How Trump bill Medicaid cuts will impact U.S. health care

President Donald Trump‘s “big beautiful bill” would make sweeping changes to U.S. health care, leaving millions of vulnerable Americans without health insurance and threatening the hospitals and centers that provide care to them. 

The Senate on Tuesday voted 51-50 to pass the spending measure after a marathon overnight voting session on amendments. But the bill will face another major test in the House, where Republicans have a razor-thin majority and some members have already raised objections to the legislation. 

Recent changes to the bill would cut roughly $1.1 trillion in health-care spending over the next decade, according to new estimates from the nonpartisan Congressional Budget Office.

More than $1 trillion of those cuts would come from Medicaid, a joint federal and state health insurance program for disabled and low-income Americans, according to the CBO. The funding cuts go beyond insurance coverage: The loss of that funding could gut many rural hospitals that disproportionately rely on federal spending.

The CBO estimates that the current version of the bill would result in 11.8 million people losing health insurance by 2034, with the majority of those people losing Medicaid coverage.

But the implications could be even bigger. Trump’s bill combined with separate policy changes could result in an estimated 17 million people losing health insurance, said Robin Rudowitz, director of the program on Medicaid and the uninsured at health policy research organization KFF.

She said those other changes include new regulations that would dramatically limit access to Affordable Care Act Marketplace coverage and expiring enhanced ACA tax credits.

“If all of this comes to pass, it would represent the biggest roll back of health insurance coverage ever due to federal policy changes,” Cynthia Cox, KFF’s director of the program on the ACA, said in an analysis published Tuesday. 

Approximately 72 million Americans are currently enrolled in Medicaid, about one-fifth of the total U.S. population, according to government data. Medicaid is the primary payer for the majority of nursing home residents, and pays for around 40% of all births. 

The Trump administration and its allies insist the cuts in the bill aim to eliminate waste, fraud and abuse. Democrats have said they break the president’s repeated promises not to touch the Medicaid program. Medicaid has been one of the most divisive issues throughout negotiations in both chambers, and some House Republicans have expressed reservations about how deep the cuts are. 

“I get that they want to cut fraud, but taking a swipe across the top is not going to solve the issue,” said Jennifer Mensik Kennedy, president of the American Nurses Association. 

She said the cuts could shutter hospitals and health centers in rural areas and lead to job losses for health-care staff such as nurses. 

One would establish a new, strict national work requirement for certain Medicaid beneficiaries ages 19 to 64. It would require childless adults without disabilities and parents of children older than 14 to work, volunteer or attend school for at least 80 hours a month to keep their insurance coverage, unless they qualify for an exception. 

Current law prohibits basing Medicaid eligibility on work requirements or work reporting rules, according to KFF. 

The new work requirement in the bill won’t kick in until 2026. It is projected to save about $325 billion over a decade, the CBO said. 

An analysis published June 23 by the UC Berkeley Labor Center said that the work requirement would cause the most people to lose insurance and “poses an especially draconian barrier to older adults.” The center said there is a steady drop-off in employment after age 50 due to factors “outside [people’s] control,” including deteriorating health, age discrimination and increasing responsibility to provide care for aging family members. 

“These same factors make older adults particularly vulnerable to coverage loss under Medicaid work requirements,” the analysis said.

People living in rural communities, such as seasonal farmers, may also struggle to find employment for parts of the year, Mensik Kennedy said.

AARP, an advocacy group focusing on issues affecting those 50 and older in the U.S., sent a letter over the weekend to Senate Majority Leader John Thune, R-S.D., and Senate Minority Leader Chuck Schumer, D-N.Y., opposing another provision that would disqualify people who fail to meet Medicaid work…