Winners and losers of “Big Beautiful Bills”
These are the potential winners and losers of the tax bills that President Donald Trump called the “big beautiful bill.”
The Senate will wipe out President Donald Trump’s domestic spending and tax cuts bills and enact a sudden cut in the national safety insurance program for low-income families.
In addition to increasing tax cuts and immigration enforcement, what Trump called the “Big Beautiful Building” will be reduced by nearly $1 trillion from Medicaid, a state territorial health program for low-income households and people with disabilities. The bill is projected to eliminate 11.8 million insurance coverage over the next decade, according to the Non-Participation Congressional Budget Office.
An additional five million people could lose coverage if Congress doesn’t extend the tax credits during the Covid-19 pandemic era that made the Affordable Care Act Plan more affordable for consumers.
The law corresponds to “the greatest rollback in health insurance in US history,” said Joan Alker, research professor, executive director and co-founder of the Joantown University Children and Families Center.
Vice President JD Vance, who voted in a tie-break vote on July 1 to pass Senate Bill 51-50, said in a social media post that Medicaid cuts were “not important” compared to the savings the bill funded through strengthened immigration enforcement. The House of Representatives is planning to consider legislation ahead of the deadline for the Signature Domestic Policy Act, July 2nd, July 4th.
How does the law reduce Medicaid?
The law requires states to double the eligibility checks twice a year. States administering Medicaid must set up a system to verify the employment or exemption status of a person.
The law requires “healthy” Medicaid recipients to work 80 hours a month or qualify for exemptions such as students, caregivers, disability, and more. The original house version restricted work requirements to low-income adults without children, while the Senate version added work requirements to parents of children aged 13 and older.
The law defines “healthy” people as those who are not identified as physically or mentally unemployed. The law would also strip the reporting of undocumented immigrants who obtain Medicaid through a state-funded program.
Health policy experts say more frequent eligibility checks and deficits add management costs and cut off those who are eligible but pass through the cracks due to administrative errors.
What do hospitals and doctors think about the bill?
Medicaid guarantees 83 million low-income children and adults, according to KFF, a health policy nonprofit. It represents more than one in five Americans.
Health policy experts warn that cuts could hurt rural hospitals and doctors who serve a higher percentage of those registered with Medicaid. The Senate bill added a $50 billion Rural Health Fund. This is twice the amount proposed by previous versions of the law.
Still, hospitals are “deeply disappointed,” the bill exempts the Senate, said Rick Pollack, president and CEO of the American Hospital Association, a trade group.
Pollack said the $1 trillion Medicaid cut would “cause irreparable harm to our health care system,” reducing access to care for all Americans.
Hospitals need to diagnose and stabilize those visiting the emergency room. Eliminating compensation for around 12 million Americans “promoting uncompensated care in hospitals and healthcare systems,” Pollack said.
Pollack said hospitals could be forced to cut down on services and staff, and patients could face longer waiting times in the emergency room. Pollack said some rural illnesses and facilities in underserved communities could close.
Dr. Richard Besser, president and CEO of the Robert Wood Johnson Foundation, said that cutting Medicaid and federal food aid programs would make it difficult to cut taxes by “it risks making our country sick, making our children hungry, and families can afford basic essentials.”
When will Medicaid cuts be effective?
Medicaid recipients are not immediately affected by the law. The bill will establish a state deadline on January 1, 2027, launching two eligibility checks per year and verifying work or exemption status for non-disabled enrollees.
However, some states have filed exemptions with the Centers for Medicare and Medicaid Services to launch Medicaid work requirements. CMS has chosen to approve the exemption and may be able to launch Medicaid labor requirements by January 2027, Alker said.
KFF’s survey shows that nearly two in three people are employed full-time or part-time in Medicaid, while others are carers or students, and therefore are eligible for exemptions from the work requirements. Just 8% weren’t working, as they couldn’t find a job, retirement or any other reason, according to KFF.
The bill does not mandate labor requirements by January 2027, but it is likely that the state will need to plan major changes prior to that, said Jennifer Tolbert, associate director of the Medicaid and uninsured KFF programs.
States must prepare small Medicaid payments from the federal government, adding additional administrative obligations to verify the status of enrollees’ work or volunteers.
“Some states expect this decline in revenue,” Tolbert said. “At the same time, we need to make some pretty expensive changes to the qualification system.”
“Death from 1 trillion cuts”: Healthcare Worker Lobby Republicans Lobbying in Congress
Johanna Arabi’s days usually consist of feeding, bathing and caring for residents in two nursing homes in Bloomfield, Connecticut. She said most of the patients rely on government health insurance programs.
Medicaid is the primary payer for 63% of nursing home residents, with an additional 13% relying on Medicare as the primary payer, according to KFF, a San Francisco-based health policy.
“If a portion of that money is taken away, then something has to be given,” Arabi said. “It’s going to come down to the care of the residents. It’s going to come down to the food. It’s going to come down to the activity.”
That’s why she was urged last week to vote against the bill and join the employee’s international union members.
They arrive at the Capitol with signs that read “Death from Trillions of Cuts” and wear shirts with the message “Republican Cut Kill.”
Jennifer Woods, another SEIU member who works in Kaiser Permanente’s billing division, met Sen. Ted Cruz, R-Texas, during a trip to Washington. She said she tried to explain that Cut could “smash people’s lives” and could potentially lead to patient death when she chased him through the Capitol building.
“He shook his head and continues,” Woods said. “He really didn’t say anything. No one else would.”
