America’s Changing Healthcare System
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Most people know that the One Big Beautiful Bill Act, or “OBBBA” that President Donald Trump signed into law on July 4, 2025 is drastically changing America’s healthcare system. But they are hearing contradictory reports about what the legislation does.
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The Reports below are intended to translate the technical healthcare jargon so that the public can understand who is responsible for the cuts, how and when the cuts are being implemented, and the direct and indirect impacts of those cuts. Co-written with input from active physicians, the reports cover Medicaid, Medicare, and the Affordable Care Act Premium Tax Credits, and are fully sourced via hyperlinks and footnotes.
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NOTE: Starting in late 2025, the Trump Administration sought to re-brand the deeply unpopular “One Big Beautiful Bill” as the “Working Families Tax Cut”.
- Although Trump said over1 and over 2 and over 3 he would not cut Medicaid or Medicare, the OBBBA will result in a massive contraction in federal spending across all federal and state-supported health insurance programs. The OBBBA is projected to result in over 14 million4 more uninsured people by 2034. Every Democrat in Congress opposed the bill, and nearly every Republican5 voted for the OBBBA despite the devastating impacts it will have on their constituents. Many6 Republicans misrepresented7 the impacts8 of the legislation, while others acknowledged 9 the catastrophic consequences10 for their most vulnerable constituents, but voted11 for it anyway, or didn’t read12 the bill.
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BOTTOM LINE: The OBBBA13 will increase health care costs14 for everyone15 — Americans with Medicaid, Medicare, Affordable Care Act (ACA) Marketplace plans, and job-based private insurance. As millions lose health coverage, fewer people covered by Medicaid, Medicare and private insurance will result in a change in insurance risk pools,16 which will result in higher costs17 for those remaining in the market. In addition, reduced hospital revenues will result in higher prices for middle-class and wealthy patients18 covered by private insurance.19 And, private job-related insurance costs will go up because insurance companies will be spending more money caring for sicker people. Fewer people will be able to afford the higher premiums so monthly premiums and out-of-pocket-expenses will rise.
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Endnotes
- Rapid Response47 (@rapidresponse47) “Exclusive Interview with President Trump and Elon Musk” https://x.com/RapidResponse47/status/1892045754178420930. February 18, 2025.
- Sanger-Katz, M. (2019, February 19) Trump Says Medicaid Won’t Be ‘Touched.’ House Republicans Want It Cut by Hundreds of Billions. New York Times. https://www.nytimes.com/2025/02/19/upshot/trump-medicaid-tax-cuts.html
- RapidResponse47 (@rapidresponse47) “Can you guarantee…” February 26, 2025. https://x.com/RapidResponse47/status/1894802469445591437
- Burns, A et al. (2025, August 20). “How Will the 2025 Reconciliation Law Affect the Uninsured Rate in Each State?” KFF https://www.kff.org/medicaid/how-will-the-2025-reconciliation-law-affect-the-uninsured-rate-in-each-state/.
- Koplowitz,H. (2025, July 3). These are the 5 Republicans who voted against Trump’s ‘Big Beautiful Bill’ All Alabama. https://www.al.com/politics/2025/07/these-are-the-5-republicans-who-voted-against-trumps-big-beautiful-bill.html.
- DeStefano, A. (2025, July 7) “Rep. Mike Lawler Has “Donald Trump’s Leash Around His Neck” Says Congressman Dan Goldman” MSN. https://www.msn.com/en-us/news/news/content/ar-AA1IdaDg?ocid=sapphireappshare
- Lalota, Nick (2025, March 5) “Congressman Nick LaLota: Resolved to Make Long Island Safer and More Affordable” https://lalota.house.gov/media/videos/congressman-nick-lalota-resolved-make-long-island-safer-and-more-affordable
- Manuel, O. et al. (2025, June 30). Republican Sen. Ron Johnson ‘satisfied’ with Trump’s bill after initial opposition. NPR. https://www.npr.org/2025/06/30/nx-s1-5450284/sen-ron-johnson-on-why-he-decided-to-support-president-trumps-spending-agenda
- Tsirkin, J. (2025, July 9). After voting for Trump’s megabill, GOP Sen. Josh Hawley wants to prevent a key Medicaid cut from taking effect, NBC News. https://www.yahoo.com/news/voting-trumps-megabill-gop-sen-191041808.html
- Karni, A. (2025, July 1). Murkowski Casts Decisive Vote for G.O.P. Policy Bill, Making an ‘Agonizing’ Choice. NY Times. https://www.nytimes.com/2025/07/01/us/politics/murkowski-republican-bill.html#:~:text=Senator%20Lisa%20Murkowski%2C%20Republican%20of,leaders%20to%20insist%20on%20changes.
- Bolton, A. (2025, June 30). Another GOP senator warns Medicaid cuts could boomerang on Republicans. The Hill. https://thehill.com/homenews/senate/5378124-jim-justice-medicaid-trump-bill/
- Sherratt, M. (2025, June 4). “ Rep. Marjorie Taylor Greene roasted for not reading Trump’s ‘big, beautiful bill’. Independent. https://www.aol.com/rep-marjorie-taylor-greene-roasted-093352628.html
- Trebes, N. et. al. (2025, August 20).”One Big Beautiful Bill Act: Understanding the healthcare impacts.” Advisory Board. https://www.advisory.com/topics/strategic-and-business-planning/obbba-healthcare-impacts
- Arguello, A. et. al. (2025, June 12). “House Republicans’ Big, ‘Beautiful’ Bill Would Make Health Care More Expensive for Americans With Medicare and Other Insurance” CAP.. https://www.americanprogress.org/article/house-republicans-big-beautiful-bill-would-make-health-care-more-expensive-for-americans-with-medicare-and-other-insurance/
- Rosen, A. (2025, July 30). How New Federal Legislation Will Affect Health Care Costs and Access for Americans. Johns Hopkins Bloomberg School. https://publichealth.jhu.edu/2025/the-changes-coming-to-the-aca-medicaid-and-medicare
- Carter, J. (2025, June 5).”A Whirlwind of Damage from Republican Budget: Increased Costs for All, Hospitals and Lives at Risk.” Medicare Rights Center. https://www.medicarerights.org/medicare-watch/2025/06/05/a-whirlwind-of-damage-from-republican-budget-increased-costs-for-all-hospitals-and-lives-at-risk?utm_source=chatgpt.com
- Lukens, G. et. al. (2025, August 1). “Administration’s ACA Marketplace Rule Will Raise Health Care Costs for Millions of Families.” Center on Budget and Policy Priorities. https://www.cbpp.org/research/health/administrations-aca-marketplace-rule-will-raise-health-care-costs-for-millions-of
- Goldstein, J.. (2025,July 9).”Why 1.5 Million New Yorkers Could Lose Health Insurance Under Trump Bill. New York Times. https://www.nytimes.com/2025/07/09/nyregion/trump-domestic-policy-bill-new-york-health-care.html
- AON. (2025, August 29). OBBBA and Beyond: Upcoming Policy Changes and Their Impact on Employers.” https://www.aon.com/en/insights/articles/obbba-and-policy-shifts-reshape-employer-health-plans
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