Zadie Sung

How does the “One Big Beautiful Bill” reshape Medicaid in ways that affect hospital funding, patient access to care, and the role of insurance companies in medical decision-making?

Started July 15, 2025

Abstract or project description

This research project investigates the effects of the One Big Beautiful Bill Act, passed in July 2025 by a narrow vote, on Medicaid, Medicare, and the broader U.S. healthcare system. The bill is 940 pages long and includes over $4.5 trillion in tax cuts but only $1.2 trillion in spending cuts—most of which target low-income programs like Medicaid. Medicaid faces historic reductions of over $1 trillion across ten years, while Medicare will see $500 billion in automatic cuts from 2026 to 2034 unless Congress intervenes. Changes include mandatory 80-hour work requirements, biannual eligibility rechecks, and the loss of provisional coverage—leading to an estimated 16 million Americans losing insurance by 2034.

In addition, the bill grants new authority to the Centers for Medicare & Medicaid Services (CMS) to combat “duplicate enrollment,” with 2.8 million people identified in 2024 as being enrolled in both Medicaid/CHIP and subsidized ACA plans. CMS estimates these duplicate enrollments waste $14 billion annually and has launched new efforts to disenroll ineligible individuals, though critics warn this could result in inappropriate coverage loss due to errors or paperwork issues.

This paper will analyze how the bill prioritizes cost-cutting and fraud prevention over care accessibility, and how hospitals—especially in rural areas—are impacted by reduced funding, increased emergency room burden, and new administrative responsibilities. Using information from GovFacts and CMS.gov, this project argues that the One Big Beautiful Bill reflects a deeper shift in healthcare policymaking: one that elevates insurance oversight and fiscal austerity at the expense of vulnerable populations and healthcare providers.