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HOW WILL HEALTH CARE CHANGE FOR YOU FROM THE “ONE BIG BEAUTIFUL
BILL ACT”?  
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Rachel Madley
July 23, 2025
HEALTH CARE un-covered
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_ Here are the dates that things will change, and what the changes
means for Americans. Below is a guide that describes what changes you
may encounter and examples of what these changes will look like to you
and your loved ones. _

Image credit: HEALTH CARE un-covered,

 

Recent passage of President Trump’s economic agenda has dominated
news coverage. However, in our already complex health care system it
can feel impossible to understand how the law will impact your health
care, especially if you are not directly insured by one of the
programs that is being cut. Below is a guide that describes what
changes you may encounter and examples of what these changes will look
like to you and your loved ones. In future pieces we will explore how
you can protect yourself from the sweeping reductions in funding and
other changes to the system.  

As you will see, there are a lot of changes, some not happening for a
few years, but some will affect you sooner than you might expect,
regardless of where you currently get your coverage. The cuts to
Medicaid and the new work requirements have been the focus of most
stories, but the law and the reaction of insurers and health care
providers will impact all of us.  

For example, as insurers release their proposed rates for 2026,
enrollees could see their premium increase by an average of 75%
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to what they are currently paying. On top of that, Curtis Medical
Center in rural Nebraska has announced that it will be closing due to
coming Medicaid cuts and other strains, the first of many hospitals
expected to close, leaving an untold number of patients without
convenient access to care. In addition:

IMMEDIATE changes to the Medicare Savings Programs will make it
harder for people to enroll in this Medicaid program, which pays
Medicare premiums and cost sharing for low income seniors.
Currently, 31 states
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enroll people in the Medicare Savings Programs if they receive
Supplemental Security Income (SSI), easing the application burden for
these patients. The bill prohibits states from doing this until 2034,
which will lead to more obstacles for seniors trying to enroll in this
program. The bill also changes the process for determining
eligibility, meaning low-income seniors could be forced to travel to
an interview to prove they need help paying their medical costs. 

REAL WORLD EXAMPLE: _You apply for and begin receiving Supplemental
Security Income because you are over the age of 65 and have a low
income. You do not know about the Medicare Savings Programs so you
never apply and have to pay 20% 
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your monthly SSI benefits to Medicare Part B premiums, and a large
portion of your benefits go toward out-of-pocket costs for your
medical care. If this bill had not prohibited states from enrolling
you in the Medicare Savings Programs when you got approved for SSI,
you would have little to no out-of-pocket medical costs and would be
better able to afford other necessities. _

Hospitals and nursing facilities will IMMEDIATELY have their
payments from Medicaid cut because the bill prohibits states from
instituting new payment levels to these facilities more than the
Medicare rate in states that expanded Medicaid, and 110% of the
Medicaid rate in other states. The bill also requires a 10% decrease
in payments currently in place that exceed these caps each year until
reaching the cap January 1, 2028. Without additional policy changes to
address how hospitals are paid, this will reduce hospital revenue.
This almost certainly will affect access to hospitals and nursing
facilities and the quality of care they provide. 

REAL WORLD EXAMPLE: _You receive care at a nursing facility in
Michigan that serves a large population of Medicaid patients. The
facility previously received payments higher than the Medicare payment
rate, which enabled them to care for those patients. Now that payments
will decrease, and it might have to close, leaving you without nearby
care. _

Medicaid reimbursement for services such as cancer screenings and
birth control provided by Planned Parenthood and related organizations
have been IMMEDIATELY stopped. 

REAL WORLD EXAMPLE: _You are a young woman in college and on Medicaid
who receives her annual exam at Planned Parenthood. Now that this bill
has passed, Planned Parenthood cannot participate in Medicaid so you
must find a new doctor who is accepting new patients, takes Medicaid,
and is close to your college campus. Due to decreases in Medicaid
funding nationwide, these providers undoubtedly will be difficult to
find. _

Beginning in SEPTEMBER 2025, there will be $50 billion in grants
available to states for payments to rural health care providers, a
tenth of what Sen. Susan Collins (R-Maine) had sought. The $50 billion
is just 5% of the $1 trillion in funding the new law will cut from
Medicaid and is almost certainly not enough to prevent more rural
hospitals from closing. 

REAL WORLD EXAMPLE: _You live in a rural area and your community
hospital receives a grant from this funding. Unfortunately, the grant
is very small compared to the funding your hospital stands to lose
from changes to Medicaid eligibility, provider taxes, and state
payments, so your hospital might not be able to stay open. _

On JANUARY 1, 2026, ACA insurance plan premiums will increase by a
median of 15%, and there will be a 75% increase in out-of-pocket
premium payments each month for the average ACA enrollee. 

REAL WORLD EXAMPLE: _You and your family of three earn $110,000 and
are enrolled in an ACA silver plan in 2025 and pay $779 in premiums
per month. You receive your expected premium notice for 2026 and see
that your monthly premium payments will jump to $1,662,
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increase of $883 per month. You decide you cannot afford that increase
and will have to go without health insurance in the future. _

Beginning OCTOBER 1, 2026, lawfully present immigrants including
refugees, individuals granted asylum or parole for at least one year,
and certain survivors of domestic violence or trafficking will no
longer be eligible for Medicaid. 

REAL WORLD EXAMPLE: _You are an immigrant granted asylum and are in
the U.S. legally and on Medicaid. You will lose your Medicaid coverage
on October 1, 2026. _

Eligibility redeterminations, including meeting work and other
requirements for Medicaid, will now be required at least every six
months rather than once a year if you are 19-64 years old and make
$15,060-$20,779 (for a one-person household). Increased
redeterminations will begin DECEMBER 31, 2026. 

REAL WORLD EXAMPLE: _You are on Medicaid and make $20,000. You
completed your annual Medicaid redetermination at the beginning of
2027 then moved to a new apartment. You are sent a Medicaid
eligibility redetermination letter in June 2027 but it does not get to
you at your new address. You are disenrolled from Medicaid and no
longer have health insurance. You try to call your state Medicaid
office but the wait times are longer than they had been because of the
increased call volume, which has historically 
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Medicaid offices because of existing eligibility redeterminations
requirements._

Funding for Medicare will be cut by $490 billion 
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will result in decreased payments to medical providers. This likely
will lead to fewer providers accepting Medicare and physicians and
more hospital closures, especially in rural areas, due to the
financial strain.

REAL WORD EXAMPLE: _You are a senior on Medicare who has been seeing
the same primary care doctor for more than 20 years. Due to the cuts
to Medicare payments to providers for their services, your physician
might not be able financially to continue treating patients on
Medicare. You are forced to find a new doctor.  _

Starting on OCTOBER 7, 2027, federal funding to states that expanded
Medicaid will decrease due to changes to a wonky provision called a
provider tax. For example, in New York funding will decrease by $3.3
billion
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2032. This funding decrease will put more than 300 rural hospitals
nationwide 
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risk of closure. It will also leave states with billions of dollars in
funding gaps for their Medicaid program, which will force them to
decrease provider payment rates or enroll fewer people in their
Medicaid programs. 

REAL WORLD EXAMPLE: _You are a patient at Lincoln Community Hospital
and Care Center in Hugo, Colorado. The CEO just announced 
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may have to start cutting services for patients because of impending
cuts to federal funding through changes to provider taxes. You are
uncertain if you will have a hospital you can get to for needed care.
On top of this, you do not know if your state will be forced to
decrease enrollment in Medicaid, which could leave you without health
insurance. _

If you are on Medicaid, your out-of-pocket medical expenses could go
up. The bill requires states to impose cost sharing, often called
co-pays, for medical services received by adults on Medicaid because
of the expansion. This means that if you are over 18 and make
$15,060-$20,779 (one person household) you will have co-pays,
sometimes up to $35 when you go to the doctor. Of note, primary care,
mental health, substance use disorder services, services from FQHCs
and rural health clinics are exempt. These co-pay requirements will
start OCTOBER 1, 2028. 

REAL WORLD EXAMPLE: _You go to your endocrinologist in New Jersey for
treatment of diabetes and your income is $17,000 and you are on
Medicaid. Starting in the fall of 2028 you will be required to pay up
to $35 for this visit, which previously did not require a copayment.
This could make it financially difficult, maybe impossible, to keep up
with your diabetes care._

Work reporting requirements will be instituted for Medicaid enrollment
and continuity by DECEMBER 31, 2028. HOWEVER, STATES CAN CHOOSE TO
IMPLEMENT THEM EARLIER. This means that if you are applying for or on
Medicaid, between the ages of 19 and 64 and have an income 100-138% of
the federal poverty line ($15,060-$20,779 for a one-person household)
you are required to work or participate in “qualifying activities”
for at least 80 hours per month and report those activities through
your state. This also means you must fulfill the work requirement for
at least one month before applying for Medicaid. If your Medicaid
application is denied or you are disenrolled for not meeting the work
requirements, you are prohibited from purchasing subsidized health
plans on the Marketplace. Parents with children under the age of 13
and those who are medically frail are exempt from these
requirements. 

REAL WORLD EXAMPLE: _You are in your 30s and make $20,000 and you are
on Medicaid. You are not successfully contacted by your state to
report your work status because, as history has shown
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states fail to successfully contact many Medicaid recipients when
instituting work requirements. You are then disenrolled from Medicaid
because of the complex work reporting system your state set up and
wind up uninsured. You try to enroll in a subsidized Marketplace plan
but are ineligible because you were disenrolled from Medicaid due to
the work reporting requirements. This will start happening in every
state in 2029. _

The staggered implementation of these health care cuts and targeting
of Medicaid and Medicare may make it seem like a lot of small changes
to our health care system that will not affect you. But they will
unless Congress acts soon to change the law, regardless of the type of
coverage you have, especially if your local hospital closes, your
doctor stops seeing patients on Medicare and Medicaid and even other
types of insurance, or a family member or friend loses coverage and
can’t get the care they need.  Emergency rooms of hospitals that
are able to stay open likely will become more crowded, potentially
leaving you without the rapid care needed in a true emergency. The
amount of uncompensated care at those hospitals will go up, which in
turn will mean your private health insurance premiums likely will also
go up, along with your own out-of-pocket costs. Finally, none of the
changes in this bill address the growing power that Big Insurance has
over our health care, meaning that insurers will continue their
abusive practices of delaying and denying care causing more obstacles
for you. And states likely will contract with private insurers to
administer the new work requirements, which will be new revenue for
them but higher administrative costs we all will pay for.

A shock to our entire health care system is coming and the dominos are
about to fall. 

_[RACHEL MADLEY is Director of Policy and Advocacy at the Center for
Health & Democracy. She previously worked for Congresswoman Pramila
Jayapal. She received her PhD from Columbia University and has written
for publications including The New York Times.]_

_HEALTH CARE un-covered is a reader-supported publication. To receive
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_Pulling back the curtains on how Big Health is hurting Americans and
how we got to this point._
 

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