The One Big Beautiful Bill and the Big, Ugly Truth About Healthcare
The Republicans are trying to pass Trump’s One Big Beautiful Bill before the July 4 holiday. It’s a sweeping piece of legislation covering many areas, but this post focuses on its impact on healthcare for Americans.
In 2010, the Obama Administration passed the Affordable Care Act (ACA). Key provisions of the ACA included:
Expanded Medicaid coverage
The establishment of health insurance marketplaces (for New York, see
Subsidies to offset insurance costs for individuals and families earning between 100% and 400% of the Federal Poverty Level
Elimination of insurance denials for pre-existing conditions
The requirement that insurance plans sold through the marketplaces include a set of essential health benefits
Since the ACA’s passage, over 40 million Americans have gained health insurance coverage. In New York State alone, the number of uninsured has dropped by 1.3 million. Arguably, the ACA is the most significant piece of social legislation passed by Congress since the 1960s, when Social Security, Medicare, and Medicaid were established.
Now, the proposed One Big Beautiful Bill directly threatens these gains. A recent report by the Center on Budget and Policy Priorities (CBPP) estimates that over 16 million people would lose coverage and become uninsured if this bill passes.
How the Coverage Losses Would Happen
On the Medicaid front, the bill is projected to cut $800 billion in funding, causing 7.8 million people to lose coverage—the largest cut in the program’s history. These cuts would be implemented through:
Stringent work requirements
Ongoing eligibility verification
In other words, the legislation creates bureaucratic obstacles, increasing the chances that qualified individuals lose coverage simply because of paperwork burdens.
Some may argue that it's reasonable to require work in exchange for Medicaid. But here’s the reality: 92% of Medicaid recipients under 65 (who aren’t receiving Social Security Disability or Medicare) are already working. The stereotype of Medicaid recipients as lazy or unwilling to work is simply false.
There’s already evidence showing that work requirements lead to coverage loss, even among eligible people. In Arkansas, between June 2018 and March 2019, over 18,000 people—about 25% of those affected—lost Medicaid when the state added work requirements. Research later showed that most of those individuals did meet the work requirement but were unaware of the new rules, confused by them, or found the reporting process too burdensome.
Attacks on Marketplace Coverage
The bill also targets people who aren’t eligible for Medicaid but rely on Marketplace coverage—particularly the self-employed and those earning 100% to 400% of the FPL.
Key proposed changes:
New documentation requirements to prove eligibility for insurance subsidies
Elimination of automatic annual renewals of health insurance coverage
No extension of the enhanced Premium Tax Credits enacted under the Biden Administration
These tax credits were critical in making coverage affordable for many families. Without them, insurance premiums could become prohibitively expensive.
According to the CBPP, 8.2 million people will lose their Marketplace insurance. Combined with Medicaid losses, an estimated 16 million Americans will lose coverage.
So What Do We Get in Exchange?
What does America gain from $800 billion in Medicaid cuts and 16 million people losing health insurance?
The answer: tax cuts for the wealthy.
A major component of the One Big Beautiful Bill is the extension of Trump’s 2017 tax cuts, which overwhelmingly benefit the top income brackets. To offset these cuts, the bill slashes Medicaid and other essential programs like SNAP, while also dramatically increasing the national debt.
The diagram below from the Congressional Budget Office, a non-partisan organization, illustrates how the One Big Beautiful Bill is essentially a Reverse Robin Hood scheme—taking from everyday Americans to give more and more to the already rich.
