^{Photo: NPR}

Millions at Risk: Trump’s "Big Beautiful Bill" Would Cut Medicaid, Endanger Health Coverage, and Threaten Rural Hospitals

President Donald Trump’s newly passed Senate healthcare package — dubbed his “big beautiful bill” — proposes drastic changes to the U.S. health system, with far-reaching consequences for insurance coverage, healthcare access, and hospital stability, especially in rural America.

The bill, narrowly passed in the Senate by a 51-50 vote after a marathon overnight session, now moves to the House, where a razor-thin Republican majority could face significant internal division over the depth and impact of the proposed cuts.

Key Numbers at a Glance

• $1.1 trillion in healthcare cuts over 10 years
• $1 trillion+ specifically slashed from Medicaid funding
• 11.8 million Americans projected to lose health insurance by 2034
• Up to 17 million could lose coverage when combined with other policy changes (KFF estimate)
• 72 million people currently rely on Medicaid
• 40% of all births in the U.S. and most nursing home stays are covered by Medicaid

Massive Medicaid Cuts at the Core of the Bill

According to new estimates from the nonpartisan Congressional Budget Office (CBO), over $1 trillion of the proposed cuts will come directly from Medicaid, the federal-state program that provides health coverage for low-income individuals, people with disabilities, and seniors. These cuts would effectively strip millions of the safety net many rely on for access to basic care, long-term services, and critical prescriptions.

This massive reduction in Medicaid funding could have a devastating ripple effect on rural hospitals and community health centers, which disproportionately depend on Medicaid reimbursements to keep their doors open. Healthcare workers, especially nurses, could face job losses, and hospitals in already underserved regions may be forced to shutter.

Coverage Cliff: Who Loses Insurance Under This Bill?

The CBO predicts 11.8 million people will lose health coverage by 2034, the bulk of them losing Medicaid eligibility. However, KFF (Kaiser Family Foundation) warns that number could balloon to 17 million when accounting for additional federal policy changes — including the expiration of enhanced ACA tax credits and new federal rules narrowing access to Affordable Care Act (ACA) marketplace plans.

“This could be the most significant rollback of health coverage ever enacted through federal legislation,” said Cynthia Cox, Director of KFF’s ACA Program.

Work Requirements: The Harshest Provision?

One of the bill’s most contentious provisions introduces a strict national work requirement for Medicaid recipients aged 19 to 64. Set to begin in 2026, this rule mandates that childless adults and parents of children over 14 work, volunteer, or attend school for at least 80 hours per month to retain coverage.

The CBO estimates this measure alone will save $325 billion over 10 years — but at a steep human cost. The UC Berkeley Labor Center recently warned that the requirement poses an “especially draconian barrier” to older adults, pointing out that job participation declines significantly after age 50 due to health issues, age discrimination, and caregiving responsibilities.

The rule would hit rural Americans hard. Many of them work seasonal or inconsistent jobs, especially in agriculture, making it difficult to consistently meet monthly hour requirements. Jennifer Mensik Kennedy, president of the American Nurses Association, said: “A blanket work requirement doesn’t account for the real lives of vulnerable communities. It’s not a solution. It’s a disqualification tactic.”

Premium Tax Credit Exclusions Could Leave Older Americans with No Options

The bill would also strip access to ACA premium tax credits from anyone disqualified from Medicaid due to the work requirement, even if they can no longer afford private insurance. AARP, which advocates for Americans 50 and older, strongly opposes this provision.

“This creates a steep coverage cliff for those in their 50s and early 60s — particularly those nearing retirement or working part-time — who may be left with no affordable coverage option at all,” AARP wrote in a letter to Senate leaders John Thune and Chuck Schumer.

Rural Hospitals and Jobs at Risk

Hospitals in small towns and rural areas — many of which operate on razor-thin margins — rely heavily on Medicaid reimbursements. A cut of this magnitude could shutter dozens of facilities, leading to loss of local emergency care, specialist access, and thousands of healthcare jobs.

“We’re not just talking about cutting waste,” said Kennedy of the ANA. “We’re talking about cutting lifelines — to care, to employment, and to public health infrastructure.”

Drug Pricing Controversy: A $5 Billion Giveaway?

Another controversial piece of the legislation is the inclusion of the ORPHAN Cures Act, which some lawmakers say is a handout to Big Pharma. The bill allows certain rare-disease drugs to be exempt from Medicare price negotiations — a move that critics argue will undermine cost-saving efforts and delay access to affordable medication.

According to the CBO, this exemption will cost taxpayers $5 billion over the next decade. Patients For Affordable Drugs Now slammed the provision, stating that Congress is “bending to pharmaceutical lobbyists at the expense of everyday Americans.”

“Pharma lobbyists will stop at nothing to maintain industry profits,” said Merith Basey, executive director of the group. “And Congress is letting them.”

What’s Next in the House

While the bill has passed the Senate, it still faces a crucial battle in the House of Representatives, where some Republicans are openly skeptical about the scope and severity of the cuts — particularly to Medicaid. With only a narrow margin, party leadership may face serious challenges in securing enough votes without additional compromises.

A Tipping Point in American Health Policy

Trump’s “big beautiful bill” may mark a turning point in how America funds and delivers healthcare. For supporters, it promises to curb government waste and promote personal responsibility. But for opponents, it’s a dangerous step toward dismantling key public health programs, stripping millions of coverage, and putting hospitals and communities at risk.

The stakes — human, economic, and political — are enormous. The coming weeks will reveal whether this bill becomes law, or whether public pressure and internal party rifts derail it before it reaches the president’s desk.