As Republicans hustle to pass Donald Trump’s “One Big Beautiful Bill” by his self-imposed July 4 deadline, a major concern has emerged from within the massive legislation: Medicaid is on the chopping block. The sweeping reconciliation bill includes deep reductions in federal funding to the joint state-federal health program that currently serves over 71 million low-income and disabled Americans. With the Senate version of the bill now projecting $1 trillion in Medicaid cuts over the next decade, the Congressional Budget Office estimates an additional 11.8 million people could be uninsured by 2034 if the bill becomes law.
Trump campaigned on protecting Medicaid, but this new legislation tells a different story. Under the bill, able-bodied adults between ages 19 and 64 without dependents must clock at least 80 hours per month in work or volunteer activities to keep their health benefits. The requirements won’t kick in until 2026, but exemptions only apply to parents of children under 14 or those with disabilities. Health policy experts say the burden of these rules will disproportionately fall on older, low-income adults—especially those between 50 and 64—who are more likely to face health issues or job market discrimination. Even those who are employed may lose coverage simply because they can’t navigate the complicated reporting and paperwork involved.
On top of that, a controversial provision would bar anyone who fails to meet Medicaid’s work rules from accessing Affordable Care Act premium tax credits—creating a healthcare “coverage cliff” for older adults nearing retirement age. AARP has come out strongly against this, stating it would leave millions in their 50s and early 60s with no affordable coverage options.
The potential fallout extends far beyond individual coverage. Healthcare leaders are warning that rural hospitals and community health centers could be forced to shut down as a result of losing Medicaid reimbursement dollars. Though Senate Republicans proposed a $25 billion stabilization fund to soften the blow, medical professionals argue that’s not enough to keep struggling rural facilities afloat.
