President Donald Trump's proposed health care bill is set to introduce significant changes to the U.S. health care system, potentially leaving millions of vulnerable Americans without health insurance. This ambitious legislation poses a serious risk to hospitals and health care centers that currently provide essential services to these populations. On Tuesday, the Senate narrowly passed the spending measure with a vote of 51-50 after a lengthy overnight session filled with amendments. However, the bill now faces a critical challenge in the House, where Republicans hold a slim majority and some members have already expressed concerns about the implications of the legislation.
Recent estimates from the nonpartisan Congressional Budget Office (CBO) indicate that the latest revisions to the bill could lead to approximately $1.1 trillion in health care spending cuts over the next decade. A staggering portion of these cuts—more than $1 trillion—would come from Medicaid, the joint federal and state health insurance program that supports disabled and low-income Americans. Beyond merely affecting insurance coverage, these funding reductions could jeopardize the viability of many rural hospitals that heavily depend on federal funding.
The CBO projects that the current version of the bill could result in 11.8 million individuals losing their health insurance by the year 2034, with the majority of these losses stemming from Medicaid coverage. However, further analysis by Robin Rudowitz, director of the program on Medicaid and the uninsured at KFF, suggests that Trump's bill, when coupled with additional policy changes, could lead to an estimated 17 million people losing their health insurance. These additional changes include new regulations that would significantly restrict access to the Affordable Care Act Marketplace coverage and the expiration of enhanced ACA tax credits.
If these proposed changes are enacted, they could represent the most considerable rollback of health insurance coverage in U.S. history due to federal policy changes, as noted by Cynthia Cox, KFF's director of the program on the ACA, in a recent analysis. Presently, around 72 million Americans are enrolled in Medicaid, accounting for about one-fifth of the U.S. population. Medicaid serves as the primary payer for most nursing home residents and covers roughly 40% of all births in the country.
The Trump administration and its supporters contend that the proposed cuts aim to eliminate waste, fraud, and abuse within the system. In stark contrast, Democrats have criticized these changes as a breach of the president's repeated assurances to protect the Medicaid program. Medicaid has consistently been a contentious issue during negotiations in both chambers of Congress, with some House Republicans voicing their discomfort regarding the depth of the proposed cuts.
Jennifer Mensik Kennedy, president of the American Nurses Association, emphasized the potential consequences, stating that while the intention may be to reduce fraud, the broad cuts could lead to hospital closures and job losses among healthcare workers, particularly nurses.
The cuts outlined in the bill originate from several provisions, with the bulk of the Medicaid savings coming from two key changes. One significant provision introduces stringent national work requirements for certain Medicaid beneficiaries aged 19 to 64. This new requirement would mandate that childless adults without disabilities and parents of children over the age of 14 must engage in work, volunteer activities, or educational pursuits for at least 80 hours per month to maintain their insurance coverage, barring any exceptions. Currently, federal law does not allow for Medicaid eligibility to be contingent upon work requirements or reporting rules.
Scheduled to take effect in 2026, this work requirement is projected to save approximately $325 billion over the next decade, according to the CBO. An analysis from the UC Berkeley Labor Center indicates that these work requirements may disproportionately impact older adults, who often face declining employment rates due to age-related health issues, discrimination, and caregiving responsibilities.
Individuals living in rural areas, including seasonal workers, may find it increasingly difficult to meet these employment requirements, according to Mensik Kennedy. AARP, an advocacy organization representing Americans aged 50 and above, has also expressed concerns over another provision that would disqualify individuals who do not meet Medicaid work requirements from receiving premium tax credits for purchasing coverage through the ACA Marketplaces. This creates a precarious situation for those in their 50s and early 60s, particularly for individuals nearing retirement or those working part-time, leaving them with limited access to affordable coverage options.
Another significant source of Medicaid savings will arise from a provision that will cap and gradually reduce the taxes that states can impose on hospitals, health plans, and other medical providers. These provider taxes are essential for funding state Medicaid programs, with the federal government matching a portion of state expenditures. Some Trump administration officials and conservative lawmakers argue that these taxes create a loophole, allowing states to receive more federal funds than they contribute.
However, experts and some GOP senators have raised alarms about the potential consequences of capping provider taxes, which could threaten vital funding for rural hospitals, leading to closures that could devastate their communities. Mensik Kennedy warned that the loss of Medicaid funding could exceed 20% in over half of the states, pushing hospitals that are already struggling further into financial jeopardy.
In a notable development, Senate Republicans have included a provision in the bill that benefits drug manufacturers by exempting more medicines from the Inflation Reduction Act’s Medicare drug price negotiations. This provision, known as the ORPHAN Cures Act, will allow medications used to treat multiple rare diseases to be excluded from these price negotiations. The pharmaceutical industry argues that this exemption will stimulate further investment in treatments for rare conditions.
While advocates for the pharmaceutical sector argue that only 5% of rare diseases currently have an approved treatment, critics, including the drug pricing group Patients For Affordable Drugs Now, have called for the removal of the ORPHAN Cures Act from the bill, arguing that it undermines progress made toward lowering drug prices. The group highlighted that including this provision represents a substantial financial giveaway to the pharmaceutical industry, costing taxpayers an estimated $5 billion over the next decade, as stated by executive director Merith Basey.
The implications of President Trump's health care bill are far-reaching, with potential consequences for millions of Americans. As the legislation moves to the House, it remains to be seen how these proposed changes will be received and whether they will pass into law. The future of health care in the United States hangs in the balance, with many advocating for a more equitable approach that ensures access to care for all citizens.
