A new analysis from the Washington, D.C.-based progressive think tank Third Way shows just how alarming that number is. Under the House version of the “big beautiful” bill and the currently proposed changes to the Affordable Care Act, 7.8 million people would be kicked off of Medicaid. This shocking forecast underscores huge consequences for millions of Americans, especially in rural areas.
The proposed legislation renews expiring subsidies and rule changes introduced through executive action during the Trump administration. Experts have raised the alarm that such changes would drastically limit access. They foresee a boom in medical debt, booming by an additional $50 billion or so. Unpaid medical debts have reached about $340 billion. That’s because the alternative proposed changes would raise current medical debts by an average of 15%.
Fears about the “big beautiful” bill go above and beyond Medicaid cuts. Further up the food chain among Republican lawmakers, there is significant concern about the provider tax changes. They are concerned that these changes could financially threaten the stability of rural hospitals. The potential for rural hospitals to reduce services or close altogether looms large over many communities that rely on these institutions for essential healthcare services.
The Senate parliamentarian just ruled on the proposal. They determined if it met the requirements of the Byrd rule, which prohibits non-budgetary changes. Republican lawmakers are making an aggressive push for the bill’s passage through budget reconciliation. Unlike many other major climate priorities, this process only requires a simple majority vote in the Senate to advance.
In fact, these possible Medicaid cuts and changes to provider taxes would deepen a long-standing rural hospital crisis. With many of these healthcare facilities already operating in the red, adding new financial pressures could threaten their capacity to deliver quality care.
Allison Orris, a senior fellow and director of Medicaid policy at the Center on Budget and Policy Priorities, commented on the situation, stating, “The Senate bill, like the House bill, includes deep cuts to Medicaid and other health programs, and is deeply harmful, whether or not these provisions stay in or out.”
Lawmakers are still working to figure out just what the “big beautiful” bill would mean for the state. Their chief concern is how these changes will impact rural communities and their access to care. Lawmakers and healthcare experts have been raising alarms about these problems. They are calling on lawmakers to fix these issues and do so before any final legislative agreement is adopted.