking the reader through the politician selection and navigating the conversation (Families USA, 2017).
There are larger alliances, like the Modern Medicaid Alliance, that are comprised of 100 regional and national organizations like the American Psychological Association and the American Academy of Physicians (Modern Medical Alliance, 2023). The Modern Medicaid Alliance offers reliable state-by-state data on Medicaid enrollment, helping citizens use accurate statistics in discussions with their state representatives. These organizations are informative, often providing information on how to apply for Medicaid and the dates and locations of rallies dedicated to the expansion on Medicaid. Informing oneself of the Medicaid application process and aiding enrollees in navigating the barriers created by ‘One Big Beautiful Bill’ is effective in improving accessibility to Medicaid, thus improving health equity and preventing unnecessary layoffs.
Works Cited:
American Hospital Association. (2024, May 6). Fact sheet: Majority of hospital payments dependent on medicare or medicaid. https://www.aha.org/fact-sheets/2022-05-25-fact-sheet-majority-hospital-payments-dependent-medicare-or-medicaid
Brownstein, M. (2025, June 5). Medicaid cuts: What's at stake. Harvard T.H. Chan School of Public Health. https://hsph.harvard.edu/news/medicaid-cuts-whats-at-stake/
Congressional Budget Office. (2025, March 26). Federal debt and the statutory limit, March 2025. https://www.cbo.gov/publication/61265
Dihwa, V., Shadowen, H., & Barnes, A. J. (2022). Medicaid can and should play an active role in advancing health equity. Health Services Research, 57(2), 1–9. https://doi.org/10.1111/1475-6773.14069
Families USA. (2024, May 30). How to set up a meeting with your member of congress. https://familiesusa.org/resources/how-to-set-up-a-meeting-with-your-member-of-congress/
Families USA. (2025, March 28). Defending health care. https://www.familiesusa.org/our-work/defending-health-care/
Galewitz, P., Appleby, J., Rayasam, R., & Wolfson, B. J. (2025, July 2). 5 ways Trump's megabill will limit health care access. National Public Radio. https://www.npr.org/sections/shots-health-news/2025/07/02/nx-s1-5453870/senate-republicans-tax-bill-medicaid-health-care
Modern Medicaid Alliance. (2023, March 7). Tips for leveraging the Medicaid dashboard. https://modernmedicaid.org/pollingresearch/tips-for-leveraging-the-medicaid-dashboard-2/
Moore, E., Grisales, C., & Walsh, D. (2025, July 3). Trump on Fourth of July signs "One Big Beautiful Bill" to implement his agenda. National Public Radio. https://www.npr.org/2025/07/03/nx-s1-5454841/house-republicans-trump-tax-bill-medicaid
Roberts, E. T., & Figueroa, J. (2025, July). Experts: Medicaid cuts could prove fatal for thousands. Penn LDI. https://ldi.upenn.edu/our-work/research-updates/experts-medicaid-cuts-could-prove-fatal-for-thousands/
Winters, M. (2025, June 24). Senate version of Trump's budget bill would raise the debt ceiling by $5 trillion—what it could mean for your wallet. CNBC.https://www.cnbc.com/2025/06/24/how-the-largest-debt-ceiling-increase-in-us-history-could-affect-you.html
