By Joni Halpern
First of 4 Parts
PART 1: IF PIGS COULD FLY
The sales pitch for H.R. 1, the so-called “One Big Beautiful Bill Act” (OBBBA) recently passed by the U.S. House of Representatives and now under consideration by
the Senate, promises, among other things, that health care will be strengthened across the nation if the bill becomes law. That would be true, if pigs could fly.
What is true is that all of us will feel OBBBA’s pain, either directly or indirectly.
Republican Senate Majority Leader John Thune (R-South Dakota) and House Speaker Mike Johnson (R-4 th Dist., Louisiana) want to pass the bill and have it on President Trump’s desk by July 4, 2025. Even if OBBBA does not pass by then, the reconciliation process will end Sept. 30. That’s why it is important for Americans to understand what will happen to our health care under the bill.
OBBBA is expected to kill health insurance coverage for 16 million low-income people, including older adults, caregivers, people with disabilities, children and lawfully present immigrants and families. Of those 16 million, over 90% are U.S. citizens and lawfully present immigrants. 1
OBBBA accomplishes this massive reduction in various ways, but some of the biggest cuts come from restricting Medicare eligibility, rescinding premium assistance
under the Affordable Care Act, and rolling back provisions that make Medicare affordable to low-income enrollees. It makes many other changes designed to reduce
access to these programs, but OBBBA eats away at so many aspects of health care coverage that it is impossible to explain them all in this article.
Some additional reductions are worthy of mention, however, without going into detail.
OBBBA provisions will reduce the quality of long-term care by reducing staffing standards in nursing homes, narrowing eligibility for long-term care by capping the home equity limit, and reducing the retroactive Medicaid coverage period from three months to one month, making it more likely that problems in obtaining necessary verifications of eligibility will cause medical costs to fall entirely on the applicant. Older adults will more easily incur medical debt and gaps in care under these provisions.
OBBBA will cut federal health insurance funding to states, forcing them to reduce or end the “optional” services they presently pay for with state funds, such as
home and community-based services (HCBS) so essential in allowing people to choose an alternative of remaining in their homes with extra care, rather than being forced into facilities.
OBBBA also introduces new obstacles that will increase the likelihood that people will lose health care coverage under Medicaid due to the unintentional failure to
comply with expanded work and reporting requirements. There are new requirements that roll back cost-sharing, increase administrative costs to states, and impose new work requirements on persons receiving coverage under Medicaid.
OBBBA Isn’t About the Well-being of Everyday Americans
At its heart, OBBBA is a tax bill. It is designed as a “budget reconciliation bill,” a strategy that allows Congress to fast-track legislation when one party holds a majority in the House, Senate and White House. 2 However, the bill is not designed to reconcile the budget – i.e., reduce the deficit, increase revenue, or improve the lives of everyday Americans who work for a living or who are too young, too old, or have disabilities that prevent them from working.
OBBBA’S true goal is to accomplish the biggest transfer of taxpayer dollars from everyday taxpayers to the very wealthy by making massive cuts in many programs,
including federally funded health insurance programs that have improved the health of our nation over decades.
Who Will Really Suffer If OBBBA passes?
OBBBA’s biggest health care cuts will affect our communities as a whole. We all intermingle economically, socially and financially, whether we realize it or not. An
uninsured person who works in a business, an organization, a place of entertainment, a facility of any kind, or our own home can’t help but pass along whatever contagious disease we have, if it is undetected by health care. We inhabit each other’s homes, ride in each other’s cars, touch the handrails of public stairways, breathe the air in crowded places, and give ourselves over to the care of others. In these and so many other situations, it is available health care that allows us to interact in all settings with a reasonable expectation that our own health will be secure.
The availability of health care coverage also liberates household members to work, because they know their loved ones can get the health care they need, including
home care in many cases, even if the breadwinner has a low-wage job cleaning the houses, mowing the lawns, or caring for the elderly in wealthier households. Basic
health care coverage also allows people to seek medical help at the onset of disease or medical conditions, when they are less expensive to treat.
It is noteworthy that as much as Americans depend on low-income workers, whether citizens or non-citizens, it seems to escape us that the health of these people is
deeply connected to our own personal and economic well-being. If it passes in its present form, or in the more severe form proposed by the Senate, OBBBA will teach us a lot about that connection.
1 “Protecting Medicaid from Cuts in Congress: Updates for Aging Advocates,” Justice in Aging Webinar, June 17 2025, Transcript. https://justiceinaging.org/protecting-medicaid-from-cuts-in-congress-updates-for-aging-advocates/
