“Big Beautiful Bill” Threatens Coverage, Access for Millions of Low-Income Americans

Sweeping legislation known as the “One Big Beautiful Bill” (OBBBA), recently passed by Congress and championed by President Donald Trump, is expected to dramatically reshape the nation’s safety net — with particularly severe consequences for Medicaid recipients and families relying on public assistance.

While the bill faces fierce opposition from Democrats and social justice advocates for its deep cuts to the safety net, Republicans and other supporters praise it as a measure to reduce federal spending and curb waste, praising it for providing fiscal restraint, pro-work incentives, local control, and conservative cultural values.

The legislation includes hundreds of billions in cuts to Medicaid, introduces new work requirements, and imposes stricter eligibility rules — changes that policy experts warn could result in millions of Americans losing access to healthcare and vital services.

Massive Medicaid Cuts Projected

According to the Congressional Budget Office, the bill slashes federal Medicaid funding by an estimated $793 billion to $930 billion over the next decade. Analysts predict this could lead to as many as 11 million people being removed from the program by 2034.

“These cuts will hit the most vulnerable Americans the hardest — children, seniors, people with disabilities, and low-income families,” said Juliette Gomez, a policy analyst with the Center on Budget and Policy Priorities.

The legislation also reduces the "provider tax" threshold — a mechanism used by states to generate matching federal dollars — from 6% to 3.5% by 2031. That change is expected to strain state budgets and force cuts to optional Medicaid services such as home care, mental health treatment, and nursing home support.

New Work Requirements and Stricter Reviews

Beginning in 2026, adults aged 19 to 64 who are considered able-bodied — including some parents — must meet a monthly minimum of 80 hours of work or approved volunteer service to maintain coverage. The bill also increases eligibility reviews from annually to twice a year and reduces the retroactive coverage window from three months to one.

Critics argue these bureaucratic hurdles will result in eligible individuals losing coverage simply because of paperwork lapses.

“People will fall through the cracks — not because they aren’t eligible, but because they miss a deadline or can't navigate the system,” said Alana Jones, a healthcare navigator based in Rochester, New York. “We’ve seen it before when states tried similar rules.”

Impact on Access and Health Infrastructure

The combination of funding cuts and new mandates could ripple through the broader healthcare system. A report from Time magazine warns that more than 600 nursing homes could close nationwide, while hospital emergency rooms — particularly in rural and low-income urban areas — may see significant strain as more uninsured patients seek care.

Marginalized Groups Face Additional Barriers

The bill includes provisions that bar Medicaid funds from being used for gender-affirming care at any age and restricts funding to providers who perform or refer for abortion services. Immigrants face stricter eligibility rules, and enhanced verification protocols could deter enrollment among mixed-status families.

“The bill’s language is a direct attack on trans people and reproductive freedom,” said Maya McDaniel, a local healthcare worker. “This is about ideology, not fiscal responsibility.”

Economic and Racial Disparities at Stake

While Republican lawmakers have praised the bill as a “fiscally responsible return to limited government,” critics note that the cost burden will fall disproportionately on low-income families. One analysis found that the poorest Americans could lose up to $1,600 a year in benefits, while the wealthiest would see tax cuts exceeding $12,000 annually.

“Let’s be clear — this is a massive wealth transfer,” said Rep. Ayanna Pressley (D-MA). “It punishes the poor to reward the rich.”

Local advocates in Rochester echoed those concerns, warning that Black and Latino communities already facing health disparities could be especially harmed by coverage loss and service reductions.

“The consequences of today’s Congressional passage of the federal budget bill will be devastating to Monroe County, New York State, and the rest of the nation," wrote Monroe County Executive Adam Bello. "Extending tax cuts for the wealthy on the backs of working people by cutting Medicaid and food assistance will damage the health and well-being of our families, and the resulting federal deficit increase will jeopardize our children and grandchildren’s financial future. Despite the upheaval this disastrous legislation will cause, I am committed to working with our government, business and community partners to find ways to support the Monroe County residents who will feel the direct impact.”

Added Benefits for Social Security Recipients

While temporary, the bill does provide some tax benefits for social security recipients. Starting in 2026, a large majority of older Americans can retain more of their benefits post-tax— Individuals aged 65 or older will receive an additional $6,000 deduction (married couples get $12,000) on taxable income from 2026 through 2028, as long as income stays under set thresholds ($75k individual / $150k joint, phasing out by $175k/$250k).

According the the CBO, with this boost, approximately 88% of seniors will pay no federal tax on their Social Security benefits, compared to around 64% under prior law. However, it is a temporary tax deduction, not a complete tax repeal — and expires in 2028.

What’s Next

Implementation of many of the bill’s Medicaid changes will fall to the states, which could offer waivers or modify enforcement. New York State officials have not yet released a full response to the bill’s passage, but advocates are already preparing to fight back.

“This is not over,” said Jones. “We’ll fight every rollback that hurts our communities — because healthcare is a right, not a privilege.”