Nearly 1 in 5 Americans—about 72 million Americans—count on Medicaid. This joint federal and state program provides health coverage to many low-income people and people with disabilities. Recent legislative developments point to real danger in this crucial program, which might soon result in millions being stripped from the most appropriate health coverage. A separate, proposed bill, frequently referred to as the ‘big beautiful bill,’ would eliminate more than $1 trillion from Medicaid. This plan increases the prospect that 17 million Americans will lose their health insurance.
The bill includes a new work requirement, phased in to begin in 2026. Childless adults without disabilities have to participate in work, volunteer activities, or education at a level of 80 hours a month just to maintain their Medicaid coverage. For parents of children over the age of 14, the requirement is the same. Critics point out that these stipulations have a greater impact on individuals living in rural communities where there is a lack of adequate job opportunities.
Jennifer Mensik Kennedy, the president of the American Nurses Association, said that Medicaid funding is vital. This support is critically important for rural health care providers. She pointed out that many residents in these regions, such as seasonal farmers, often struggle to find consistent employment throughout the year. Consequently, they would be ill-equipped to make the types of engagements that the new work requirements enactment in the bill would require.
The implications of these cuts go beyond just limiting eligibility. We’re especially pleased to see the proposed bill’s inclusion of restrictions on provider taxes. It seeks to limit state directed payments, limiting overall spending by $375 billion. Cynthia Cox, director of the program on the Affordable Care Act (ACA) at Kaiser, issued a stark alarm. She warned that the bill’s deep cuts would lead to the largest loss of coverage for Americans we’ve experienced in recent memory.
The bill points to a depressing reality — jobs for people age 50 and older are disappearing. This drop usually results from a decline in health or other unavoidable circumstances experienced by these people. Yet the new work requirements could place this demographic at an even further disadvantage. This will only compound the difficult and confusing challenges older Americans already face in maintaining their health insurance.
House Democratic leaders immediately came out in strong opposition to the proposed changes. They contend that these changes directly undercut President Trump’s many claims to safeguard Medicaid. As the argument drags on, stakeholders have rightfully become alarmed at the possible damage these plans could inflict on susceptible communities around the country.
Beyond the Medicaid cuts, the bill makes historic overall cuts to healthcare spending. Experts project these cuts could reach upwards of $1.1 trillion in savings over the next 10 years. The ORPHAN Cures Act would facilitate such studies by expanding what constitutes an orphan disease. It is expected to save taxpayers around $5 billion over the next 30 years. Critics argue that these proposed cuts could jeopardize access to critical health services for millions of low-income individuals and families.
Kennedy raised the concern that the fund authorized by the ORPHAN Cures Act still seems inadequate. He contrasted it with the similar clear cuts from provider tax caps and other similar provisions, explaining that contrast eloquently. She stated that it is akin to “putting a bucket of water on the house fire,” indicating that the measures do not adequately address the underlying issues caused by the proposed cuts.