THE WAR ON THE POOR:

HOW THE GOP’S BUDGET BILL GUTS

MEDICAID AND ELDERCARE

On May 22, 2025, the U.S. House of Representatives narrowly passed the "One Big Beautiful Bill Act" (HR 1) by a 215–214 vote. This sweeping budget reconciliation package, championed by President Trump and House Republicans, proposes deep cuts to Medicaid and the Affordable Care Act (ACA), threatening the health coverage of millions of Americans. The bill's provisions could significantly reduce healthcare access, particularly for the elderly, low-income individuals, and rural communities.

Medicaid Cuts: A Blow to Vulnerable Populations

The bill introduces stringent work requirements for certain Medicaid recipients, mandating 80 hours of work or community service monthly, which could take effect on December 31, 2026. According to the Congressional Budget Office (CBO), these provisions could lead to 7.7 million people losing Medicaid coverage and $698 billion in reduced federal Medicaid subsidies between 2026 and 2034.

Furthermore, the legislation targets the "provider tax" system, allowing states to tax healthcare providers and use the revenue to draw additional federal Medicaid funds. Critics argue that restricting this system could destabilize funding for nursing homes, which rely heavily on Medicaid. Medicaid covers more than 60% of nursing home residents, and further cuts could lead to facility closures and reduced care quality.

The Affordable Care Act (ACA) Under Siege

The bill also undermines the Affordable Care Act by eliminating enhanced premium tax credits, which are set to expire at the end of 2025. If these credits are not extended, millions could see substantial increases in out-of-pocket premiums, leading to coverage losses. Additionally, the bill codifies a recent Trump Administration proposed rule that could increase the number of uninsured people by 1.8 million by 2034.

Policy experts warn that these changes could slash ACA enrollment by one-third, reversing years of progress in expanding healthcare access.

Broader Implications

Beyond healthcare, the bill includes provisions that could have far-reaching effects:

Medicare Cuts: The bill would impose $500 billion in automatic Medicare cuts due to the Pay-As-You-Go Act, raising concerns about access to care for seniors.

SNAP Reductions: Stricter work requirements and eligibility checks for the Supplemental Nutrition Assistance Program (SNAP) could result in 3 million households losing food assistance.

Discriminatory Healthcare Policies: The bill bans Medicaid and CHIP from covering gender-affirming care for individuals of all ages, a move criticized by civil rights groups as discriminatory.

The "One Big Beautiful Bill Act" presents a significant shift in U.S. healthcare policy, with potential consequences that could disproportionately affect the most vulnerable populations. As the bill moves to the Senate, stakeholders across the healthcare spectrum are voicing concerns about its implications for access to care, health equity, and the nation's social safety net.

H.R.1 - One Big Beautiful Bill Act

H.R.3590 - Patient Protection and Affordable Care Act

The Statutory Pay-As-You-Go Act of 2010 PDF

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