How will health care change for YOU from the “One Big Beautiful Bill Act”? [HEALTH CARE un-covered]
How will health care change for YOU from the “One Big Beautiful Bill Act”?
By Rachel Madley
Jul 23, 2025
Recent passage of President Trump’s economic agenda has dominated news coverage. However, in our already complex health care system it can feel impossible to understand how the law will impact your health care, especially if you are not directly insured by one of the programs that is being cut. Below is a guide that describes what changes you may encounter and examples of what these changes will look like to you and your loved ones. In future pieces we will explore how you can protect yourself from the sweeping reductions in funding and other changes to the system.
As you will see, there are a lot of changes, some not happening for a few years, but some will affect you sooner than you might expect, regardless of where you currently get your coverage. The cuts to Medicaid and the new work requirements have been the focus of most stories, but the law and the reaction of insurers and health care providers will impact all of us.
For example, as insurers release their proposed rates for 2026, enrollees could see their premium increase by an average of 75% compared to what they are currently paying. On top of that, Curtis Medical Center in rural Nebraska has announced that it will be closing due to coming Medicaid cuts and other strains, the first of many hospitals expected to close, leaving an untold number of patients without convenient access to care. In addition:
Immediate changes to the Medicare Savings Programs will make it harder for people to enroll in this Medicaid program, which pays Medicare premiums and cost sharing for low income seniors. Currently, 31 states automatically enroll people in the Medicare Savings Programs if they receive Supplemental Security Income (SSI), easing the application burden for these patients. The bill prohibits states from doing this until 2034, which will lead to more obstacles for seniors trying to enroll in this program. The bill also changes the process for determining eligibility, meaning low-income seniors could be forced to travel to an interview to prove they need help paying their medical costs.
Real world example: You apply for and begin receiving Supplemental Security Income because you are over the age of 65 and have a low income. You do not know about the Medicare Savings Programs so you never apply and have to pay 20% of your monthly SSI benefits to Medicare Part B premiums, and a large portion of your benefits go toward out-of-pocket costs for your medical care. If this bill had not prohibited states from enrolling you in the Medicare Savings Programs when you got approved for SSI, you would have little to no out-of-pocket medical costs and would be better able to afford other necessities.
Hospitals and nursing facilities will immediately have their payments from Medicaid cut because the bill prohibits states from instituting new payment levels to these facilities more than the Medicare rate in states that expanded Medicaid, and 110% of the Medicaid rate in other states. The bill also requires a 10% decrease in payments currently in place that exceed these caps each year until reaching the cap January 1, 2028. Without additional policy changes to address how hospitals are paid, this will reduce hospital revenue. This almost certainly will affect access to hospitals and nursing facilities and the quality of care they provide.
Real world example: You receive care at a nursing facility in Michigan that serves a large population of Medicaid patients. The facility previously received payments higher than the Medicare payment rate, which enabled them to care for those patients. Now that payments will decrease, and it might have to close, leaving you without nearby care.
Medicaid reimbursement for services such as cancer screenings and birth control provided by Planned Parenthood and related organizations have been immediately stopped.
Real world example: You are a young woman in college and on Medicaid who receives her annual exam at Planned Parenthood. Now that this bill has passed, Planned Parenthood cannot participate in Medicaid so you must find a new doctor who is accepting new patients, takes Medicaid, and is close to your college campus. Due to decreases in Medicaid funding nationwide, these providers undoubtedly will be difficult to find.
Beginning in September 2025, there will be $50 billion in grants available to states for payments to rural health care providers, a tenth of what Sen. Susan Collins (R-Maine) had sought. The $50 billion is just 5% of the $1 trillion in funding the new law will cut from Medicaid and is almost certainly not enough to prevent more rural hospitals from closing.
Real world example: You live in a rural area and your community hospital receives a grant from this funding. Unfortunately, the grant is very small compared to the funding your hospital stands to lose from changes to Medicaid eligibility, provider taxes, and state payments, so your hospital might not be able to stay open.
On January 1, 2026, ACA insurance plan premiums will increase by a median of 15%, and there will be a 75% increase in out-of-pocket premium payments each month for the average ACA enrollee.
Real world example: You and your family of three earn $110,000 and are enrolled in an ACA silver plan in 2025 and pay $779 in premiums per month. You receive your expected premium notice for 2026 and see that your monthly premium payments will jump to $1,662, an increase of $883 per month. You decide you cannot afford that increase and will have to go without health insurance in the future.
Beginning October 1, 2026, lawfully present immigrants including refugees, individuals granted asylum or parole for at least one year, and certain survivors of domestic violence or trafficking will no longer be eligible for Medicaid.
Real world example: You are an immigrant granted asylum and are in the U.S. legally and on Medicaid. You will lose your Medicaid coverage on October 1, 2026.
Eligibility redeterminations, including meeting work and other requirements for Medicaid, will now be required at least every six months rather than once a year if you are 19-64 years old and make $15,060-$20,779 (for a one-person household). Increased redeterminations will begin December 31, 2026.
Real world example: You are on Medicaid and make $20,000. You completed your annual Medicaid redetermination at the beginning of 2027 then moved to a new apartment. You are sent a Medicaid eligibility redetermination letter in June 2027 but it does not get to you at your new address. You are disenrolled from Medicaid and…