In states that opposed the Affordable Care Act, Trump's recent legislation may bring about health repercussions
The recently passed Republican budget law, known as the "One Big Beautiful Bill," is set to bring sweeping changes to health care across the country, particularly in states that have refused to expand Medicaid under the Affordable Care Act (ACA).
Insurance Coverage Losses
Non-expansion states like Georgia and Florida are expected to see significant numbers of people lose ACA Marketplace coverage due to new stringent enrollment requirements, paperwork burdens, and reduced funding for enrollment assistance. For instance, Georgia is estimated to lose as many insured lives as much larger California due to more residents in non-expansion states relying on ACA coverage.
Medicaid Cuts and Work Requirements
The bill trims federal Medicaid spending by over $1 trillion over a decade, with Medicaid work reporting requirements implemented in 2027 posing the greatest coverage risk. In expansion states, adults must report at least 80 hours per month of work or community engagement to keep coverage; failure to comply results in not only losing Medicaid coverage but also losing access to ACA marketplace subsidies, potentially driving millions off insurance.
Disproportionate Impact on Holdout States
Because a higher proportion of residents in holdout states rely on ACA plans, cuts such as shortened enrollment periods and reduced navigator funding lead to more severe erosion of coverage there compared to expansion states. Additionally, some budget provisions cut funding for emergency services usage by immigrants in expansion states, indicating shifting cost burdens.
Hospital and Patient Burdens
Hospital executives warn that both patients and healthcare providers in holdout states will face burdens similar in scale to more populous expansion states but without the benefits of expanded Medicaid coverage. This strains hospital resources and overall healthcare infrastructure in holdout states.
Rural Areas and the Budget Law
The budget law includes a $50 billion fund intended to insulate rural hospitals and clinics from its changes to Medicaid and the ACA. However, this fund only offsets about one-third of the cuts to Medicaid in rural areas.
The Consequences of the Budget Law
According to the nonpartisan Congressional Budget Office, ten million people will lose coverage over the next decade due to the law. Health experts and hospital leaders warn that the new Republican budget law creates more severe and multifaceted long-term health coverage and care access challenges in Medicaid expansion holdout states versus expansion states through disproportionate insurance losses, stringent enrollment rules, and cuts that strain hospitals and patients alike.
- The Republican budget law, known as the "One Big Beautiful Bill," is predicted to result in millions of people losing their health insurance coverage, particularly in non-expansion states like Georgia and Florida, due to increased enrollment requirements, paperwork burdens, and reduced funding for assistance.
- The bill plans to reduce federal Medicaid spending by over $1 trillion over a decade, enforcing work reporting requirements in 2027 that pose a significant coverage risk. In expansion states, adults must report at least 80 hours of work or community engagement per month to maintain coverage, with failure to comply resulting in both Medicaid and ACA marketplace subsidy losses.
- Due to a higher proportion of residents relying on ACA plans, holdout states like Georgia face more severe erosion of coverage from cuts such as shortened enrollment periods and reduced navigator funding compared to expansion states. This law also potentially shifts cost burdens onto emergency services usage by immigrants in expansion states.
- Hospital executives warn that both patients and healthcare providers in holdout states will face burdens similar in scale to more populous expansion states, but without the benefits of expanded Medicaid coverage, putting an immense strain on hospital resources and overall healthcare infrastructure in these states.
