How Trump bill Medicaid cuts will impact U.S. health care

President Donald Trump’s “big beautiful bill” would make sweeping changes to U.S. health care, leaving thousands and thousands of vulnerable Americans without medical insurance and threatening the hospitals and centers that provide care to them. 

The Senate on Tuesday voted 51-50 to pass the spending measure after a marathon overnight voting session on amendments. However the bill will face one other major test within the House, where Republicans have a razor-thin majority and a few members have already raised objections to the laws. 

Recent changes to the bill would cut roughly $1.1 trillion in health-care spending over the subsequent decade, in accordance with recent estimates from the nonpartisan Congressional Budget Office.

Greater than $1 trillion of those cuts would come from Medicaid, a joint federal and state medical insurance program for disabled and low-income Americans, in accordance with the CBO. The funding cuts transcend insurance coverage: The lack of that funding could gut many rural hospitals that disproportionately depend on federal spending.

The CBO estimates that the present version of the bill would end in 11.8 million people losing medical insurance by 2034, with nearly all of those people losing Medicaid coverage.

However the implications might be even greater. Trump’s bill combined with separate policy changes could end in an estimated 17 million people losing medical insurance, said Robin Rudowitz, director of this system on Medicaid and the uninsured at health policy research organization KFF.

She said those other changes include recent regulations that may dramatically limit access to Reasonably priced Care Act Marketplace coverage and expiring enhanced ACA tax credits.

“If all of this involves pass, it might represent the largest roll back of medical insurance coverage ever resulting from federal policy changes,” Cynthia Cox, KFF’s director of this system on the ACA, said in an evaluation published Tuesday. 

Roughly 72 million Americans are currently enrolled in Medicaid, about one-fifth of the full U.S. population, in accordance with government data. Medicaid is the first payer for nearly all of nursing home residents, and pays for around 40% of all births. 

The Trump administration and its allies insist the cuts within the bill aim to eliminate waste, fraud and abuse. Democrats have said they break the president’s repeated guarantees not to the touch the Medicaid program. Medicaid has been some of the divisive issues throughout negotiations in each chambers, and a few House Republicans have expressed reservations about how deep the cuts are. 

“I get that they wish to cut fraud, but taking a swipe across the highest is just not going to unravel the problem,” said Jennifer Mensik Kennedy, president of the American Nurses Association. 

She said the cuts could shutter hospitals and health centers in rural areas and result in job losses for health-care staff comparable to nurses. 

The cuts within the bill come from several different provisions, however the lion’s share of Medicaid savings will come from two changes. 

One would establish a recent, strict national work requirement for certain Medicaid beneficiaries ages 19 to 64. It could require childless adults without disabilities and fogeys of kids older than 14 to work, volunteer or attend school for at the least 80 hours a month to maintain their insurance coverage, unless they qualify for an exception. 

An evaluation published June 23 by the UC Berkeley Labor Center said that the work requirement would cause essentially the most people to lose insurance and “poses an especially draconian barrier to older adults.” The middle said there’s a gentle drop-off in employment after age 50 resulting from aspects “outside [people’s] control,” including deteriorating health, age discrimination and increasing responsibility to offer take care of aging relations. 

“These same aspects make older adults particularly vulnerable to coverage loss under Medicaid work requirements,” the evaluation said.

People living in rural communities, comparable to seasonal farmers, may additionally struggle to search out employment for parts of the 12 months, Mensik Kennedy said.

AARP, an advocacy group specializing in issues affecting those 50 and older within the U.S., sent a letter over the weekend to Senate Majority Leader John Thune, R-S.D., and Senate Minority Leader Chuck Schumer, D-N.Y., opposing one other provision that may disqualify individuals who fail to satisfy Medicaid work requirements from receiving premium tax credits to buy coverage through the ACA Marketplaces.

“This creates a steep coverage cliff for those of their 50s and early 60s — particularly for those nearing retirement or working part-time — who could also be left with no reasonably priced coverage option in any respect,” the group said. 

Some members of the Trump administration and conservative lawmakers argue that it’s a loophole for states to receive disproportionately more federal funds than they contribute. 

The bill’s restrictions on provider taxes and one other strategy called state-directed payments would cut spending by a combined $375 billion, in accordance with the CBO report.

But some GOP senators and experts raised concerns that capping provider taxes would threaten a critical funding stream for rural hospitals, which could force them and other health centers to shut. Mensik Kennedy said health-care providers in rural areas, particularly critical access hospitals, rely more on Medicaid funding to support them compared with those in urban areas. 

“You are going to see closures of rural hospitals which are the backbone of their community and were already struggling financially. You are going to see half 1,000,000 job losses,” Mensik Kennedy said. 

She said pregnant women in rural areas might be forced to drive 30, 40 or more miles to deliver a baby, while emergency medical services could must drive an hour to achieve a patient having a heart attack. 

Patients in rural communities have already got higher rates of chronic illnesses and mortality because they’ve limited access to care, in accordance with the Centers for Disease Control and Prevention. 

Senate Republicans have added a $25 billion fund to the bill to assist rural hospitals stay open within the face of Medicaid cuts. 

But Mensik Kennedy said that fund is “putting a bucket of water on the home fire,” adding that it is just not enough to offset the cuts from the cap on provider taxes and other provisions. 

Cuts in overall Medicaid funding for rural hospitals would exceed 20% in greater than half of states, in accordance with a report from the National Rural Health Association.

“The ORPHAN Cures Act will enable more options for Americans living with rare disease,” the trade group Biotechnology Innovation Organization wrote Wednesday in a post on X. The group also said only 5% of rare diseases have an approved treatment, while the economic toll of rare conditions within the U.S. surpassed $997 billion in 2019. 

But on Tuesday, drug pricing group Patients For Reasonably priced Drugs Now called on the House to remove the ORPHAN Cures Act from the bill and permit Medicare drug price negotiations to deliver more savings to patients. 

The choice to incorporate it within the laws “moves us within the incorrect direction, undermining hard-fought progress to lower drug prices,” Merith Basey, executive director of the group, said in a press release. 

“Pharma lobbyists will stop at nothing to keep up industry profits, and when a majority of the Senate caves to their interests, it is a reminder to Americans why they’re paying the very best drug prices on this planet. Simply put: it’s because Congress allows it,” Basey said.

She called it a “completely unnecessary $5 billion giveaway” to the pharmaceutical industry, referring to CBO estimates for the way much the ORPHAN Cures Act would cost taxpayers over the subsequent decade.