Back to Healio<\/p>\n
Key takeaways:<\/p>\n
- \n
- The legislation cuts Medicaid funding by $930 billion over 10 years and may lower ACA enrollment rates. <\/li>\n
- An expert broke down the bill\u2019s \u201cunethical\u201d implications.<\/li>\n<\/ul>\n
The House has passed the Trump administration\u2019s sweeping domestic agenda bill, which experts said will have massive implications for health care in the United States.<\/p>\n
The legislation, known as the \u201cBig Beautiful Bill,\u201d now goes to the president to be signed into law. Trump previously assigned an arbitrary deadline of July 4.<\/p>\n
\n
\n
\n
\n
\n
\n
\n
\n![\"The](\"https:\/\/www.europesays.com\/us\/wp-content\/uploads\/2025\/07\/capitol_stock.jpg\")
\n
\n
\n The House has passed the Trump administration\u2019s sweeping domestic agenda bill with massive implications for health care in the United States. Image: Adobe Stock
\n <\/p>\nThe bill includes tax cuts and increased funding for defense, immigration enforcement and energy production. Leading up to the vote, House Speaker Mike Johnson<\/b> <\/b>said the bill will \u201cmake this country stronger, safer and more prosperous than ever before, and every American is going to benefit from that.\u201d<\/p>\n
Researchers warned against the detrimental impacts of an earlier version of the bill<\/a>, which they said would lead to at least 16,000 annual preventable deaths and leave at least 7 million without insurance. But as the bill has passed through the Senate, and then the House again, changes have been made that would worsen these impacts.<\/p>\n
For example, the Senate version of the bill adds roughly $1 trillion more to the deficit than the version the House passed back in May and leaves millions more Americans uninsured than that initial estimate.<\/p>\n
These impacts remain in the version of the bill that passed on Thursday.<\/p>\n
\u201cThis big, beautiful bill \u2014 in terms of its impact on health care, on how physicians and hospitals are going to navigate the next few years \u2014 I think is the biggest immoral piece of health care legislation I\u2019ve ever seen,\u201d Arthur L. Caplan, PhD,<\/b> a professor and founding head of the division of medical ethics at NYU Grossman School of Medicine, told Healio. \u201cJust unethical, indefensible and tragic.\u201d<\/p>\n
The details<\/p>\n
Over the next decade, federal support for Medicaid will be cut by $930 billion.<\/p>\n
Plus, for the first time in the program\u2019s nearly 60-year history, certain able-bodied adults aged 19 years to 64 years will be required to work, participate in job training, volunteer or enroll in school at least 80 hours a month to maintain their Medicaid benefits. This will also be required for parents of children aged 14 years and older.<\/p>\n
Medical organizations, including the AMA, ACP, the American College of Obstetricians and Gynecologists and the Emergency Nurses Association, condemned the Medicaid cuts. ACP President Jason M. Goldman, MD, MACP,<\/b> said they \u201cwill have devastating consequences for the American health care system and the health of the American public.\u201d<\/p>\n
\u201cSlashing Medicaid in the way that they propose, leading millions to go without insurance, and then adding on a work requirement in many states to stay on Medicaid is punishing our poorest, most vulnerable, disabled, mentally ill population,\u201d Caplan said. \u201cI can\u2019t imagine any ethical system \u2014 secular or religious \u2014 that would say, \u2018So if you want to reform the economy, one place to start is cut basic health care for your poorest people.\u2019 And that is what\u2019s going on here.\u201d<\/p>\n
There are also new changes to the Affordable Care Act (ACA), which the Trump administration and its allies have long sought to dismantle, that are projected to reduce enrollment. Policyholders will no longer be able to automatically reenroll, but they must update their information annually. The window to do that has also been shortened \u2014 the open enrollment period will now end about a month earlier.<\/p>\n
Additionally, anyone applying for ACA coverage outside of that period (because they changed jobs or need to add family members to their policy, for example) will need to wait for all of their documentation to be processed before they can receive government subsidies to help pay for their monthly premiums, according to NPR. But today, they can receive 90 days of help with their premiums while their applications are pending, as this process can take weeks. Proponents of the change have argued it is necessary to reduce fraudulent enrollments, NPR reported.<\/p>\n
Between the projected cuts to Medicaid and changes to the ACA, the Senate version of the bill would leave approximately 11.8 million more uninsured in 2034, according to an analysis from the Congressional Budget Office released Sunday.<\/p>\n
These patients who will no longer be able to access preventive services do not just disappear, Caplan stressed. They will end up in emergency rooms, further straining an already stressed system.<\/p>\n
\u201cOne word of warning for doctors: be ready to institute much more aggressive triage if you\u2019re working in an ER, because all of these people \u2014 the millions who are getting dropped, are the ones who can\u2019t do copays, the ones who lose their ACA coverage \u2014 they don\u2019t go nowhere. They go to the ER and they sit there with their headache, or kid with a cough, or chest pain and on and on,\u201d Caplan said. \u201cThat means enormous strain on ERs, which were not meant to handle primary care, and it also means all of us face much longer waiting times, if that\u2019s possible, in ERs. There\u2019s going to be a lot more people there.\u201d<\/p>\n
\u201cThese cuts, they look like they\u2019re just going to hurt very poor people, but they will hurt everybody,\u201d he continued. \u201cHospitals will close, ERs will be jammed and services will get reduced.\u201d<\/p>\n
The bill will also impact the federally funded Supplemental Nutrition Assistance Program (SNAP) and the roughly 42 million Americans who use the assistance. The bill makes it more difficult to qualify for SNAP benefits as well as reduces the benefits for anyone who is eligible, according to The New York Times.<\/p>\n
Currently, everyone except for parents with dependents must work until age 54 years to qualify, but the bill raises that age to 64 years for everyone except parents with children aged 7 years or younger. According to The New York Times, millions will now lose their benefits and many more will receive less than they do now ($292 for one person; $975 for a family of four).<\/p>\n
Access to reproductive and sexual health has also been diminished. The bill included a provision to defund Planned Parenthood by making it ineligible to serve patients on Medicaid. This will be a major blow, according to the Contraceptive Access Initiative. In 2021, 10% of women on Medicaid who received family planning services did so at a Planned Parenthood location. (The recent South Carolina SCOTUS case<\/a> paved the way for the provision.)<\/p>\n
Caplan noted that the bill does nothing to address the key issue: why is health care in the U.S. so expensive?<\/p>\n
\u201cIf you have the most expensive, inefficient health care system in the world \u2014 which we do \u2014 then you don\u2019t do something about its cost and its prices, no wonder you\u2019re cutting access through disqualifying people for Medicaid,\u201d he said. \u201cYou must \u2014 and they didn\u2019t \u2014 take on the attempts to get prices … under control.\u201d<\/p>\n
\u201cThey have failed completely to attack the core problem: … the cost of health care,\u201d Caplan continued. \u201cThis big bill does nothing to address that. Zero.\u2019\u201d<\/p>\n
Good news? Or just adding lifeboats to a sinking ship?<\/p>\n
The bill also increases reimbursement rates for providers and lowers the cap on taxes that states levy on providers to help fund Medicaid.<\/p>\n
However, this only applies to Washington DC and the 40 states that have already expanded Medicaid. And curtailing provider taxes \u2014 which almost every state has used for decades to increase Medicaid payments to nursing homes, hospitals and more, according to NPR \u2014 will lead to more strain on rural hospitals, which usually \u201coperate on thin profit margins and rely on Medicaid tax payments to sustain them,\u201d NPR said.<\/p>\n
\u201cThe income that normally would be going to hospitals that have Medicaid patients is going to drop. That means, for sure, some rural hospitals are going to be in trouble right away because they\u2019re merely scrimping by,\u201d Caplan said. \u201cThey\u2019re going to reduce their services for everybody, or just close.\u201d<\/p>\n
Caplan noted that the Senate added a $50 billion fund \u201cto help cushion the blow of dropping Medicaid, but it doesn\u2019t match what the income loss will be by throwing all these people off the government Medicaid program and the ACA coverage.\u201d<\/p>\n
It is also unclear if the increased reimbursement rates will make up for the lost payments physicians will face as their patients lose Medicaid coverage.<\/p>\n
\u201cThat\u2019s nibbling on the edge,\u201d Caplan said. \u201cThat\u2019s like saying, \u2018Well, the ship is going to sink, but we did add two lifeboats for the 1,000 people that are on it.\u2019\u201d<\/p>\n
Similarly, the bill includes a 1-year, 2.5% increase to the Medicare Physician Fee Schedule for 2026, which is meant to \u201caccount for \u2018exceptional circumstances\u2019 impacting physician practices,\u201d according to the American Osteopathic Association (AOA). Although this will be helpful in the short-term, according to the AOA, \u201cthis increase is temporary and does not address the long-term instability of the Medicare payment system.\u201d<\/p>\n
Another potential positive is that the bill solidifies some telehealth flexibilities, according to the American Telemedicine Association. The legislation included \u201ca key telehealth provision\u201d that reinstates and makes permanent first-dollar coverage for High-Deductible Health Plan-Health Savings Accounts.<\/p>\n
Still, AMA President Bobby Mukkamala, MD,<\/b> said the bill ultimately \u201cmoves us in the wrong direction.\u201d<\/p>\n
\u201cIt 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. That is disappointing, maddening, and unacceptable,\u201d he said in a statement.<\/p>\n
For more information:<\/p>\n
Arthur Caplan, PhD,<\/b> can be reached at primarycare@healio.com<\/a>. <\/p>\n
References:<\/p>\n
- \n
- ATA action gives high praise to U.S. Senate for including permanent telehealth provision in draft legislation, to benefit millions of American workers and employers. Available at: https:\/\/www.americantelemed.org\/press-releases\/ata-action-gives-high-praise-to-u-s-senate-for-including-permanent-telehealth-provision-in-draft-legislation-to-benefit-millions-of-american-workers-and-employers\/<\/a>. Published June 28, 2025. Accessed July 2, 2025.<\/li>\n
- Estimated budgetary effects of an amendment in the nature of a substitute to H.R. 1, the One Big Beautiful Bill Act, relative to CBO\u2019s January 2025 baseline. Available at: https:\/\/www.cbo.gov\/publication\/61534<\/a>. Published June 29, 2025. Accessed July 2, 2025.H.R.1 – One Big Beautiful Bill Act. Available at: https:\/\/www.congress.gov\/bill\/119th-congress\/house-bill\/1\/text<\/a>. Accessed July 2, 2025.<\/li>\n
- New York Times. What are SNAP benefits and how might they change? Available at: https:\/\/www.nytimes.com\/2025\/07\/01\/dining\/snap-food-stamps-trump-bill.html<\/a>. Published July 1, 2025. Accessed July 3, 2025.<\/li>\n
- NPR. 5 ways Trump\u2019s tax bill will limit health care access. https:\/\/www.npr.org\/sections\/shots-health-news\/2025\/07\/02\/nx-s1-5453870\/senate-republicans-tax-bill-medicaid-health-care<\/a>. Published July 2, 2025. Accessed July 2, 2025.<\/li>\n
- Senate reconciliation bill advances: What happens next? https:\/\/osteopathic.org\/2025\/07\/02\/senate-reconciliation-bill-advances-what-happens-next\/<\/a>. Published July 2, 2025. Accessed July 2, 2025.<\/li>\n
- What they are saying: Senate approves landmark One Big Beautiful Bill. https:\/\/www.whitehouse.gov\/articles\/2025\/07\/what-they-are-saying-senate-approves-landmark-one-big-beautiful-bill\/<\/a>. Published July 1, 2025. Accessed July 3, 2025.<\/li>\n<\/ul>\n
\n
\n Perspective
\n Back to Top <\/a><\/p>\n![\"Rita](\"https:\/\/www.europesays.com\/us\/wp-content\/uploads\/2025\/07\/kuwahara_rita.jpg\")
<\/p>\nToday\u2019s House passage of the Senate-passed 2025 reconciliation bill will have devastating impacts on the health of families across our nation. This bill, which will imminently be signed into law, threatens millions of families\u2019 access to critical health services and nutrition. <\/p>\n
The health provisions in this bill will cause over $1 trillion in cuts to Medicaid and ACA marketplace coverage and will cause substantial reductions in federal funding for SNAP. In addition, many categories of lawfully present immigrants, including refugees, asylees and survivors of domestic violence and human trafficking, will lose eligibility for Medicare, Medicaid, CHIP, ACA coverage and SNAP.<\/p>\n
Without access to basic health and nutrition services, our nation\u2019s families and communities will experience worsening health outcomes and a rise in preventable deaths.<\/p>\n
It is unacceptable to politicize access to health care, yet the Republican-majority U.S. Senate and House have passed a partisan bill that will cause an estimated 17 million people in our nation to lose health insurance coverage, including 1.1 million Asian Americans, Native Hawaiians and Pacific Islanders. This bill will also destabilize our health care system and severely limit access to primary care.<\/p>\n
Community health centers, which form the backbone of primary care in our nation and care for families living in rural and underserved communities, will be disproportionately affected by this bill, losing an estimated $7 billion in uncompensated care due to families\u2019 anticipated loss of Medicaid and ACA health insurance coverage, which will threaten the financial viability and range of services offered by our nation\u2019s community health centers and threaten access to essential primary care. Further, by jeopardizing families\u2019 Medicaid and ACA coverage, rural hospitals, which are already under strain, will face increased risks of closure or will be forced to significantly reduce the critical and life-saving services they provide. <\/p>\n
The harm that this bill will do to the health of our families and nation will last for decades. Access to health care and food is a basic human right and should be a nonpartisan issue. It is, therefore, extremely disappointing that this bill was allowed to pass both chambers of Congress and we must do everything in our power to counter the detrimental health effects of this bill.<\/p>\n
Rita K. Kuwahara, MD, MIH, FACP<\/p>\n
Primary Care Internal Medicine Physician<\/p>\n
Association of Asian Pacific Community Health Organizations<\/p>\n
Healio Primary Care Peer Perspective Board Member<\/p>\n
\n Disclosures: <\/strong> Kuwahara reports no relevant financial disclosures. \n <\/p>\n
\n
\n
\n Add topic to email alerts
\n \n <\/p>\n
\n Receive an email when new articles are posted on \n <\/p>\nPlease provide your email address to receive an email when new articles are posted on .<\/p>\n
“
\n data-action=”subscribe”>
\n Subscribe <\/p>\n - Estimated budgetary effects of an amendment in the nature of a substitute to H.R. 1, the One Big Beautiful Bill Act, relative to CBO\u2019s January 2025 baseline. Available at: https:\/\/www.cbo.gov\/publication\/61534<\/a>. Published June 29, 2025. Accessed July 2, 2025.H.R.1 – One Big Beautiful Bill Act. Available at: https:\/\/www.congress.gov\/bill\/119th-congress\/house-bill\/1\/text<\/a>. Accessed July 2, 2025.<\/li>\n
- ATA action gives high praise to U.S. Senate for including permanent telehealth provision in draft legislation, to benefit millions of American workers and employers. Available at: https:\/\/www.americantelemed.org\/press-releases\/ata-action-gives-high-praise-to-u-s-senate-for-including-permanent-telehealth-provision-in-draft-legislation-to-benefit-millions-of-american-workers-and-employers\/<\/a>. Published June 28, 2025. Accessed July 2, 2025.<\/li>\n