Trump’s Tax Bill: How Medicaid Cuts Will Affect Millions
President Donald Trump’s latest domestic spending and tax bill—nicknamed the “Big Beautiful Bill”—has cleared the Senate with sweeping implications for healthcare in America. In addition to delivering broad tax cuts and increasing immigration enforcement, the legislation proposes nearly $1 trillion in Medicaid cuts, potentially stripping healthcare access from millions of low-income Americans.
According to the Congressional Budget Office (CBO), the bill could eliminate insurance coverage for 11.8 million people over the next decade. An additional 5 million could lose coverage if Congress fails to extend pandemic-era Affordable Care Act subsidies. Critics argue the bill represents the largest rollback in healthcare coverage in U.S. history.
Medicaid Cuts and Work Requirements
Under the proposed legislation, Medicaid—a federal-state health insurance program that currently insures 83 million low-income Americans—would undergo major restructuring. Key provisions include:
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Biannual Eligibility Checks: States would be required to verify Medicaid eligibility twice a year.
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Work Requirements: Able-bodied recipients must work 80 hours a month or qualify for exemptions (such as being a student, caregiver, or disabled).
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Expanded Definition: The Senate version extends work requirements to parents with children over 13.
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Immigration Clause: Undocumented immigrants currently covered under state-funded Medicaid programs would lose eligibility.
These new mandates, according to health policy experts, will increase administrative complexity and costs while cutting off coverage for many who still qualify but get caught in the red tape.
The Economic and Healthcare Fallout
Hospitals and healthcare professionals have voiced alarm. Rick Pollack, President and CEO of the American Hospital Association, said the proposed Medicaid cuts would cause “irreparable harm to our healthcare system” and lead to increased uncompensated care, especially in rural and underserved areas.
Though the Senate included a $50 billion rural healthcare fund, Pollack and other leaders argue that this measure does not compensate for the depth of the cuts. Hospitals could be forced to cut staff and services, resulting in longer ER wait times and even closures of some rural facilities.
Dr. Richard Besser, CEO of the Robert Wood Johnson Foundation, said the bill will “make our country sicker”, put children at risk, and reduce access to basic necessities for millions.
Focus Keyword Subheading: Medicaid Cuts to Hit in 2027
While the cuts won’t take immediate effect, the bill sets a January 1, 2027 deadline for states to implement the new eligibility and work verification systems. However, some states may fast-track the changes by applying for federal waivers.
States will also face reduced federal Medicaid funding and the need to overhaul eligibility systems—an expensive and resource-intensive task.
Jennifer Tolbert of KFF warns that many states are already budgeting for these reduced funds and must plan for the added administrative burden.
Workers and Families Push Back
Healthcare workers are taking a stand. Johannah Alabi, a caregiver at two Connecticut nursing homes, joined a protest with the Service Employees International Union (SEIU). Their signs read “Death by a trillion cuts”, highlighting the potentially devastating impact on nursing home residents—63% of whom rely on Medicaid.
Jennifer Woods, an SEIU member working at Kaiser Permanente, confronted lawmakers like Sen. Ted Cruz, pleading with them to understand the bill’s real-world implications. Her efforts, however, were met with silence.
The Bigger Picture
Supporters of the bill, including Vice President JD Vance, downplayed the Medicaid cuts as “immaterial” compared to the projected savings from increased immigration enforcement. But the broader concern remains: can the U.S. afford tax breaks if they come at the cost of basic healthcare for its most vulnerable citizens?
As the House prepares to vote on the bill, healthcare providers, advocacy groups, and families brace for the outcome—one that could reshape the American healthcare landscape for generations.
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