As Republicans rush to pass President Donald Trump’s sweeping reconciliation package before the July 4 deadline, mounting concerns are emerging over the bill’s potentially devastating impact on Medicaid—the federal health insurance program for low-income Americans. According to reports from ABC News and the Associated Press, the bill, informally known as the “One Big, Beautiful Bill Act,” proposes slashing Medicaid funding by $1 trillion over the next 10 years.
CBO: Nearly 12 Million Could Lose Coverage
New projections from the Congressional Budget Office (CBO) warn that 11.8 million Americans could lose health coverage by 2034 if the legislation is enacted. The bill not only targets Medicaid, but also scales back provisions of the Affordable Care Act (ACA) and the Children’s Health Insurance Program (CHIP), signaling a major reduction in federal healthcare spending.
Here’s who could be most affected:
Older Adults Could Be Pushed Off Coverage
The bill introduces a monthly 80-hour work requirement for non-disabled adults ages 19 to 64 without dependents. While there are exemptions for individuals with disabilities and parents of children under 14, many older adults in their 50s and early 60s may fall into a coverage gap.
Dr. Nari Rhee of UC Berkeley told ABC News that older workers—especially those with years of physically demanding labor—may find it difficult or impossible to meet the work requirements or manage the complex documentation.
“By your late 50s, your body is worn out. Even if you want to work, navigating the paperwork may be too complex,” Rhee said.
Rural Communities Could See Hospitals Close
The AP reports that deep cuts to Medicaid reimbursement rates could force rural hospitals and clinics to shut down. These facilities, already operating on razor-thin budgets, rely heavily on Medicaid to stay open.
Jennifer Kennedy of the American Nurses Association warned that the closures could mean people in remote areas would have to travel hours for basic care.
“It’s unacceptable to force communities to go without hospitals because of funding cuts,” Kennedy said.
Low-Income and Homeless Populations in Jeopardy
The bill also mandates stricter eligibility requirements, including income and residency verification every six months. Advocates argue that transient or homeless individuals are at high risk of losing coverage simply due to missed paperwork deadlines.
In addition, under the bill, states could delay enrolling children in CHIP if their parents fall behind on premium payments—rolling back current protections enacted under President Biden.
Immigrants Could See Reduced Support
Legal immigrants would see a reduction in federal Medicaid support, with the federal match rate dropping from 90% to 80%, according to the report. Some states, including California and Illinois, have already begun limiting or freezing Medicaid access for immigrant populations in anticipation of federal changes.
FAQs: What You Need to Know
Q: How many Americans could lose insurance if the bill passes?
A: The CBO estimates 11.8 million could become uninsured by 2034.
Q: Who is most at risk?
A: Older adults, rural residents, low-income families, immigrants, and children.
Q: When would new work requirements take effect?
A: Starting in 2026, under the bill’s current draft.
As debate intensifies, healthcare advocates and lawmakers warn the consequences of the legislation could be far-reaching—especially for the nation’s most vulnerable communities.
