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Who could lose Medicaid? Trump's ‘big, beautiful bill’ threatens health insurance of millions
From older adults to rural residents and immigrants, here’s who may be hit hardest if Republicans pass their sweeping health reform bill.
As Republicans are racing to pass President Donald Trump’s reconciliation bill before the July 4 deadline, concerns are mounting over its dramatic impact on Medicaid, the federal-state health insurance program for low-income Americans. ABC News and Associated Press reported that the bill, informally dubbed the ‘One Big, Beautiful Bill Act’, proposes $1 trillion Medicaid cuts over the next decade.
As per the new projections of the Congressional Budget Office, 11.8 million Americans stand to lose health coverage by 2034 if the bill becomes law. The sweeping legislation, reportedly, also targets the Affordable Care Act (ACA) and the Children’s Health Insurance Program (CHIP). This will significantly shrink federal healthcare spending. Here’s who stands to lose the most:
Older Americans may be forced off coverage
According to ABC News, the bill introduces 80-hour monthly work requirements for non-disabled adults (19-64) without dependents. However, exemptions exist for people with disabilities and parents of children under 14; older adults in their 50s and early 60s will face unique challenges.
Nari Rhee of UC Berkeley told the outlet that many older Americans are physically unable to continue working, especially after years of manual labour. Rhee noted that age discrimination makes it harder to find new work and said even if the elderly wanted to work, navigating the paperwork might be too complex.
“By your late 50s, your body is worn out. Even if you want to work, navigating the paperwork may be too complex,” Rhee said.
Rural Americans may lose access to local hospitals
As per the AP report, cuts to medicaid reimbursement could lead to closure of rural hospitals and clinics, many of which heavily rely on the policy payments to stay afloat. Jennifer Kennedy of American Nurse Association warned the rural hospitals already have tight finances and the shrinking financial grant could compel people to drive for hours to access basic care. She said it was “unacceptable”.
Low-income, homeless populations at risk
The bill would tighten eligibility checks, requiring income and residency verification every six months. Advocates, according to the report, say this will disproportionately affect homeless or transient people, who may miss paperwork notices and lose coverage.
States will also be allowed to delay CHIP enrolment for children if parents fall behind on premium payments, a reversal of current Biden-era protections.
Immigrants could face exclusion
Legal immigrants would also face a drop in federal support, from 90 per cent to 80 per cent, the report said. Several states are already freezing or halting immigrant Medicaid programs, such as California and Illinois.
FAQs
Q: How many people could lose coverage if Donald Trump’s Big Beautiful bill passes?
The Congressional Budget Office estimates 11.8 million Americans would be uninsured by 2034.
Q: Who is most at risk?
A: Older adults, rural residents, low-income families, immigrants and children.
Q: When would the work rules take effect?
A: Starting in 2026, under the current draft of the bill.
