On 4 July 2025, US President Donald Trump signed into law a tax and spending package designed to fulfil several of his electoral campaign promises. These relate to tax cuts, immigration enforcement and more. However, it may have serious implications for health care, with potentially significant cuts to Medicaid.
The signing of the ‘One Big Beautiful Bill Act’ followed the House of Representatives vote that secured the bill's passage on 3 July, with a 218-214 outcome.
As part of the bill, over a 10-year period, it predicted there will be nearly US$1 trillion in cuts to Medicaid. Congressional Budget Office analyses estimate that the policy changes will lead to at least 11.8 million more Americans becoming uninsured.
American Medical Association President Bobby Mukkamala said that the bill ‘… will make it harder to access care and make patients sicker. It will make it more likely that acute, treatable illnesses will turn into life-threatening or costly chronic conditions.’ Additionally, Chip Kahn, President and CEO of America’s Essential Hospitals said, ‘It cannot be overstated—the health cuts passed by Congress today represent the largest cuts to care our country has ever seen. Americans will feel the reverberations of this legislation in communities across the nation—whether directly due to a loss of coverage, the increase of their costs, or as doctors and hospitals scramble to sustain services and keep their doors open.’
In response to statements such as this, the White House published a ‘Myth vs. Fact’ article on the ‘One Big Beautiful Bill’ (BBB) [1].
Related to families losing access to Medicaid, the article says, ‘The One Big Beautiful Bill protects and strengthens Medicaid for those who rely on it—pregnant women, children, seniors, people with disabilities, and low-income families—while eliminating waste, fraud, and abuse’. The BBB removes illegal aliens and enforces work requirements.
Related to the bill cutting Medicaid overall, it states ‘Medicare has not been touched in this bill— absolutely nothing in the bill reduces spending on Medicare benefits. This legislation does not make a single cut to welfare programs—it safeguards and protects these programs for all eligible Americans’.
And in response to fears that the bill will lead to the closure of rural hospitals, it says ‘Rural hospitals comprise just 7% of all hospital spending on Medicaid, illustrating that they have not benefited from the massive increase in waste, fraud, and abuse under the Biden administration. By strengthening Medicaid, we are making more resources available for vulnerable populations and safety net providers, like rural hospitals. We are expanding rural hospital protection, providing targeted funds for rural care, and giving states flexibility to support local providers.’
At present, the outcome of this bill is yet to be determined. However, it is clear that the US is divided over its implications for health care.
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Reference
1. Myth vs. Fact: The One Big Beautiful Bill – The White House. Available from:
https://www.whitehouse.gov/articles/2025/06/myth-vs-fact-the-one-big-beautiful-bill/
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