Milbank Memorial Fund, September 2025
In March of this year, the Affordable Care Act (ACA) turned 15 as the Trump administration and GOP legislators announced potential cuts to Medicaid. An op-ed that I wrote outlined the GOP Plan to End Obamacare by fiscally starving it to death rather than an explicit repeal. Trump’s recent signing of the “One Big Beautiful Bill” (OBBB) brings us closer to that harsh reality.
In addition to Medicaid cuts, expiring ACA subsidies will result in an estimated 17 million Americans losing their coverage. The reduction in Medicaid provider taxes will likely result in hospital closures. About 500,000 health care jobs could also be lost due to these cuts. The OBBB also includes non-budgetary changes such as an end to automatic reenrollment, coverage delays for life-changing events (losing a job, married, having a baby), and shorter enrollment periods.
People across the country will feel the pain, but those in rural areas and red states will be hardest hit. Simply put, the OBBB erodes all the progress Obamacare made extending access to coverage. But these detrimental cuts to health care for Americans should be no surprise.
